Biomedical subjects

Kristian Emmertsen

Publications and source records attributed to Kristian Emmertsen.

6 recordsLinked to original sources

PubMed2006

Surgical repair of coarctation of the aorta: up to 40 years of follow-up.

OBJECTIVE: Coarctation of the aorta (CoA) was previously considered cured after surgical repair. Evidence for excess mortality and late morbidity has later accumulated, although studies with long-term follow-up remain sparse. The aim was to identify patients operated for CoA at Aarhus University Hospital, Denmark between 1965 and 1985 and to assess surgical and late mortality and cardiovascular morbidity in this cohort and possible predictors for an adverse outcome. METHODS: Two hundred and twenty nine patients were identified. Baseline characteristics and morbidity and mortality data were obtained from medical records, registries and databases and analysed by Kaplan-Meier graphs and multivariate Cox regression analyses. RESULTS: There were 14 (6%) surgical deaths. The survival in patients who were alive 30 days postoperatively was 95% 10 years after surgery, and 91%, 83% and 69% after 20, 30 and 40 years, respectively. The mortality rate ratio for all long-term survivors compared with an age- and sex-matched reference group was 4.3 (2.9-6.4). In those with no cardiovascular comorbidity at the time of repair, it was 3.4 (1.8-6.4). The causes of late deaths were cardiovascular in 63%. CoA repair in the early decade, age below 1 year at repair and high level of comorbidity were predictors for late mortality. Twenty five percent of current survivors were on antihypertensive medication and further cardiovascular morbidity had occurred in 46 (26%), including cardiovascular surgery and catheter interventions in 35 (19%). Freedom from death, reintervention and cardiovascular complications other than hypertension was 60% 30 years after surgery in the entire study population. CONCLUSIONS: Repaired CoA is associated with excess cardiovascular mortality and morbidity and often in need of reintervention. These patients, therefore, need careful follow-up.

Adolescent↗

PubMed2006

Medium-term follow-up of mechanical valves inserted in children.

OBJECTIVE: We reviewed our experience with mechanical valves inserted between 1988 and 2002 in children aged 15 years or younger. METHODS: Hospital files were extracted retrospectively. Follow-up was completed by March 2005. RESULTS: Of 41 patients, we inserted a valve in atrioventricular position in 27 children, having a median age of 3.1 years, ranging from 0.4 to 14.5 years, and in aortic position in the remaining 14, having a median age of 13.5 years, and a range from 7.0 to 14.9 years. For the valves inserted in atrioventricular position, the underlying disease was congenital in 23, rheumatic in two, post-endocarditic in one, and Marfan's syndrome in one. Mean follow-up was 7.7 years, with standard deviation of 5.3, giving a total follow-up of 209 patient years. Mortality at 30 days was 7%, and survival was 73% at up to 16 years follow-up. Events related to anticoagulation were seen in 3 patients, corresponding to 1.4% per patient year. In 6 patients (22%), heart block ensued which required implantation of a pacemaker treatment, and 5 patients (19%) had reoperations. For the implantations in aortic position, the underlying disease was congenital in 13, stenosis in 10 and insufficiency in three, and post-endocarditis in one. Mean follow-up was 6.8 years, with standard deviation of 4.6, giving a total of 95 patient years. We lost one patient within 30 days (7.7% mortality), and survival was 77% at up to 13 years follow-up. There were no incidents of thrombosis, nor events related to anticoagulation, but one patient (7%) needed insertion of a pacemaker due to a perioperative heart block, and one (7%) required new valvar replacement. CONCLUSIONS: Although preferably avoided, mechanical valves can be implanted in children with an acceptable mortality and morbidity, and good long-term results.

Adolescent↗

PubMed2005

Hemodynamic function of the standard St. Jude bileaflet disc valve has no clinical impact 10 years after aortic valve replacement.

OBJECTIVES: Size mismatch and impaired left ventricular function have been shown to determine the hemodynamic function of the standard St. Jude bileaflet disc valve early after aortic valve replacement (AVR). We aimed to analyse St. Jude valve hemodynamic function and its clinical impact in the survivors of a prospective series 10 years after AVR for aortic stenosis. DESIGN: Forty-three survivors aged 32-90 years from a prospective series attended a follow-up study with Doppler echo and radionuclide cardiography 10 years after AVR for aortic stenosis. Six patients with significant left sided valve regurgitation were excluded from further analysis: they had significantly lower St. Jude valve gradient and left ventricular ejection fraction (LVEF) and larger mass index (LVMi) than 37 without. RESULTS: In the 37 patients without left sided valve regurgitation peak and mean gradients were inversely related to St. Jude valve geometric orifice area (GOA) indexed for either body surface area or left ventricular end-diastolic dimension (LVEDD). The gradients correlated directly with LVEDD but not with LVEF or LVMi. Eleven patients with hypertension had higher peak gradients (31+/-13 versus 22+/-8 mmHg, p<0.05), lower LVEF, and higher LVEDD and LVMi than 26 without. Peak gradient was greater than 35 mmHg in five hypertensive patients with normal LVEF but lesser than 30 mmHg in six with impaired LVEF. Supranormal LVEF and severe size mismatch identified the remaining patients (N=3) with peak gradient above 35 mmHg. In a multilinear regression analysis GOA indexed for LVEDD, hypertension, and LVEF were independently related to peak gradient. CONCLUSION: High gradients of the standard St. Jude bileaflet disc valve 10 years after AVR was primarily related to systemic hypertension and mismatch between valve and left ventricular cavity size. Hypertension and left sided valve regurgitation, but not St. Jude valve gradient or size mismatch, were the dominant determinants of left ventricular hypertrophy and impaired function.

Adult↗

PubMed2004

Predictable changes in left ventricular mass and function during ten years after valve replacement for aortic stenosis.

BACKGROUND AND AIM OF THE STUDY: Left ventricular (LV) hypertrophy is the underlying basis for longevity after aortic valve replacement (AVR) for aortic stenosis (AS). However, a detailed account of changes in LV mass and function in the long term after AVR and identification of the determinants of such changes have not yet been presented. METHODS: Ninety-one unselected consecutive adult patients with AS underwent AVR and were followed up to 10 years, at which time 41 survivors without new mitral disease underwent repeat measurement of LV mass index (LVMi), ejection fraction (LVEF), fast filling fraction (LVFFF), and end-diastolic volume index (LVEDVi). A subgroup comprising 49 patients was also assessed at eight days, three months, and 1.5 years postoperatively. All measurements were analyzed in a longitudinal regression model for repeated measures. RESULTS: LVMi fell from 202 +/- 58 g/m2 (n = 91) via 150 +/- 45 g/m2 (n = 39) at 1.5 years to 139 +/- 40 g/m2 (n = 41) at 10 years in all patients, and to 124 +/- 31 g/m2 (n = 29) in non-hypertensive patients. The LVMi falls were paralleled by improvements in LVEF and LVEDVi. LVFFF was not correlated to LVMi before the 10-year study. The longitudinal model indicated progressive reduction of LVMi to 1.5 years, but no change thereafter. The predictor variables were preoperative LVMi and end-systolic dimension index (high values of both related to high postoperative LVMi), hypertension, and male gender. The model for LVEF indicated a rapid increase to three months, followed by a slight decrease to 1.5 years and further to 10 years, predicted by preoperative LVEF and LVFFF. LVFFF fell sharply by three months, had recovered somewhat at 1.5 years and fully at 10 years, positively related to preoperative LVFFF and inversely to end-systolic chamber radius:wall thickness ration and small-sized prosthetic valves. LVEDVi converged from extreme values over time predicted by preoperative LVEF, but rose with hypertension and coronary artery disease. Hemodynamic function of the prosthetic aortic valve at any of the measurement times had no impact. CONCLUSION: Changes in LV mass and function up to 10 years after AVR for AS were highly predictable. Poorer outcomes were related to preoperative excessive hypertrophy and indices of underlying irreversible myocardial disease and further compromised by hypertension and, to a lesser extent, coronary artery disease. The hemodynamic function of the aortic prosthetic valve did not seem to play a role.

Adult↗

PubMed2003

Regression of left ventricular hypertrophy during 10 years after valve replacement for aortic stenosis is related to the preoperative risk profile.

BACKGROUND: Previous studies have suggested that regression of hypertrophy may be the underlying determinant of longevity and left ventricular function after valve replacement (AVR) for aortic stenosis (AS). The potential for hypertrophy regression could therefore be related to the preoperative risk profile. METHODS: Ninety-one consecutive patients with AS had a "project" Doppler-echo and radionuclide ventriculography in addition to the standard investigation programme prior to AVR with a disc valve (19-29mm, n=82), a caged ball valve (26-29mm, n=8), or a stented porcine valve (26mm, n=1); 49 (group A) were selected for a serial follow-up study while 42 served as controls (group B). Forty-two group A patients took part in a 1.5-year examination while 47 (26 group A, 21 group B) patients were studied at 10 years. RESULTS: Groups A and B were comparable as regards all pre- and intra-operative data including left ventricular mass index (LVMi). A previously developed preoperative prognostic index (PI) separated the patients into groups with low (n=23), intermediary (n=19) and high risk (n=49) with 10-year survivals of 87%, 58% and 43% (P<0.01). LVMi dropped from 202+/-58g/m(2)preoperatively to 152+/-45g/m(2)(P<0.0001) at 1.5 years, and 139+/-40g/m(2)(P<0.0001) at 10 years (three and six patients, respectively, with paravalvular leak or mitral regurgitation excluded). PI correlated with preoperative (r=0.51, P<0.001), 1.5-year (r=0.46, P<0.01), and 10-year LVMi (r=0.41, P<0.01). Also preoperative left ventricular ejection fraction correlated with the three LVMi measurements. Patients with systemic hypertension had higher LVMi at 1.5 years (193+/-42, n=6 vs 144+/-42, n=33, P<0.05) and 10 years (175+/-39, n=12 vs 124+/-31g/m(2), n=29, P<0.001). Patients with low, intermediary or high PI, excluding those with hypertension, had 1.5-year LVMi of 110+/-35 (n=8), 134+/-43 (n=9) and 164+/-33g/m(2)(n=16; P<0.01), respectively, and 10-year LVMi of 116+/-25 (n=17), 126+/-27 (n=6), and 146+/-41g/m(2)(n=6; P<0.05), respectively. There was no relation between LVMi at 1.5 or 10 years and peak or mean Doppler gradient, prosthetic valve size, or valve size index. CONCLUSIONS: Left ventricular hypertrophy regression for patients who survived up to 10 years after AVR for AS is dependent on the preoperative risk profile indicating that irreversible myocardial disease is the underlying factor. Systemic hypertension is an important factor in its own right.

Aged↗

PubMed2002

[Transcatheter closure of atrial septal defects].

INTRODUCTION: Transcatheter based device closure of secundum atrial septal defects (ASD) have been offered at our institution since September 1997. During the first three years, closure was attempted in 56 patients aged 3 to 71 years (median 15). MATERIAL AND METHODS: Hospital notes on all patients undergoing device closure of atrial septal defects between September 1997 and September 2000 were reviewed. Indications for attempted closure were significant arteriovenous shunting (n = 49), venoarterial shunting (n = 3), and suspected paradoxical embolism (n = 4). RESULTS: Device delivery was achieved in 51 (91%) patients. In five patients, the procedure was abandoned, owing to the unsatisfactory position of the device. In one patient, embolisation occurred within 24 hours. At three months follow-up, 44 of the 46 patients investigated had completely closed defects. Residual flow was seen in two patients, including one (with three defects) who subsequently underwent elective surgical closure. There were no other complications. DISCUSSION: Device closure of ASD is a realistic alternative to surgical treatment.

Adolescent↗