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Biomedical subjects

L Egloff

Publications and source records attributed to L Egloff.

17 recordsLinked to original sources
PubMed1992

Similar endothelium-dependent relaxation, but enhanced contractility, of the right gastroepiploic artery as compared with the internal mammary artery.

The right gastroepiploic artery is an alternative coronary bypass graft. The excellent graft function of the internal mammary artery has been related to its physiologic properties, particularly to endothelial function. Isolated artery rings were suspended in organ chambers for recording of isometric tension. Norepinephrine and potassium chloride evoked threefold greater contractions in the gastroepiploic artery than in the mammary artery (p less than 0.01 to 0.05), whereas the sensitivity to the catecholamine was comparable. Acetylcholine induced endothelium-dependent relaxations, but the sensitivity (pD2: 6.7 +/- 0.3) and maximal relaxation (81% +/- 9%) were slightly less in the gastroepiploic artery than in the mammary artery (pD2: 7.6 +/- 0.2; 100% +/- 0%; p less than 0.05). Histamine induced endothelium-dependent relaxations with a similar sensitivity (pD2: 7.5 +/- 0.3 and 7.2 +/- 0.1), whereas the maximal relaxation was slightly enhanced in the gastroepiploic artery. The relaxation to the nitric oxide donor SIN-1 was identical in the two arteries. Thus the right gastroepiploic artery exhibits better contractility than the internal mammary artery but comparable endothelium-dependent and endothelium-independent relaxations. The good endothelial function of the gastroepiploic artery might be important for graft function and patency, whereas the enhanced contractility may facilitate vasospasm, especially in the presence of high circulating levels of catecholamines.

Acetylcholine↗
PubMed1991

[Developments in mitral valve surgery].

Between 1987 and 1990 we operated on 104 patients for mitral valve disease. If possible the valve was reconstructed according to CARPENTIER's technique: 8 of 28 stenotic, 43 of 57 regurgitant and 2 of 7 mixed lesions were repaired. Twelve patients underwent re-replacement of a previously inserted mitral prosthesis. Six patients died early (7.8% after replacement, 8% after isolated replacement, 3.7% after repair and 2% after isolated repair). Five of these six patients were in NYHA class IV preoperatively. Seven patients died late after a mean observation period of 18 months (5 after replacement, 1 after double valve replacement and 1 after repair and multiple coronary bypass surgery). Prognosis is best for patients whose valve can be repaired and who are not already in NYHA class IV. The postoperative NYHA class for surviving patients is excellent (1.3 in the replacement group and 1.2 after repair).

Adult↗
PubMed1991

Dealing with dilated ascending aorta during aortic valve replacement: advantages of conservative surgical approach.

Five to fifteen percent of patients undergoing aortic valve replacement (AVR) will have an ascending aortic aneurysm requiring a concomitant surgical procedure. On the other hand, a dilated ascending aorta is known to be a potential source of complications after AVR. From 1972 to 1988, 2278 AVR, either isolated or combined with a second cardiac procedure, were performed in our institution. In the same time interval, a dilated ascending aorta was treated in additional 291 consecutive patients during AVR. Three different surgical options were employed: aortic remodelling and external wall support in 164 patients (56.4%), composite graft replacement in 81 patients (27.8%) and a supracoronary graft in 46 patients (15.8%). Early mortality was 4.8%. Aortic remodelling plus external wall support had the lowest early mortality (1.8%) and the best 8-year survival (89.6%). Supracoronary grafting had a higher early mortality (6.4%) and lower 8-year survival (73.2%). The results of the composite graft were least favourable: early mortality was 9.8% and 8-year survival 76.5%. The results point out the necessity for instituting the appropriate surgical procedure for a dilated ascending aorta during AVR. They show that conservative aortic surgery with preservation of endothelial lining gives excellent early and late results.

Actuarial Analysis↗
PubMed1991

[Use of the right gastroepiploic artery as a coronary bypass graft. Indications, technique and early results].

435 isolated coronary artery procedures have been performed between January and December 1989 at the HerzZentrum Hirslanden. In 93% of the cases, one or two internal mammary arteries (IMA) and in 7%, saphenous vein grafts only were used as a bypass conduit. In 12 patients, the right gastroepiploic artery (RGE) was used as a free (3) or pedicled (9) graft to the posterior surface of the heart. This group of 12 patients was analyzed in a retrospective study. Postoperative complications in this group included one myocardial infarction and reexploration for intraabdominal bleeding in the same patient. All patients were discharged from hospital after an average of 9.7 days. After a mean follow-up time of 5 months, all patients are in NYHA-functional class I without antiischemic drugs. Postoperative angiography in 7 patients (mean postoperative interval 4 months) showed all 13 IMA-grafts and 5 RGE-grafts patent, 1 RGE-conduit is occluded, 1 RGE-graft could not been assessed for technical reasons. The RGE is an viable additional arterial bypass conduit and an alternative to other grafts. Indications for use of the RGE are lack of sufficient other conduits, calcified ascending aorta, coronary reoperation after vein graft failure and probably young patients with severe hyperlipidemia.

Arteries↗
PubMed1991

[Micrococcus luteus: a rare pathogen of valve prosthesis endocarditis].

A rare case of prosthetic valve endocarditis caused by Micrococcus luteus is described and compared with the few cases reported in the literature, as well as the clinical features, microbiological profile, therapy, and prognosis of common prosthetic valve endocarditis. Micrococcus luteus is a constituent of the normal human buccal bacterial flora which forms yellowish colonies and appears as a gram-positive coccus typically arranged in tetrades. Although of low virulence, the germ may become pathogenic in patients with impaired resistance, colonizing the surface of heart valves. In contrast to staphylococci (for which it may easily be mistaken) it is usually penicillin-sensitive. However, the most promising antibiotic regimen proposed for treatment of Micrococcus luteus seems to be a combination of vancomycin, amikacin, and rifampicin. If the infection leads to severe hemodynamic alterations, however, valve replacement may become necessary similar to the situation in prosthetic valve endocarditis caused by more aggressive and highly resistant bacteria.

Aged↗
PubMed1991

[Emergency surgery for PTCA complications: tactics and results].

Incidence, risk and results of emergency coronary bypass surgery after failed percutaneous transluminal coronary angioplasty (PTCA) have been analyzed in a retrospective study. Failed PTCA has been defined as visible pathology (dissection, occlusion) of the dilated vessel associated with acute chest pain and ECG changes. From 3-1-1987 to 11-30-1990, 23 patients of 433 (5%) underwent emergency surgery for failed PTCA (19 male, 4 female, mean age 55 +/- 8 years). PTCA was performed in 16 cases of one-vessel-disease, 3 cases of two-vessel-disease and 4 cases of three-vessel-disease. All had an ejection fraction beyond 40%. 19 patients remained in stable hemodynamic condition. In average 2.1 vessels have been bypassed; in 13 cases the internal mammary artery (IMA) has been used, in 10 cases the saphenous vein (VSM) only. No early nor late death occurred. The perioperative infarction rate is 30%. Comparing the group with IMA and the group with VSM only, no difference could be found regarding the number of unstable hemodynamics, the use of catecholamines nor the perioperative infarction rate. After a mean follow-up period of 14.3 months, 21 patients are in NYHA class I, 2 in NYHA class II. Emergency coronary bypass surgery can be performed with low risk and favorable results, if the operation is timed without delay after the onset of acute chest pain and ECG changes in failed PTCA. The infarction rate is remarkably higher than in elective coronary surgery. The use of the IMA seems to be no additional risk factor.

Angioplasty, Balloon, Coronary↗
PubMed1990

[Heart center surgery in the private hospital: heart surgery in the hospital with covering physicians].

Based upon the experiences at the "Herzzentrum Hirslanden" Zurich it is demonstrated that heart surgery and invasive cardiology, including cardiac catheterization and PTCA, can readily be performed by surgeons and cardiologists in private practice at a private hospital not receiving any government funds. The needs for additional heart surgical beds in the greater area of Zurich is confirmed. Manpower needed and necessary apparative infrastructure are discussed and present activities at the "Herzzentrum Hirslanden" illustrated. Finally problems with medical insurance companies covering the cost are dealt with.

Cardiac Surgical Procedures↗
PubMed1989

[Blood saving measures in heart surgery].

Retransfusion of mediastinal shed blood after cardiopulmonary bypass has markedly reduced requirements of homologous blood or blood products. It also decreased the incidence of early reoperation for bleeding. The additional use of a cell saver has not further reduced blood requirements but it improved the patient's perioperative water balance.

Adolescent↗
PubMed1988

[Prolonged course in patients with symptomatic ventricular tachycardia].

In a retrospective study we analyzed the long-term course in 77 patients (71 males and 6 females) with symptomatic ventricular tachycardias. Initially all patients had undergone an electrophysiological examination. 56/77 patients received drug therapy and 19/77 underwent surgery (implantation of an automatic defibrillator in 2 patients). Two patients received no therapy. After an observation period of 30 (5-81) months, 60% of the patients who had received drug therapy and 77% who had undergone surgery were free of tachycardia. 16/56 (29%) of the patients under drug management and 6/19 (32%) of the surgically treated had died in the meantime. In the whole group the mortality rate was 9.6 times higher than in an age and sex matched control group. In younger subjects (16-50 years) the mortality rate was 4 times greater than in those aged 51-81 years. The highest mortality was observed in the first year. The most important prognostic parameter was the left ventricular ejection fraction, which was significantly higher in survivors. We conclude that ventricular arrhythmias can be effectively controlled, and quality of life enhanced, with drug therapy or surgery.

Adolescent↗
PubMed1988

[Replacement of the aortic valve with a bioprosthesis: 5-year surgical results].

To evaluate the clinical course after replacement of the aortic valve with a porcine heart-valve, 87 patients (mean age 52 years [5-70] at time of surgery) were followed up for a five-year period. Operative mortality was 1% and late mortality 8%. The actuarial probability of survival at five years for all patients was 91%. Embolic events occurred in two patients and endocarditis in six. Valve dysfunctions requiring reoperation resulted from bacterial endocarditis in three patients, from primary valve dysfunction in three patients and from paravalvular leak in another three patients. Echocardiographic cross examination of the bioprostheses showed degenerative processes in eight asymptomatic patients. Patients who underwent reoperation or showed valve degeneration were significantly younger (41 +/- 19 years and 42 +/- 9 years respectively) than patients without valve degeneration (52 +/- 9 years) [p less than 0.05]. We conclude that there is an increased risk of primary valve degeneration for patients under age 35. Echo-Doppler sonographic cross examinations of the heart are a highly sensitive means of detecting early degeneration of the bioprostheses.

Actuarial Analysis↗
PubMed1988

[Ruptured aneurysm of the abdominal aorta and iliac arteries. An analysis of 132 cases].

A series of 132 consecutive patients with ruptured aneurysms of the abdominal aorta or iliac arteries treated between 1979 and 1984 is retrospectively reviewed. 13% had a known abdominal aneurysm before rupture. Workup consisted of clinical assessment alone in 69%, assisted by ultrasound in 23%. Perioperative mortality was 35% (70%-confidence limits (CL) 30%-39%). Preoperative factors associated with increased mortality were age over 80 years, shock and evidence of coronary artery disease. In addition, intraoperative blood transfusion over 10 liters, suprarenal site of rupture, presence of free intraperitoneal blood, suprarenal aortic clamping and operation lasting longer than 3.5 hours were related to death, though higher mortality was statistically significant only for operating time and site of clamping. Cardiac morbidity was the most common and most critical factor affecting 52% of patients with a mortality of 59% (CL: 52%-65%). Development of oligo-anuric renal failure in postoperative course was almost uniformly associated with death (91%, CL: 83%-96%) even with use of dialysis, usually from multiple systems failure. Actuarial five-year survival, including perioperative mortality, was 38% (CL: 33%-43%). After a mean follow up of 3.3 years 82% (CL: 76%-87%) of surviving patients are in good health comparable to the pre-rupture state. Although many risk factors exist there are few contraindications to surgery, and results can be improved if workup and operation are rapid and simple. Minimizing blood loss is essential, while supportive measures in postoperative multiple systems failure still remain a serious problem. Prevention of rupture by resection of the intact aneurysm remains the ultimate goal.

Acute Kidney Injury↗
PubMed1988

Left ventricular systolic series elastic properties in aortic stenosis before and after valve replacement.

In seven patients with aortic valve disease the time course of an auxotonic beat was compared with that of an isovolumetric beat produced by aortic cross clamping during open heart surgery. The rate of systolic stress rise (dS/dt; g.cm-2) of the isovolumetric beat at peak meridional wall stress (Sp; g.cm-2) of the auxotonic beat was determined by tipmanometry and simultaneous sonomicrometry and was found to be 87% of maximum dS/dt. In the second part of the study the stiffness index (k) was calculated in patients undergoing cardiac catheterisation according to: k = 0.87.(max.dS/dt)/Sp.Vcf, where Vcf = normalised midwall circumferential fibre shortening velocity (circ.s-1). In 22 patients, 10 controls and 12 patients with aortic stenosis before (pre) and after (post) valve replacement the systolic stiffness index k (circ-1) was determined using tipmanometry and frame by frame angiocardiography. Muscle fibre diameter and interstitial fibrosis were assessed from left ventricular endomyocardial biopsies. The systolic stiffness index k was 15 circ-1 in controls, 14 in preoperative patients with aortic stenosis and 12 (p less than 0.01 v controls) in postoperative patients. There was a significant correlation between k and muscle fibre diameter (r = 0.55; p less than 0.01) but not between k and interstitial fibrosis or ejection fraction. We conclude that systolic stiffness index k is normal despite marked left ventricular hypertrophy in preoperative patients with aortic stenosis. Following successful valve replacement systolic stiffness index decreased and was significantly lower than in controls. Series elasticity appears to be determined by structures related to the muscle cell rather than to interstitial fibrosis.

Aortic Valve Stenosis↗
PubMed1987

Early results after mitral valvuloplasty for pure mitral regurgitation.

In this study we present the results of 105 consecutive patients with pure mitral regurgitation who underwent surgical treatment. In all patients mitral regurgitation was associated with mitral valve prolapse: 54 patients underwent mitral valvuloplasty and 51 patients mitral valve replacement. Clinical assessment and echocardiography were used as follow-up criteria at one year after surgery. After mitral valvuloplasty, NYHA decreased from 2.7 +/- 0.8 to 1.1 +/- 0.7 (P less than 0.01) and workload capacity increased from 65 +/- 28% to 96 +/- 25% (P less than 0.001); left endsystolic atrial dimension and enddiastolic dimension decreased from 6.2 +/- 0.8 to 4.8 +/- 1.2 cm (P less than 0.001) and from 7.2 +/- 1.3 to 5.9 +/- 0.8 cm (P less than 0.01); ventricular contraction fraction did not change significantly. After mitral valve replacement, clinical and echocardiographic improvement was significant but less remarkable than after valvuloplasty; ventricular contraction fraction fell from 39 +/- 7% to 29 +/- 8% in contrast to patients undergoing mitral valvuloplasty in whom no significant change occurred. Complications were rare in both groups though only a minority of patients undergoing mitral valvuloplasty received anticoagulants. We conclude that mitral valvuloplasty in patients with pure mitral regurgitation when compared with the patients after mitral valve replacement.

Echocardiography↗
PubMed1987

[Relation between systolic and diastolic elastic muscle properties and the morphology of the hypertrophic pressure-loaded left ventricle].

According to Maxwell's model, left ventricular (LV) systolic elastic properties are characterized by a series-elastic element and LV diastolic properties by a parallel-elastic element. It is not known whether this functional concept is reflected by some morphological counterparts. In 12 patients with aortic stenosis (AS) before and 19 months after aortic valve replacement, and in ten controls, LV biplane volume and simultaneous high-fidelity pressure measurements were performed during diagnostic catheterization. The constant (k) of systolic myocardial stiffness was determined from LV peak wall stress, the maximum rate of systolic stress rise and instantaneous LV midwall circumferential fiber shortening rate at peak stress. The constant (k*; circ-1) of diastolic stiffness was assessed from the diastolic stress-stiffness relationship, using a viscoelastic model. In AS patients pre- and postoperative endomyocardial biopsies were taken to assess muscle fiber diameter, interstitial fibrosis and LV fibrous content. Systolic myocardial stiffness constant was 15 circ-1 in controls, 14 circ-1 in preoperative and 12 circ-1 in postoperative AS patients (P less than 0.01 vs. controls). Diastolic myocardial stiffness constant was 19 circ-1 in controls, 23 circ-1 in preoperative AS patients and increased slightly but not significantly to 33 circ-1 after valve replacement. Parallel to the postoperative decrease in systolic stiffness, muscle fiber diameter decreased significantly from 33 to 27 mu (P less than 0.05). The slight increase in diastolic stiffness was accompanied by a significant increase in interstitial fibrosis from 15% to 26% (P less than 0.05); LV fibrous content remained essentially unchanged after operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve Stenosis↗
PubMed1986

[Coronary surgery].

Explore the source record for details and available documents.

Coronary Artery Bypass↗
PubMed1979

Isolated mitral valve replacement with the Björk-Shiley tilting disc prosthesis.

Between July 1970 and June 1977, 151 patients underwent isolated mitral valve replacement with the Björk-Shiley valve. The follow-up period extended over 8 years to June 1978. Hospital mortality was 5.2% (8/151), late mortality 8.4% (12/143). Actuarial survival analysis predicts 84 (+/- 4) % of patients to be alive at 5 years and 80 (+/- 6) % at 8 years. Thirteen patients sustained 15 episodes of thromboembolic complications; actuarially 88 (+/- 4) % of patients were free from this complication at 5 years and 81 (+/- 8) % at 8 years. Other valve-related complications included paravalvular leak (7), prosthetion showed an improvement of at least one class in 84% of patients.

Adolescent↗