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Biomedical subjects

K Emmrich

Publications and source records attributed to K Emmrich.

At least 19 recordsLinked to original sources
PubMed1996

[Enoximone--clinical experiences in heart surgery].

In 1991 and 1992, we introduced the new phosphodiesterase-III-inhibitor, enoximone, in the treatment of cardiac low-output-syndromes in the early phase after valve replacement or coronary bypass grafting. We introduced enoximone in cases which met the following criteria: cardiac index < or = 2.4 l/min/m2; systolic arterial pressure < or = 90 mmHg; left ventricular filling pressure > or = 20 mmHg despite the use of dopamine (> or = 12 micrograms/kg/ min); epinephrine (> or = 0.12 microgram/kg/min) and glyceroltrinitrate (1 microgram/kg/min). After clarification of preoperative risk factors and postoperative complications, retrospective evaluation of complete haemodynamic monitoring in patients after valve replacement (14 out of 86) and patients after coronary bypass grafting (22 out of 228) led to the following conclusions. Enoximone is of essential importance for the treatment of cardiac low-output at the end of extracorporeal circulation, particularly in cases complicated by preoperative myocardial deterioration. The use of enoximone is especially effective combined with beta-sympathomimetics as a result of elevation of cAMP-levels in two ways: by stimulation of beta-adrenoceptors directly and by inhibition of phosphodiesterase. Cardiac indices early after bypass, compared with measurements taken before bypass, reveal a clear rise indeed caused by increase in heart rate. Only in patients who underwent coronary bypass grafting did we observe a moderate increase in stroke volume indices. The therapeutic principle of using vasodilators--to lower peripheral resistance for improving stroke volume --appears to be effective immediately after extracorporeal circulation only in part. The vasodilating effect of enoximone has to be constantly compensated for by volume supplementation and alpha-mimetic stimulation, especially after valve replacement surgery. In contrast to this, we continued the application of glyceroltrinitrate in about 25% of the cases. Coronary surgery patients tolerated the vasodilating action particularly well; consequently, despite inotropic stimulation to a high degree, these patients showed no additional signs of ischaemia. Based on our therapeutic measures, the therapy led to very good short-term results. However, this therapeutic regime failed in patients suffering from extended myocardial infarction or irreversible pulmonary hypertension.

Adult↗
PubMed1993

[Coronary artery fistula--surgical or percutaneous embolization treatment?].

Three children aged 4 months, 2.7 and 7 years with the unusual fistula of the left coronary artery to the right atrium were observed over a 2-year period. The two younger children underwent emergency surgery although they showed no clinical symptoms. The reasons for surgical intervention were an aneurysm in the right atrium with obstruction of the vena cava superior and a considerably enlarged fistula, respectively. In the older child, we percutaneously embolized a terminate fistula of the ramus circumflexus with two platinum microcoils without complications. Two-dimensional-echocardiography and color flow mapping were used to confirm the diagnosis. After such diagnosis we recommend a coronary angiography in every case. The transcatheter-coil-embolization is an alternative method to surgical closure in selected cases. We recommend an early onset intervention in case of congenital coronary artery fistula.

Aortography↗
PubMed1990

Relationship between design and control of artificial heart for protection of the right/left balance.

Right/left matching in the total artificial heart (TAH) is essential to prevent fatal volume displacement into the pulmonary circuit. Measurements were made with three different sized Rostock pneumatic artificial ventricles incorporated in the Donovan mock circulatory system together with the heart driver AKT 86. First for each ventricle we determined the dependence of the maximum effective stroke volume on the systolic driving pressure and the afterload. The right ventricle (RV) is about 10% more effective than the left ventricle (LV). Control of the TAH permits different or equal frequencies for the RV and LV. For control with equal frequencies and full-to-empty regimen of one ventricle (RV-Master or LV-Master) the ratio of designed stroke volumes between RV and LV is important. This follows from the smaller efficiency of the LV and the left-to-left shunt. Otherwise a control mode with different heart rates must be used.

Heart, Artificial↗
PubMed1989

[Current status of the use of the artificial heart and ventricular assist systems].

The state of the technical development of the mechanical assist systems and the artificial heart, respectively, guarantees a sufficient support of the circulatory system up to the improvement of the own heart function or to the possible heart transplantation. There is the necessity for the temporarily limited support of the heart, but also for the long-term one. Independent of the underlying etiology in acute conditions of cardiac failure in many cases the external supporting system may be sufficiently helpful. The antithrombotic therapy and the prophylaxis of infections demands particular carefulness. There is still no representable release for the long-term use of the hitherto available cardiovascular supporting systems. The question is controversial, whether then an experiment on patients or an already accepted therapeutic intervention is still taken into consideration. Essential prerequisites for the long-term use would be a full implantability of the systems in transcutaneous energy transmission, a further biologization of the blood-contacting materials, a clarification of the immune phenomena, a possibly automatic mode of action adapted to the need as well as a reliable strategy of antithrombotic therapy. The increased risk of infection should be taken into consideration.

Animals↗
PubMed1989

[A successful prolonged resuscitation following mitral valve replacement--a case report].

Based on a case report a successful resuscitation lasting 2 hours and 28 minutes is described and discussed. This case report demonstrates that particularly with cardiosurgical patients the recently fixed "Do not resuscitate order" is hardly to be taken into account. If the absolute criteria for breaking off the resuscitative measures are not present, resuscitation should be continued regardless of its duration.

Heart Arrest↗
PubMed1989

[Results of the differentiated use of catecholamines and vasodilators in the early post-bypass phase].

Presented are the results of a procedure to characterize the haemodynamic situation and the required therapy in the early post-bypass period by including haemodynamic parameters (Part, CVP, PLA, TPR, PVR, f, Cl) in a system of seven parameter constellations although directly measured values must be supplemented by clinical data. In this way situations with increased or normal cardiac output and pathological peripheral resistance can be more easily distinguished from situations with reduced cardiac output. The investigations were performed in 300 patients who underwent cardiac surgery in 1985 and 1986. In more than 80% of the patients increased volume alone was not able to end the bypass, and so therapy including catecholamines and/or vasodilatators was instituted. Due to a relatively intensive but specific treatment, a favourable result with a 3% mortality was achieved. The frequency of patients after coronary surgery, valve replacement or correction of congenital heart defects in the seven situations of parameters corresponded to the expected haemodynamic peculiarities. In the group treated with catecholamines only, including 34% of the coronary patients, no increased mortality occurred compared with the total number. In patients in whom the constellation of parameters required a treatment with catecholamines combined with vasodilators, a higher mortality of 8.6% occurred compared with the total result. Here patients are concentrated with whom a good surgical result could not be obtained or the changes of myocardial stimulation were exhausted. Our findings emphasize the importance of the following points for further practice: improvement of invasive monitoring to apply vasodilators more intensively especially in infancy, careful selection of patients for coronary surgery, reduction of negative inotropic drugs preoperatively in high risk patients for improving postoperative stimulation of the myocardium.

Adult↗
PubMed1987

[Catheter problems in the use of ventricular cardiovascular assist systems].

The prerequisite for efficient assist-ventricles and impulses in the pulsatile pumping function are sufficiently dimensioned afflux and flowing off connections. In systematic investigations on the hydraulic circulation model the cannulas from an internal parameter of 12 mm with a total length of the connection distance to the inflow and outflow valve, respectively, at the bypass ventricle of 30 cm proved sufficient for performing a volume of output of 5-6 l/min in clinic-relevant filling pressures in a hypodynamic circulatory situation. Connection cannulas for the heart-lung machine used in routine work are not sufficient in periodic filling and ejection processes in the pulsatile pumping function for an effective decompression and effective increase of the cardiac output. In case of an ECG-triggered mode of action of the ventricular assist-system an increase of frequency up to 130/min in after that incomplete filling of the assist-ventricle does not remarkably restrict the effectiveness of the assist-system.

Assisted Circulation↗
PubMed1985

Results of total repair of tetralogy of Fallot after previous subclaviopulmonary or aortopulmonary anastomosis.

Total repair of tetralogy of Fallot was performed in 69 patients after the primary construction of a Blalock (28 patients) or a Waterston (41 patients) anastomosis. A total of 7 patients (10.1%) died. One to 5 yrs after correction, 62 patients (89.9%) survive: 52 (75.4%) are in a very good condition, 7 (10.1%) are in a good condition and the condition of 3 (4.4%) is unsatisfactory. 8 (11.6%) patients have serious late complications. The result of correction is not much influenced by the previous Blalock anastomosis (mortality rate 6.9%). After the Waterston anastomosis, however, there are frequent serious complications (pulmonary hypertension in 25.0% of patients), which adversely affect the result and increase mortality (12.5%) of the subsequent correction. The authors prefer two-stage repair of tetralogy of Fallot in the first two years of life. By administration of beta-blockers and prostaglandins they endeavour to postpone the construction of a Blalock anastomosis or an anastomosis performed by means of a polytetrafluoroethylene vascular prosthesis up to the age when the pulmonary artery branches are at least 4 mm in diameter. They plan the subsequent correction to be performed between the 2nd and the 5th year of age.

Aorta, Thoracic↗
PubMed1983

[The value of computer tomography in the postoperative long-term surveillance of patients with a vascular prosthesis for aorta replacement].

Because of the possibility of life-threatening late complications by anastomotic aneurysms and the danger of their rupture, all patients in whom a coarctation of the aorta was resected and replaced by a vascular prosthesis must be followed up continuously for life. Their chest x-rays show-in addition to unequivocally normal or pathological findings-sometimes questionable variations of the aortic outline, which must be diagnosed definitely by further investigations. By means of computerized tomography, the suspicion of an anastomotic aneurysm can either be refuted or confirmed in almost all cases. Thus, the invasive examination by aortography, which is desirable before operation of an aneurysm, may be omitted in the group of unsuspicious patients. Out of 198 patients, who received a vascular prosthesis for correction of an aortic coarctation in the time from 1960 to 1980, 27 were examined by computerized tomography because of irregular findings in their chest x-rays. In 6 patients the suspicion of an anastomotic aneurysm was confirmed and could be proved by aortography and reoperation. In 21 patients an aortography could be omitted because of its unsuspicious findings by computerized tomography.

Aorta, Thoracic↗
PubMed1982

[Central venous long-term catheter in the treatment of acute leukemia: implantation of a modified Hickman technic].

Central venous catheters are an essential prerequisite for the supportive ascertainment of highly aggressive cytoreductive therapy programmes in patients with acute leukaemia. From the indications (parenteral nutrition, transfusions, blood taking a. o.) and the particular conditions of the patient with acute leukaemia (granulo- and thrombocytopenia) results the superiority of a subcutaneously tunnelled central venous catheter with a particular occlusion of the place of entry into the skin in contrast to usual techniques.

Catheters, Indwelling↗
PubMed1981

Long-term results of anastomotic operations in 120 children with cyanotic congenital heart disease operated on the the first two years of life.

The author analyse results of anastomosis in 120 children with cyanotic heart disease operated on in the first two years of life. At the age up to 3 months of life 21 infants were operated on, 11 (52.4%) of whom died in connection with the procedure. Between the 3rd and 24th month of life 99 children were operated on with a death rate of 11.1%. In 94 children hypoxic spells disappeared, cyanosis and hypoxia were relieved. In the majority of patients, however, the duration of an improved general condition was limited to five years. Both immediate and long-term results depended first of all on the age of the child and on the type of heart lesion. Patients with tetralogy of Fallot had the lowest operative mortality (7.1%) and the best long-term results. In pulmonary atresia, which has poor prognosis without operation, the results of anastomosis were the least gratifying. The authors consider an anastomotic operation, especially the Blalock and Waterston shunt, to be an important life-saving procedure in infants with cyanotic congenital heart disease with hypoxic spells and critical hypoxia.

Aorta↗