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L Faber

Publications and source records attributed to L Faber.

34 records · Page 2Linked to original sources
PubMed1998

Outflow acceleration assessed by continuous-wave doppler echocardiography in left ventricular hypertrophy: an analysis of 103 consecutive cases.

The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 103 nonselected, consecutively enrolled patients with LV hypertrophy (LVH), either due to pressure overload (97 patients) or hypertrophic cardiomyopathy (HCM, 6 patients). In 34 patients with LVH, outflow acceleration (gradients ranging from 18 to 122 mm Hg) was induced or accentuated by the Valsalva maneuver after 1.6 mg nitroglycerine sublingually independent of LVH etiology. Factors associated with LV outflow acceleration were female sex, small body surface area and LV cavity size, increased relative wall thickness, LV contractility, and resting LV outflow velocity, mitral anulus calcifications and systolic anterior movement of the mitral valve. It is concluded that dynamic, intracavity LV gradients are a nonspecific flow abnormality that merit consideration because they can be frequently found in LVH patients.

Aortic Valve Stenosis↗
PubMed1996

[Catheter treatment of hypertrophic obstructive cardiomyopathy].

BASIC PROBLEMS AND OBJECTIVE: In addition to medication with negative inotropic drugs, surgical myectomy and DDD pacemaker implantation are standard procedures in the treatment of hypertrophic obstructive cardiomyopathy (HOCM). In a preliminary series the results obtained with a recently described method, consisting of transcatheter myocardial reduction, are evaluated. PATIENTS AND METHODS: Six patients (two women, four men; mean age 52.7 [44-68] years), who remained in moderate heart failure despite medical treatment, underwent the procedure. After atrial transseptal puncture (via a catheter introduced percutaneously into the femoral vein) the left ventricular outflow tract (LVOT) gradient was measured at rest and after 5-minute balloon occlusion of the first septal branch of the left coronary artery. After demonstration of significant reduction of the gradient by the occlusion, one (n = 3) or two (n = 3) septal branches were occluded by the injection of 2-5 ml of 96% alcohol. RESULTS: The LVOT gradient was reduced from 57.8 +/- 22.4 (38-97) mm Hg to 11.3 +/- 8.6 (0-21) mm Hg and postextrasystolic from 131.0 +/- 40.7 (78-198) mm Hg to 44.0 +/- 35.6 (19-69) mm Hg. All patients had angina for 24 hours after the procedure. Maximal rise in creatine kinase activity was 982 +/- 589 (392-1729) U/l after 8.0 +/- 3.9 (4-15) hours. In three patients transitory complete atrioventricular block developed 10 min to 5 days later, requiring temporary pacemaker implantation. The further course was without complication in all patients and they were discharged after 7.5 +/- 1.8 (6-11) days. CONCLUSION: The described catheter method provides a nonsurgical means of reducing the amount of septal myocardium with subsequent reduction of the LVOT gradient in HOCM. Long-term observation in a larger group of patients and comparison with conventional forms of treatment are required to determined the method's ultimate place in the treatment of HOCM.

Adult↗
PubMed1995

[Reproducible (latent) obstruction of the left ventricular outflow tract].

BACKGROUND AND OBJECTIVE: Left ventricular outflow tract obstruction (LVOTO) with flow acceleration in late systole (Vmax > or = 2.0 m/s and acceleration/ejection time [AT/ET] > or = 0.5) is often present in a latent form in left ventricular hypertrophy; it can be unmasked by administration of glyceryl trinitrate or with the Valsalva manoeuvre (preload reduction). It was investigated prospectively whether latent LVOTO also occurs on ergometric exercise. PATIENTS AND METHODS: 61 patients (19 female, 42 male, mean age 55.5 +/- 12.9 years) with left ventricular hypertrophy at rest were examined by Doppler echocardiography at rest, under provocation with glyceryl trinitrate and the Valsalva manoeuvre, and during bicycle ergometry. Manifest LVOTO was already present before the test in 3 patients. RESULTS: In 24 patients LVOTO occurred during the provocation (Vmax rose from 1.38 +/- 0.25 to 2.93 +/- 0.53 m/s; AT/ET rose from 0.47 +/- 0.16 to 0.68 +/- 0.09). In 19 of these 24 patients LVOTO also occurred during the ergometry. In four additional patients changes were marginal (AT/ET > or = 0.5; Vmax = 1.8 and 1.9 m/s, respectively). There was a highly significant correlation between provocation and ergometry with regard to Vmax, as well as AT/ET (with r = 0.84 and 0.76, respectively). CONCLUSIONS: These findings show that provokable LVOT gradients are likely to occur during exercise to a similar degree as those on preload reduction. Thus, course of disease could possibly be influenced by early treatment in patients with left ventricular hypertrophy.

Adult↗
PubMed1994

Dynamic intracavity gradients: a 'new' hemodynamic abnormality in the spectrum of secondary left ventricular hypertrophy.

The effect of provocation on left ventricular (LV) outflow was studied by continuous-wave Doppler echocardiography in 93 patients with LV hypertrophy (LVH), either due to pressure overload or hypertrophic cardiomyopathy (HCM), and in 39 healthy volunteers. In 50 patients with LVH, outflow acceleration (gradients ranging from 19 to 130 mm Hg) was induced or accentuated by at least one provocative situation independently of LVH aetiology. In normal persons LV outflow remained unchanged. Calcium antagonist treatment reduced outflow acceleration. It is concluded that dynamic LV gradients are a non-specific flow abnormality in the spectrum of LVH that merits consideration.

Administration, Sublingual↗
PubMed1993

[Pulmonary valve endocarditis, bilateral deep vein thrombosis amd recurrent pulmonary emboli].

A 57-year-old obese man with hypertensive heart disease and long-standing varicose veins developed recurrent bouts of fever, lung infiltrations, cardiac arrhythmias and increasing dyspnoea. On admission multiple lung emboli and bilateral deep vein thromboses were confirmed. The echocardiogram demonstrated floating vegetations on all three pulmonary valve cusps. Biochemical tests indicated an inflammatory constellation (ESR 62/105 mm, C-reactive protein 13.3 mg/dl), partial respiratory insufficiency (pO2 54.6 mm Hg; pCO2 29 mm Hg). Streptococcus bovis was grown from several blood cultures. Conservative treatment over several weeks, complicated by "drug fever", with penicillin G (10 mega IU four times daily) and gentamicin (80 mg twice daily intravenously), later vancomycin (500 mg four times daily intravenously), then roxithromycin (150 mg three times daily by mouth), as well as maintenance anticoagulation with heparin (800-1,200 IU/h intravenously, later 15,000 IU subcutaneously twice daily), followed by phenprocoumon, contained the disease. One year after onset of treatment a good functional results had been achieved.

Endocarditis, Bacterial↗
PubMed1991

[The provocation of dynamic obstruction of the left ventricular outflow tract in secondary myocardial hypertrophy].

The effect of the Valsalva manoeuvre before and after sublingual administration of 1.6 mg nitroglycerin on maximal velocity (Vmax), acceleration time (AT) and ejection time (ET) of left-ventricular outflow was measured by Doppler echocardiography in 49 patients (28 men and 21 women; mean age 65 [48-84] years) with secondary left-heart hypertrophy, and in 8 controls. Changes in flow profile typical of dynamic obstruction in the left-ventricular outflow tract (LVOT) occurred in 30 of the patients, Vmax increasing from a mean of 137 to 302 cm/s. Latent LVOT obstruction was associated with a thickened posterior wall, an accelerated left-ventricular outflow even at rest and systolic anterior motion of the anterior mitral leaflet (SAM phenomenon). The size of the provoked LVOT gradient correlated significantly with Vmax or the AT/ET ratio at rest. Obstruction of the LVOT is apparently a non-specific phenomenon which also occurs in secondary left-heart hypertrophy. These findings may have therapeutic consequences.

Aged↗
PubMed1987

Effect of an education-orientation program on family members who visit their significant other in the intensive care unit.

An education-orientation program given to family members may be an effective initial intervention technique for alleviating familial stress. The findings suggest that the intervention program had a positive effect on the experimental group. A comprehensive, ongoing program is needed to ensure that each family is given the attention they require to promote and maintain family function and integrity during the hospitalization crisis. Future research is needed to identify stressors perceived by family members and to identify effective nursing interventions that would decrease familial stress and promote and maintain the family integrity during the hospitalization crisis. Future research should be time-sequenced to examine the effect of an intervention program as initial coping mechanisms begin to diminish. Finally, research is needed to determine whether family intervention alleviates stress in the stricken family member.

Education↗
PubMedDate not supplied

Alcohol septal ablation for hypertrophic obstructive cardiomyopathy.

Until the early 1990s, surgical myectomy was the standard treatment for patients with hypertrophic obstructive cardiomyopathy and drug refractory symptoms. In the past few years, the potential therapeutic options have dramatically changed with the introduction of DDD-pacemaker implantation and percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion. The circumscribed therapeutic myocardial infarction results in widening of the left ventricular outflow tract with consecutive gradient reduction. Follow-up studies show impressive clinical improvement, as well as further gradient reduction as a result of left ventricular remodeling. In this article, we provide an updated review of the latest results of percutaneous transluminal septal myocardial ablation.

Cardiomyopathy, Hypertrophic↗