PubMed Health⌕ Search

Biomedical subjects

K H Leitz

Publications and source records attributed to K H Leitz.

At least 19 recordsLinked to original sources
PubMed2000

[Dilated coronary sinus. A preoperative transesophageal echocardiographic diagnosis].

A 36-year old woman was presented to our hospital with congenital ventricular septal defect and one-vessel coronary artery disease (75% proximal left main coronary artery) for CABG and repair of the VSD. After induction, a transesophageal echocardiographic (TEE) baseline examination was performed, showing a severely dilated coronary sinus (CS) measuring approximately 3 cm (abnormal >1 cm). We suggested a persistent left superior vena cava (PLSVC) draining into the CS. PLSVC is a common venous congenital anomaly, with a reported incidence of 0.5% in general population and in 3-5 % of patients with congenital heart defect. Injection of echo-contrast solution in a left arm vein, visualizing microbubbles passing through the PLSVC into the CS confirmed our suspicion. The diagnosis of a PLSVC and dilated CS is a contraindication for retrograde cardioplegia because of the loss of cardioplegia into the PLSVC resulting in a inadequate myocardial protection. It may be difficult to pass a pulmonary artery catheter (PAC) through a left internal or left subclavian vein and it may be associated with arrhythmias. A chest radiograph shows the anomalous course of the PAC along the left heart.

Adult↗
PubMed1997

[Perspectives in applying guidelines].

Definition, purpose and future fate of guidelines are presented. Special stress is placed on the fact that guidelines represent a tool for rationalization by which economical capacities are activated and rationing is prevented.

Cost Control↗
PubMed1994

[Results of immediate and delayed bypass operation in PTCA emergencies].

UNLABELLED: The therapeutic strategy for irreversible coronary occlusion as a complication of PTCA is influenced by the rate of myocardial infarctions and mortality after emergency bypass surgery. If immediate bypass operation cannot prevent myocardial infarction, medication will be the treatment of choice. Since the duration of ischemia is of critical importance for the preservation of myocardium, we analyzed our results with respect to the time interval from the onset of ischemia to surgery. From 12/84 to 12/93 there were 49 emergency operations for 4,478 PTCAs. In 38 patients acute closure occurred in the cath lab; because of very strict standby arrangements these patients could be brought to the operating rooms without delay (group A). In 11 patients acute closure occurred during the following 24 hours in the intermediate care unit (group B); attempts of catheter recanalisation and/or preparation for surgery accounted for an additional time delay until surgery of 79 minutes. RESULTS: In the 38 patients of group A there were only one small transmural (CKmax 533/U/l) and four non-Q wave (CK-max 322 U/l) myocardial infarctions. Of the 11 patients in group B only two did not suffer any loss of myocardium. In seven cases there were transmural (CKmax 1,296 U/l) and in two cases non-Q wave (CKmax 721 U/l) myocardial infarctions. Two patients of group B died on the second and third postoperative day. Thus the results of emergency bypass operations were excellent if surgery could be performed immediately after failure of catheter interventions (all survived, no transmural M.I. in 97%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1993

A new sternal retraction device for the dissection of the internal mammary artery.

For the dissection of the internal mammary artery (IMA), we use a new sternal retraction technique. The retractor is an angled stainless steel device with a slotted face and two sternal arresting hooks. The method is simple and the device acts as a unit with a standard sternal spreader. The time period between mounting and the exposure of the IMA is only a few seconds. The entire procedure takes place in the sterile operative field. By utilizing this method, we dissected nearly 300 IMAs without any complications or serious sternal injuries.

Dissection↗
PubMed1992

[Acute pulmonary embolism--are vena cava interruption procedures and extracorporeal circulation always necessary?].

Between 1983 und 1991, emergency pulmonary embolectomy with the aid of extracorporeal circulation was performed in 13 patients. Ten patients were in class IV according to Greenfield, seven came into the operating theater with external cardiac massage. The 30-day mortality was 46%. In the same period, 15 venous interruption procedures were performed (three Adams de Weese Clip, ten Greenfield-Filter, and two femoral vein ligations). Eight times the venous interruption procedure was done prophylactically. The acute pulmonary embolism of class III and IV according to Greenfield is an indication for lytic therapy. We operate only if there is a contraindication to lytic therapy or if there is deterioration of the clinical state.

Combined Modality Therapy↗
PubMed1989

[Accidental drowning with extreme hypothermia--rewarming with extracorporeal circulation].

A 3 1/2 year old boy had fallen into a fishpond. After about one hour the boy was brought to our hospital. He was cyanotic and bloated, the rectal temperature was 18.4 degrees C. There was no heart beat, the pupils were wide without reaction to light. Via a sternotomy the heart lung machine was connected and core rewarming was achieved. After 7 days of artificial respiration the boy could be extubated, after 16 days the boy left our hospital without neurological consequences.

Acid-Base Equilibrium↗
PubMed1989

[A drowning accident of long duration with deep hypothermia and rewarming with extracorporeal circulation. A report of 2 patients].

Two nearly drowned, 2 9/12 and 3 6/12 years old boys with profound hypothermia were admitted to our pediatric intensive care unit with all signs of clinical death. Both patients could be rewarmed and oxygenated by extracorporeal circulation. One of them died 36 hours after the accident with severe brain edema. The second one survived without any defect. Rewarming of cold-water nearly-drowned patients by extra-corporeal circulation seems to be a very effective way of treatment.

Accidents↗
PubMed1988

[Coronary spasm immediately following coronary revascularization].

Of 2,600 coronary operations performed from August 1983, to December 1988, two ischemic reactions of the inferior wall immediately after operation were observed. In both patients the right coronary artery was either dissected or revascularized intraoperatively. Under the diagnosis of postoperative spasm both patients had reangiography three hours after surgery. Right coronary artery spasm was demonstrated in both patients. After intracoronary injection of calcium channelblockers the spasm resolved completely. Patient 1 demonstrated a small inferior infarction during control angiography, patient 2 remained free of a myocardial infarction. The possible causes of coronary spasm during or after surgery are discussed. The diagnosis and an approach to therapy are outlined.

Coronary Artery Bypass↗
PubMed1987

Use of the left internal thoracic artery to correct a left main coronary atresia.

Dyspnea with a slightly enlarged heart was noticed in a five year old girl at a checkup. The cardiological investigation revealed an enlarged left ventricle with slight mitral regurgitation. The right coronary artery was enlarged and filled the entire left arterial system via collaterals. The left main coronary artery could not be detected. In addition, outflow of contrast medium into the large vessels was absent. With the diagnosis of left main coronary atresia, the left internal thoracic artery was implanted on to the proximal left anterior descendent in October 1985. In the control angiogram, the anastomosis conditions were normal, the left ventricle had decreased in size and contracted almost normally. The collaterals from the right could no longer be demonstrated. The child (now six years old) has full exercise tolerance today. In the ultrasonogram, the ventricle shows normal contraction behavior. Up to know, four cases with congenital main coronary atresia have been reported in the literature.

Child, Preschool↗
PubMed1986

[Use of the mammary artery in coronary revascularization].

From August 1983 through December 1985 1088 patients underwent coronary surgery. 406 (37%) received a single or bilateral internal mammary artery (IMA) graft with single or sequential anastomoses. The youngest patient was 6 years old, the oldest 75, with a mean age of 55.7 years. A total of 672 IMA anastomoses was constructed. In addition 348 patients received 610 saphenous vein grafts. 83% of the IMA were anastomosed to the LAD and its branches, 12% to the circumflex and 5% to the right coronary artery. 4 patients (0.98%) died postoperatively, 402 survived and are free of angina. In our experience the IMA can be used routinely with low operative risk and good results.

Adolescent↗
PubMed1985

A new technique for measuring oxygen saturations of hemoglobin and myoglobin and its application in open heart surgery.

Light reflected from the human heart surface was used to determine mixed hemoglobin and myoglobin oxygen saturations (O2SAT) in the cardiac tissue. The measurements were performed in 8 patients with coronary heart disease including stenosis of left anterior descending coronary artery (LAD) who underwent aorto-coronary bypass surgery. At the end of the operation the O2SAT was measured in the supply area of the LAD either with patent or occluded coronary bypass. In 13 experiments occlusion of the bypass resulted in a decrease of O2SAT from 74 +/- 16% to 61 +/- 24% (p less than 0.02). A new technique is introduced and its limitations are discussed. Preliminary results of application in coronary bypass surgery demonstrate an increase in tissue oxygenation following myocardial revascularization.

Coronary Artery Bypass↗
PubMed1983

Thermographic evaluation of myocardial temperature during infusion of cold cardioplegia.

Delay in myocardial cooling during an infusion of cold cardioplegic solution may occur in patients with coronary artery disease. Forty patients with significant stenosis of the left anterior descending coronary artery (LAD) were divided into 3 groups according to the extent of the LAD stenosis. Group A consisted of 12 patients with 70% stenosis. Group B included 23 patients with 90% stenosis, and in group C there were 5 patients with LAD occlusion. Myocardial temperature was measured with a thermocamera during infusion of 2000 ml 8 to 10 degrees C cold Bretschneider's cardioplegic solution and compared to 10 other patients without coronary artery disease undergoing mitral valve replacement (group D). In group A the myocardium cooled to 15 degrees C after 4 1/2 minutes and to 12 degrees C after 10 minutes. In group B the myocardial temperature was 15 degrees C after 5 minutes and 12 degrees C after 10 minutes. In group C the temperature reached 18 degrees C after 5 minutes and 14 degrees C after 10 minutes. In group D the myocardial temperature was 12 degrees C after 3 minutes and 10 degrees C after 7 minutes. This study shows far better myocardial cooling rates in patients with unobstructed coronary arteries.

Body Temperature↗
PubMed1982

[Whole body oxygen uptake in coronary artery bypass surgery (author's transl)].

In 10 patients who underwent aorto-coronary bypass operations haemodynamic parameters and whole body oxygen uptake were monitored, beginning after induction of anaesthesia, during extracorporeal circulation and the postoperative period up to 5 h. In the intensive care unit a new device for the continuous measurement of whole body oxygen uptake from expired gases was used. For anaesthesia constant doses of fentanyl (10 micrograms/kg/h) and nitrous oxide were given. These were supplemented by low concentrations of halothane and nitroglycerine if hypertension occurred. Before extracorporeal circulation hypertensive states were observed in 8 cases and were effectively controlled without compromising tissue oxygenation. During extracorporeal circulation oxygen consumption was reduced more than could be explained only by the effects of hypothermia, indicating a limited shock state. Within the first postoperative hour the total peripheral resistance increased more than during the whole operation, impairing cardiac function at low levels of oxygen uptake. Thereafter a rise in metabolism was seen, partially induced by shivering which led to a marked (235% of control) increase in whole body oxygen uptake. This was accompanied by a reduction of the total peripheral resistance and an improvement of cardiac function. No acidosis was observed. Artificial ventilation is mandatory until metabolic demands have normalized. Noninvasive continuous monitoring of whole body oxygen uptake was useful for the assessment of cardiovascular function, increased postoperative metabolic demands, early detection of hypovolaemia and weaning from artificial ventilation.

Anesthesia↗
PubMed1981

Surgical correction of an atherosclerotic coronary artery aneurysm. Case report.

A 56-year-old male patient became symptomatic with angina pectoris. Selective coronary angiography revealed an aneurysm of the stem of the circumflex artery and a subtotal stenosis of the left anterior descending coronary artery (LAD). At cardiac surgery the anterior wall of the aneurysm was resected and the resulting defect closed with a venous patch. Bypass grafts to the LAD and the first marginal branch were also implanted. Three months later both grafts were shown to be patent, and flow through the reconstructed stem of the circumflex artery was undisturbed.

Aneurysm↗
PubMed1980

Combined medical and surgical procedure in acute myocardial infarction--a preliminary report.

The purpose of this investigation was to evaluate a new therapeutic approach, by which acutely ischemic human myocardium could be reperfused. The procedure was as follows: intracoronary application of nitroglycerine, intraluminal recanalization by catheters and intracoronary application of streptokinase. Before and after these interventions coronary angiograms were made. Surgical coronary revascularization was performed 1--64 days after reestablishment of flow through the occluded vessels. Seven patients with acute myocardial infarction were treated in this manner. The mean preoperation ejection fraction was 48.6%, the mean enddiastolic pressure was 17.5 mmHg and the mean maximal CPK activity was 616 units/liter (u/l). By the conservative regimen outlined, reopening of the occluded vessels was achieved in all cases. Critical stenoses of 80--85%, however, persisted. But, reperfusion appeared sufficient since in none of the patients hemorrhagic myocarditis was produced intra-operatively. There was no hospital mortality. The mean post-operative ejection fraction was 60% and the mean enddiastolic pressure was 10.6 mmHg. It is concluded that ischemic myocardium can be reperfused by the active conservative regime tested. Emergency revascularization performed after induced reperfusion appears to carry a low operative risk.

Aged↗