PubMed Health⌕ Search

Biomedical subjects

J von der Emde

Publications and source records attributed to J von der Emde.

At least 19 recordsLinked to original sources
PubMed1992

[Carbohydrate and lipid metabolism following heart bypass operations. The effect of the intravenous hypocaloric administration of glucose versus glucose xylitol (1:1)].

The effect of glucose-xylitol infusion on carbohydrate and lipid metabolism was investigated in 18 metabolically normal men (mean age 56.1 [35-65] years) with coronary heart disease after they had undergone a coronary artery bypass operation. During the first postoperative hours, group I (n = 6) received glucose only (2 mg/kg.min), group II (n = 6) glucose+xylitol (1 mg/kg.min each), and group II a glucose-containing electrolyte solution (0.83 mg/kg.min glucose). Blood glucose and insulin concentrations during the infusion period were significantly (P < 0.05) lower in groups II and III than I (glucose after 6 h: group I 21.5 [15.3-26.8] mmol/l; group II 14.2 [11.2-18.1] mmol/l; group III 12.6 [6.8-16.0] mmol/l). The highest lactate concentrations were reached in group I, 6 hours after the operation. Palmitine and stearine, as well as oleic and linoleic acid concentrations were significantly lower 12 hours postoperatively in group I than groups II and III (P < 0.05). These data indicate that energy-ineffective high glucose concentrations were avoided and endogenous lactate production reduced by the postoperative infusion of glucose+xylitol. In addition, it achieved a higher supply of free fatty acids as energy source to the myocardium without reaching toxic concentrations in the postischaemic myocardium.

Adult↗
PubMed1992

Is epicardial dual chamber pacing a realistic alternative to endocardial DDD pacing? Initial results of a prospective study.

Seventeen patients, in whom an epicardial (n = 7) or a transvenous DDDM pacemaker system had been implanted between June 1988 and October 1990, were followed up for pacemaker and lead related complications, pacemaker longevity, and electrophysiological lead parameters. The mean follow-up interval was 18 +/- 12 months, maximum 34 months. There were no differences in chronic atrial and ventricular sensing thresholds between epicardial and endocardial stimulation, nor were there any differences concerning lead related complications between the two pacing modalities. However, atrial as well as ventricular chronic stimulation thresholds were significantly higher with epicardial stimulation resulting in a twofold increase in atrial energy consumption and a threefold increase in the ventricular energy consumption. Thus, in one patient with an epicardial DDD system, the pacemaker had to be replaced prematurely because of battery depletion. It is concluded that epicardial DDD stimulation can be reliably performed as far as atrial and ventricular sensing is concerned, but that the energy requirements of available myocardial leads are not satisfactory for making optimal use of modern pacemaker capability.

Adult↗
PubMed1991

[Cardiac surgery interventions in patients over 70 years of age].

In consequence of a longer life expectancy and improved surgical results, patients aged over 70 years now account for 10 to 15% of patients undergoing surgery on the heart. Such patients do, however, make greater demands on peri-operative management; the adaptability of the cardiopulmonary and renal functions to stress is reduced, homeostasis is fragile, and the diseases that commonly accompany old age represent an additional risk. Furthermore, greater demands are also made on the operating skills of the surgeon. Nevertheless, no patient should be considered inoperable merely on account of advanced age. However, the indications for surgery must always be established on an individual basis, and against the background of the expected risk/benefit ratio. The biological rather than the chronological age is always decisive. The main aim of surgical treatment is to achieve an improvement in the patient's quality of life.

Aged↗
PubMed1991

Brachial plexus lesions following median sternotomy in cardiac surgery.

The incidence of neurological deficits of the upper extremity was studied in a prospective trial on 201 consecutive patients who underwent median sternotomy at cardiac surgery. In 13 patients (6.5%), a brachial plexus paresis was diagnosed postoperatively. We were unable to demonstrate any statistically significant correlation between brachial plexus paresis and the side of arm placement, the side of cannulation of the jugular vein, the duration of operation, the bypass time, sex, or type of operation. All patients who suffered from neurological deficit were aged 50 years and more, however without any statistically significant correlation. In our opinion, brachial plexus lesions following median sternotomy in cardiac surgery depend on the extent of sternal spread and the height of placement of the retractor in dependence of the rigidity of the rib cage. By reason of the iatrogenic cause of brachial plexus lesions, it appears to us that these complications should be included in those of which the patient needs to be informed preoperatively.

Brachial Plexus↗
PubMed1991

Role of the electrocardiogram in assessing irreversibly impaired left ventricular systolic function in chronic mitral regurgitation.

The study set out to determine whether the electrocardiogram (ECG) might be useful in assessing left ventricular (LV) volumes and systolic function in patients with pure, chronic mitral regurgitation. To do this preoperative haemodynamic and angiocardiographic data, QRS duration, total 12-lead QRS amplitude, R peak time in V6, R peak delay in V6 (RPDV6) (i.e. the R peak in V6 is later than the S peak in V2) and a T wave score assigned to the extent of LV strain were evaluated. Twenty-seven out of 62 patients were subjected to stepwise discriminant multivariate analysis. Radionuclide (RN) LV ejection fraction (EF) was obtained postoperatively; RPDV6, gender, LVEF and LV end-diastolic volume index (EDVI) were selected in decreasing order of discriminatory importance to identify 13 (81.3%) of 16 patients with RNEF greater than or equal to 50% and 10 (90.9%) of 11 with RNEF less than 50% at rest. Preoperatively, 18 subjects with RPDV6 had a significantly greater end-systolic volume index (ESVI) (75.6 +/- 37.8 ml.m-2 versus 50.7 +/- 31.5 ml.m-2, P = 0.003), greater EDVI (196.9 +/- 73.4 ml.m-2 versus 155.2 +/- 48.5 ml.m-2, P = 0.034) and lower LVEF (61.1 +/- 11.9% versus 68.8 +/- 12.7%, P = 0.014) compared to 44 cases without this finding. With respect to postoperative RNEF, eight subjects with RPDV6 had a significantly lower EF compared to 19 cases without this finding (40.1 +/- 8.2% versus 56.0 +/- 9.9%, P = 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

Thromboembolic and bleeding complications after mitral valve replacement.

One thousand six hundred and sixty-eight consecutive patients who underwent isolated mitral valve replacement (MVR) from 1963 to 1984 were evaluated retrospectively. Thromboembolism occurred with a linearised rate of 2.5% +/- 0.2%/patient-year (PY) for Starr-Edwards disc prosthesis Model 6520, 2.4% +/- 0.3%/PY for Bjørk-Shiley plane prosthesis, 3.0% +/- 0.8%/PY for Bjørk-Shiley convexo-concave 60 degrees prosthesis, 3.0% +/- 0.8%/PY for St. Jude Medical prosthesis and 3.4% +/- 0.5%/PY for Carpentier-Edwards tissue valve without the differences reaching significance. In the SJM group, the incidence of thromboembolism was significantly higher (P less than 0.025) in smaller sizes (less than M29) probably due to a more turbulent flow. The linearised rate for major haemorrhage was 1.6% +/- 0.1%/PY. Twenty-three percent of the thromboembolic and 18% of the bleeding events were fatal. Sixty-eight percent of the emboli involved the central nervous system and bleeding apart from fatalities was predominantly non-cerebral (81%). Whereas thromboembolism was a time-related event with more than twice as high a risk in the first postoperative year (4.2% +/- 0.5% vs. 1.7% +/- 0.8%, P less than 0.01), bleeding occurred with a constant rate over time (0.9% +/- 0.4%). Adequacy of anticoagulation was an important risk factor for postoperative embolism with the prothrombin time (PT) exceeding the therapeutic range in 65% of all events. A preoperative history of embolism was the only additional patient-related risk factor for postoperative embolism (18.3% vs. 9.6%, P less than 0.001). In 30% of all haemorrhage, the PT was below 15%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1990

[20 years surgery of the thoracic aorta].

Between 1969 and 1990, 119 patients underwent operations for aneurysmatic disease of the thoracic aorta in our department: 63 patients suffered from an aneurysm of the ascending aorta, 32 from an acute dissection (26 Type A, 6 Type B), 2 from an isolated aneurysm of the arch, 10 from an aneurysm of the descending aorta and 12 had a traumatic rupture of the aorta. The death rate due to operations for aneurysms of the thoracic aorta and acute type A dissections was clearly lowered. In case of an acute type A dissection emergency intervention is indicated; in acute type B dissection primarily conservative treatment.

Aortic Dissection↗
PubMed1989

R peak delay in V6. Diagnostic implications in coronary heart disease.

Epimyocardial excitation is delayed in areas overlying infarcted myocardium. On the assumption that a delayed R peak in V6 could indicate anterior myocardial infarction (AMI) in the absence of diagnostic Q waves, the findings of angiocardiography (n = 148) and thallium scanning (n = 46) of 194 patients with suspected coronary heart disease (CHD) were compared with regard to two criteria: A (R peak in V6 precedes S peak in V2, or both peaks occur simultaneously, n = 158) and B (R peak in V6 is later than S peak in V2 [R peak delay in V6], n = 36). Of 92 patients with unconfirmed CHD, 4 fit criterion B, and 3 of these had hypertensive heart disease. In 102 patients with confirmed CHD, B was present in 15 of 79 evaluated with angiocardiography and in 17 of 23 patients who had nuclear scanning. Anterior akinesis or dyskinesis was more prevalent in group B (13 cases, 86%) than in group A (17 cases, 26.6%; p = 0.000), as were irreversible anterior thallium defects, with 16 cases in group B (94.1% and 3 cases in group A (50%) (p = 0.016). Two of the three false positives had anterior hypokinesis and one had hypertensive cardiovascular disease. B was less sensitive (59.2%) but demonstrated a specificity of 95.2% and a positive predictive value of 80.6% for the detection of AMI. If used in conjunction with C (poor or reverse R wave progression from V1 to V4, notching at the R upstroke or rsR' in V4, V5, or V6), sensitivity was decreased (38.6%) but false positives were eliminated (specificity and positive predictive value reached 100%). Thus, in the setting of CHD, B can be recommended as a marker of non-Q wave AMI, and its diagnostic reliability is maintained, even in systemic arterial hypertension, if C is taken into consideration.

Adolescent↗
PubMed1989

Electrocardiographic markers of impaired left ventricular ejection performance in aortic stenosis.

To determine whether the ECG would be useful in the prediction of impaired left ventricular ejection performance in aortic valve stenosis, the authors evaluated 121 patients according to (1) the time relationship of the R peak in V6 to the S peak in V2; and (2) the negative P wave terminal force in V1 (Morris index, n = 109). Left ventricular ejection fraction (LVEF) was significantly depressed in patients with the R peak in V6 later than the S peak in V2 (R peak delay in V6, n = 24), compared with those with the R peak in V6 preceding the S peak in V2 or with both peaks occurring simultaneously (n = 97) (LVEF 40.8 +/- 11.8% vs 69.9 +/- 13.3%, p = .000). LVEF less than 55% was present in 87.5% of patients with the R peak delay in V6 and in only 23.7% of those without this finding. The Morris Index was significantly greater in patients with LVEF less than 55% (n = 39) than in those with LVEF greater than or equal to 55% (n = 70) (Morris Index 0.063 +/- 0.035 msec vs 0.030 +/- 0.025 msec, p = .000). The R peak delay in V6 is a highly specific (96.1%), but less sensitive (47.7%), indicator of depressed LVEF, its positive predictive value and predictive accuracy being 87.5% and 78.5%, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Assessment of left ventricular function from the electrocardiogram in left bundle branch block.

The QRS duration, maximum right precordial S amplitude, sum of amplitudes of the maximum right precordial S and T wave and T wave polarity in lead I have been analyzed in order to identify electrocardiographic predictors of left ventricular end-diastolic volume index and ejection fraction in 165 patients with complete left bundle branch block and various forms of heart disease. Multivariate analysis selected the duration, maximal amplitude of the S wave and polarity of the T wave in decreasing order of discriminatory power, which correctly identify 76.6% of the patients with a normal end-diastolic volume index less than or equal to 90 ml/m2 and a normal ejection fraction greater than or equal to 60% (n = 64) and 73.3% of those with an end-diastolic volume index greater than 90 ml/m2 or an ejection fraction less than 60% (n = 101). The comparisons of the QRS duration with the end-diastolic volume index and the ejection fraction give the best single correlations: r = 0.57 and -0.63, respectively. Multiple correlations lead to no substantial improvement of the r values: 0.06 and -0.65, respectively. A QRS duration less than 140 msec is almost always predictive of the presence of a normal end-diastolic volume index and a normal ejection fraction (sensitivity 100%, specificity 91.9%, positive predictive value 73.3%). A QRS duration greater than 170 msec is most accurate in predicting depressed left ventricular ejection fraction less than 55% (sensitivity 36.5%, specificity 98%, positive predictive value 92%). Thus, only the QRS duration provides a useful reference and guide for the evaluation of left ventricular function in the presence of left bundle branch block.

Adult↗
PubMed1989

Lethal blockage of a Bjørk-Shiley artificial heart valve caused by strut fracture--the metallurgical aspect.

The fracture of the outlet strut of a Bjørk-Shiley artificial heart valve implanted in a 21 year old man lead--6 years after the operation--to the valve disc jamming closed with a resulting lethal heart failure and circulation standstill. The probable cause of the valve strut fracture could be determined by metallurgical/metallographical investigation of the material and the production methods.

Adult↗
PubMed1987

The effect of preoperative L-carnitine supplementation on myocardial metabolism during aorto-coronary bypass surgery.

68 patients with defined myocardial ischemia, undergoing aorto-coronary bypass operation were assigned either to a group supplemented with L-carnitine (n = 41) or to a control group (n = 27). When extracorporeal circulation was established, a small piece of the right atrial appendage was biopsied and prepared for analysis for ATP, lactate and carnitine fractions. The ATP concentrations were higher in the patients supplemented with carnitine. A negative correlation existed between ATP and lactate levels. The amount of total carnitine was similar in both groups. However, free carnitine was higher, and long-chain acylcarnitine was lower when L-carnitine was supplemented. Postoperatively, the patients needed less inotropic medicaments, when supplemented with L-carnitine. L-carnitine supplementation in patients needed less inotropic medicaments, when supplemented with L-carnitine. L-carnitine supplementation in patients undergoing aorto-coronary bypass operation proved to be effective and beneficial for the normalization of myocardial energy metabolism parameters.

Adenosine Triphosphate↗
PubMed1986

Measures of prevention and technical problems during reoperations in cardiac surgery.

Reoperations after cardiac valve replacement are unavoidable: their frequency depends on surgical technique, type of valve used, and the anatomical situation. Erlangen, almost 300 such procedures were required among 3500 valve replacements, while 19 out of 700 bioprostheses had to be exchanged. Statistically relevant complications occurring with variable frequency are paravalvular leakage, thrombosis and degeneration of the bioprostheses which have to be corrected for hemodynamic reasons. Other indications are thromboembolism and endocarditis. Rare complications are: rupture of the posterior wall of the ventricle or aortic root with subsequent development of aneurysm, entrapment of the occluder due to long sutures, pannus, muscle chordae, strut fracture (Björk) or wear of the occluder (Wada, Starr, Edwards, Beall). Some complications as dehiscence, entrapment, rupture and aneurysm of the posterior wall of the ventricle and aortic root can largely be avoided by good surgical techniques. Reoperative mortality rate is slightly higher due to greater possibilities of injury and bleeding. Emergency procedures in grade IV NYHA have the highest rate (50%), elective procedures for leakage, calcified or regurgitant bioprostheses the lowest. The most frequent indication for re-operation is perivalvular leakage. Dehiscence requires surgery to deal with hemolysis or for hemodynamic reasons. Dehiscence is more common in aortic than in mitral position; the latter can be closed by felt-padded stitches in 80%. This technique is the most reliable in preventing leakage, although thrombosis is more likely. Causes of dehiscence are endocarditis, suture-line tearing, calcium in the annulus. The incidence of valve thrombosis is related to valve type, usually associated with inadequate or abruptly terminated anticoagulation therapy (rebound). Disc valve are at particular risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1979

[Surgical treatment of left ventricular aneurysm (author's transl)].

174 cardiac aneurysms were resected between 1970 and 1977. In 49 patients the remaining contractile segment was revascularised at the same time. The hospital mortality was 10.3%, the late mortality was 14%. The uncorrected cumulative survival rate calculated by the acturial method was 90% at 3 years (84--96), and 80% at 5 years (74--85). Results were excellent or good in two thirds of the survivors; 44% were free of angina pectoris, 40% were improved, 73% had no disturbances of cardiac rhythm, and in 15% they were improved. Comparison of the pre- and postoperative ejection fraction showed that the indication for surgery of a cardiac aneurysm exists when more than 20% of the musculature of the left ventricle is affected, when the total ejection fraction is larger than 10% when one vessel is affected, and more than 30% when more than one vessel is affected. Contraindications are diffuse coronary heart disease, when ejection fraction of the contractile segment is less than 30% reduction in contractility of the ventricular septum, and the generally applicable surgical contraindications.

Adult↗
PubMed1979

[Coronary collaterals and function of the left ventricle. Practical applications of a collateral score].

The most important collateral pathways in the coronary artery system goes through the apex, the ventricular septum, left and right atrial branches and the ventricular wall of the left ventricle. In a collective of 52 patients who underwent aortocoronary-bypass surgery we controlled the collateral circulation and left ventricle function. Patients with multiple-vessel-disease had in 71% good collateral circulation and the collateral score was more than twice as high as in patients with one-vessel-disease. In addition we compared the LVEDP in these 52 operated patients and in 52, whose condition did not permit coronary surgery. The enddiastolic pressure is lower in patients with good collaterals and was also better in patients who underwent surgery.

Blood Pressure↗