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Biomedical subjects

K Bühlmeyer

Publications and source records attributed to K Bühlmeyer.

At least 55 records · Page 3Linked to original sources
PubMed1985

[Clinical uses of digital subtraction angiography for imaging anatomy immediately following heart operations in childhood].

Within the last three years, digital subtraction angiography (DSA) was performed 60 times in 58 children with congenital heart disease (coarctation of the aorta, tetralogy of Fallot or transposition of the great vessels) in the immediate post-operative period to delineate residual defects. The DSA was carried out 3.7 +/- 1 days postoperatively with a total of 3.8 +/- 2.5 ml (0.47 +/- 0.2 ml/kg) Conray 70 or Solutrast 300 injected by hand into a catheter which generally had been positioned preoperatively at the transition between superior vena cava and right atrium. The outflow of the contrast medium was recorded on video tape and, additionally, single images of important anatomical details were obtained. In six patients with resected aortic coarctation, the patency of the entire aortic arch was documented with DSA; these patients had undergone surgery at a mean age of 3.3 +/- 4.8 years. Seven patients, with a mean age of 2.5 +/- 4.7 years, had tetralogy of Fallot, three additionally with pulmonary valve atresia; in all, postoperatively, the entire right ventricular outflow tract and the large pulmonary vessels could be demonstrated. In 45 patients with transposition of the great vessels, mean age 4.5 +/- 3.1 months, an atrial inversion with the Senning procedure was carried out; postoperatively, in all patients, the confluence of the superior and inferior vena cavae into the systemic venous portion of the atrium could be delineated. The pulmonary veins were visualized in one-third of the patients. In eight patients, DSA demonstrated obstruction at the opening of the superior vena cava into the atrium together with the collateral circulation via the azygos vein and the inferior vena cava.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

Urapidil therapy for acute hypertensive crises in infants and children.

In 19 infants and children with acute and severe hypertension following a cardiovascular operation urapidil infusion was started for treatment of the hypertensive crisis. In all patients blood pressure was effectively reduced within 15 min. The drop in systemic blood pressure was combined with a reduction of central venous pressure. Heart rate and urine volume remained unaltered. Serum electrolytes after 12-24 h therapy showed a slight but significant decrease in serum sodium and an increase in serum potassium concentration. In one case urapidil treatment had to be interrupted because of hypotension. In this case the urapidil therapy was tolerated later in lower doses. Serious side effects were not observed. In our experience urapidil can be recommended for the treatment of hypertensive crises in children.

Acute Disease↗
PubMed1984

Tetralogy of Fallot. Development of hypoplastic pulmonary arteries after palliation.

Thirty-one patients with tetralogy of Fallot were studied angiographically before and after palliation with Blalock-Taussig operation (n = 9), Brock operation (n = 12), or enlargement of the right ventricular outflow tract with extracorporeal circulation (ECC) (n = 10). The relative diameter of the pulmonary vascular ring (PVR), pulmonary trunk (PT), and right and left pulmonary arteries (RPA, LPA) were measured before and 24.8 +/- 20.9 months after palliation. Using correlation analysis, the magnitude of growth of the pulmonary artery system was inversely related to its initial size. Mean pressure in the pulmonary artery after palliation as well as the period between date of surgery and recatheterization did not correlate significantly with growth. After Blalock-Taussig operation, the ipsilateral pulmonary artery predominantly increased in size without significant growth of PVR and PT. Brock operation and enlargement of the right ventricular outflow tract with ECC, improving the flow in the pulmonary vascular system centrally, induced a significant, symmetrical growth of the pulmonary vascular system and, therefore, are our methods of choice for palliation in patients with tetralogy of Fallow combined with hypoplastic pulmonary arteries.

Adolescent↗
PubMed1984

The treatment of tetralogy of Fallot: early repair or palliation?

Between 1974 and 1983, 380 consecutive patients with tetralogy of Fallot underwent surgery. In 73 patients, undergoing palliative surgery, the operative mortality and late mortality was 6.8%. Twenty-five of these patients have undergone subsequent complete repair, while 38 are awaiting correction. During the last 4 years we preferred operative procedures with enlargement of the right ventricular outflow tract (80%) to shunt operations (20%). In contrast to shunts, enlargement of the outflow tract induces a symmetrical growth of hypoplastic pulmonary arteries without the risk of acquired pulmonary atresia or peripheral stenosis at the site of anastomosis. Three hundred twenty-nine patients have undergone repair. In 101 patients, who had palliative operations before complete repair, the operative mortality was 12.9% and late mortality 2.9%. Those patients undergoing repair as a first operation had an operative mortality of 8.8%, and a late mortality of 1.3%. In the last 5 years the operative mortality for all patients, whether or not they had had previous palliative surgery, was 4.7%. The incidence of transannular outflow tract patching was not greater in children less than 2 years of age (16.9%) than in older children, 2 to 14 years of age (16.5%). However, in our experience the requirement for subvalvular outflow patches was higher in younger children (52.1%) than in the older children (34.1%). Because of this high incidence, particularly in younger patients, we have now begun to repair tetralogy of Fallot using the transatrial approach, thus reducing our use of subvalvular patches.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Isolated aortic isthmus stenosis: operation indications and results].

The goal of surgical correction of isolated coarctation of the aorta is normalization of the blood pressure. To assess the optimal age for the intervention with respect to operative morbidity and mortality, residual stenosis and recoarctation rate as well as the postoperative persistence of arterial hypertension without recoarctation, the pre- and postoperative findings of 237 patients (age at surgery: range one week to 17 years) were analyzed. The blood pressure, which was above the 95th percentile of age-matched normal values preoperatively in 93%, showed a clear decrease postoperatively in all age groups. On surgical correction, however, performed as of six years of age, there was a continuously increasing rate of persistent arterial hypertension without recoarctation which ranged from about 10% in those undergoing surgery between the ages of six and eight years to 31% in patients operated at ages between 13 and 17 years. In consideration of the operative results only with respect to the response of the resting blood pressure, insight is enabled only into one aspect of the prognosis, since the latter is equally dependent on the postoperative systemic arterial resistance. The systemic arterial resistance is already slightly elevated at three to five years of age, significantly increased as of six years of age, and at surgery after the age of six, shows a further increasing tendency. Accordingly, patients with postoperative normal or borderline-elevated blood pressure and apparently adequate surgical results, may be at risk of subsequent development of hypertension due to persistence of increased resistance, in particular, if surgery is performed after the age of five years.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1984

[Diagnostic possibilities of 1- and 2-dimensional Doppler and contrast echocardiography in congenital heart defects].

Indications and accuracy of real-time one- and two-dimensional echocardiography in combination with Doppler- and contrast methods in the noninvasive diagnosis of congenital cardiac malformations are presented. In contrast to the conventional 1-dimensional (M-Mode) echocardiography the 2-dimensional approach provides precise anatomic cardiac details in almost all cardiac lesions. Even complex congenital cardiac heart disorders and situs abdominalis can readily be differentiated. In some lesions like hypoplastic left heart syndrome, pericardial effusion, different forms of cardiomyopathy, uncomplicated bicuspid aortic valves, acute bacterial endocarditis, patent ductus arteriosus in prematures and in cardiovascular tumors cardiac catheterization is not indicated. In the remaining malformations 2-dimensional echocardiography is an excellent screening test and provides accurate and detailed informations with regard to spatial anatomy and valve morphology so that invasive studies can be performed with less contrast agent and hence with greater safety. With the use of contrast echocardiography right-to-left shunting, in some cases even left-to-right shunts, due to negative contrast effects can be demonstrated. Pulsed and continuous Doppler echocardiography allows noninvasive detection of valvular stenoses and -incompetence, aorto-pulmonic connections and small atrial- or ventricular septal defects. Pressure gradients, cardiac output and left to right shunting can be determined accurately.

Cardiac Output↗
PubMed1983

[Early correction of the interrupted aortic arch].

Between 1974 and March 1983, 14 infants with interruption of the aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) have been operated at our institution. In the beginning of our experience only palliative operations were performed, consisting in reconstruction of the aortic arch, closure of PDA and pulmonary artery banding (PBA). According to this procedure five patients were operated. Three of them died, the two survivors underwent successful closure of the VSD subsequently. Since 1979 the primary total correction, with repair of the extra- and intracardial anomalies in deep hypothermia and circulatory arrest, is the operation of choice. A total of nine patients underwent primary correction, in this latter group we observed two deaths only.

Aorta, Thoracic↗
PubMed1983

[Unusual contrast medium distribution in the left ventricular myocardium in infants with a high degree of aortic valve stenosis and endocardial fibroelastosis. Pathologico-morphologic findings].

In 5 newborn infants with severe valvular aortic stenosis, left ventricular angiocardiography revealed conspicuous pathologic-morphologic findings consisting of a fine network of contrast medium opacification in the region of the posterior wall. Subsequently performed histologic examination of tissue removed from the involved regions showed, in addition to endocardial fibroelastosis, two structures which were assumed to be the morphologic substrates for the unusual distribution of contrast medium. On the one hand, antler-like spaces with a well-demarcated lining of fibroelastic tissue, similar to the thickened endocardium, were found in the inner half of the left ventricular wall connected to the lumen of the left ventricle through bottle-necked communications. On the other hand, oval or oblong lumina, substantially larger in caliber than capillaries but showing only a single endothelial layer could be demonstrated. With the sectioning technique employed, anastomoses of the latter spaces with the left ventricle or the previously mentioned system of spaces could not be established. The cause of the development or maintenance of these sinusoidal spaces may be attributable to the elevated diastolic left ventricular pressure, while the elevated systolic pressure may have been a decisive etiologic factor for the endocardial fibroelastosis. Whether the intratrabecular spaces represent persistent embryonic myocardial sinusoids cannot be differentiated unequivocally. In support of the stated contentions, however, are other results indicating that the extent of structural changes in the ventricular wall increases proportionately with the duration of existence of the obstructive lesion in the embryonic period.

Angiocardiography↗
PubMed1983

[Quantification of atrial septal defects of the secundum type by subcostal 2-dimensional echocardiography].

Visualization of the interatrial septum (IAS) was most consistently achieved by subcostal 2-dimensional echocardiography (s2-DE) as compared with the apical and parasternal view. This approach also enabled a quantitative assessment of isolated atrial septal defects of secundum type (ASD II). The study group consisted of 33 children aged 5-14, mean 8 years, with ASD II (2 patent foramina ovale) and normal pulmonary vascular resistance. A good correlation was demonstrated between the end-diastolic diameter of the defect measured by s2-DE and left-to-right shunt determined by the Fick principle (r = 0.89). With respect to the endsystolic diameter of the defect, the correlation was less favourable (r = 0.76). This may be explained by the greater variability of the maximal defect in size in end-systole determined frame-by-frame. In conclusion, the size of an ASD II can be evaluated with accuracy by s2-DE. School children with isolated ASD II and diameters larger than 15 mm, corresponding to a 40% left-to-right shunt, will need surgical closure. However, surgery is not indicated in defects less than 11 mm and shunts smaller than 30%. In questionable cases we would be in favour of surgical closure.

Adolescent↗
PubMed1983

[Anomalous coronary drainage from the pulmonary artery with associated heart and vascular abnormalities. Report on 3 patients and review of the literature].

The clinical and cineangiocardiographic findings of three children with anomalous coronary artery origin were analyzed: in the first case, associated with Scimitar syndrome, the left coronary artery arose from the left posterior pulmonary sinus; in the second case, in addition to Fallot's tetralogy, the left coronary artery had its origin from the right pulmonary artery; and in the third case, the left circumflex artery arose anomalously from the right pulmonary artery in association with coarctation of the aorta, aortic valve stenosis and diverticulum of the left ventricle. The findings of 46 cases reported in the literature to have anomalous origin of one or both coronary arteries, a single coronary artery, or of the left anterior descending coronary artery reveal that additional cardiovascular anomalies can also be found in 4 to 17% of the cases described in collectives of more than ten patients. Almost any type of cardiovascular malformation can coexist with anomalous origin of a coronary artery from the pulmonary artery. There seems to be a preponderance of conotruncal malformations accounting for 33%, whereas their incidence among all congenital heart defects is 15%. The effect of the hemodynamics of the associated malformation can exert can influence on the natural history of the disease and, experience indicates that the coronary anomaly may be masked by the signs and symptoms of the associated cardiovascular malformation. Accordingly, to exclude such anomalies, preoperative studies should include assessment of the coronary arteries. To establish the diagnosis of anomalous origin of a coronary artery from the pulmonary artery, in addition to an injection of contrast medium into the main pulmonary artery, an aortic root injection is adequate in the majority of patients and, in general, selective coronary arteriography is not required.

Abnormalities, Multiple↗
PubMed1982

[Children with implanted pacemakers. Recommendations for ambulatory follow-up and emergency therapy in case of pacemaker failure].

Permanent pacemaker implantation in children is a necessary therapy in case of life-threatening bradycardias, which cannot be treated satisfactorily by drugs. Because of the relative high frequency of complications in comparison with the pacemaker therapy in adults there is need for a consequent follow-up by a pacemaker-center, the family-doctor and the parents. Recommendations are given for the outpatient follow-up and for the emergency therapy in case of pacemaker-failure.

Bradycardia↗
PubMed1982

[PFC syndrome (persistent fetal circulation). Central cyanosis in a full-term newborn infant without congenital heart defect].

In a case report the main features of the PFC-syndrome (persistent fetal circulation) are demonstrated: 1. general central cyanosis, 2. pulmonary hypertension, 3. right-to-left shunting via foramen ovale and (or) ductus arteriosus. At postmortem analysis in some of these patients the muscular thickness of the pulmonary vessels was found to be increased: primary PFC-syndrome. Hypoxia, shock, and many pulmonary disturbances of the newborn can produce the clinical picture of "persistent fetal circulation": secondary PFC-syndrome. Under adequate therapy with O2-insufflation, vasodilatory drugs, and if necessary mechanical ventilation the prognosis in the majority of cases is good.

Cyanosis↗
PubMed1982

[Complications of retrograde arterial catheterizations in infants and children (author's transl)].

550 retrograde arterial catheterizations, performed between 1974 and 1980, including 50 infants below the age of one year, 120 children between one and 5 years of age and 380 schoolchildren, were reviewed with respect to the rate of complications. Within this period the portion of open arteriotomies decreased from 41% during 1974-1977 to 7% during 1978-1980. Only 130 patients had systemic heparinization during the catheterization procedure, without preponderance of any age group. Complications occurred in 10% of the patients, 4% being major complications necessitating mostly thrombectomia or thrombolysis. The rate of major complications decreased from 6% during the first period (1974-77) to 3% during the second period (1979-80), which can partly be attributed to the decrease of open arteriotomies within the entire period. According to our results the open arteriotomy of the A. femoralis should be avoided as far as possible. The rate of arterial obstructions was highest in infancy, where it amounted to 14%, and did not change considerably between the first and second period of time in this age group. In schoolchildren, however, the rate of arterial obstruction diminished from 7% during the first period to 0.5% during the second period. Considering the entire period, systemic heparinization did not appear to influence significant the rate of complications. During the last 3 years, however, arterial obstruction was observed in none of 74 patients having undergone systemic heparinization, but in 8 of 228 patients without this measure, 7 of them being infants and children below the age of 6 years. We therefore conclude that systemic heparinization should be performed in infants and small children during retrograde catheterization.

Cardiac Catheterization↗