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Biomedical subjects

M E Rothlin

Publications and source records attributed to M E Rothlin.

At least 19 recordsLinked to original sources
PubMed1995

[Acquired heart diseases and pregnancy].

Understanding of the mechanisms of cardiovascular and hemodynamic adaptation during pregnancy helps to prevent or manage complications in cardiac patients during gestation. Manifestations of coronary heart disease are exceptional during pregnancy and delivery. The same is true of disorders of the pericardium. Peripartal cardiomyopathy is a myocardial disorder of undetermined cause occurring shortly before, during or after delivery, which may take a fatal course. Hypertrophic obstructive or non-obstructive cardiomyopathy is compatible with gestation and delivery without serious complications in most cases. Rheumatic mitral stenosis was the most common cardiac disorder until the 1950s. Nowadays it is rarely seen in this country. Surgical and other interventional therapies have greatly changed the outlook in pregnant women with valvular heart disease. A highly controversial issue is heart valve replacement in young women and management of anticoagulation during pregnancy. Like any other drug therapy, anticoagulation during gestation requires careful weighing of the benefit for the mother against toxic and teratogenic effects for the fetus. In women with heart disease the management of pregnancy should start, if possible, before conception. Thorough counseling and proper planning of pregnancy and of therapeutic measures is essential in order to avoid or manage complications.

Abnormalities, Drug-Induced↗
PubMed1991

[Myocardial infarction in pregnancy].

Myocardial infarction during pregnancy and puerperium is very rare. Increased awareness of its possible occurrence is important for diagnosis. We report on a 37-year-old woman without coronary risk factors who suffered an anterior septal infarction in the last trimester. Coronary angiography one month after normal delivery and two months after infarction revealed normal coronary arteries. Ventriculography showed anteroseptal akinesia. The assumed etiology of myocardial infarction appears to be coronary spasm. A history of vasospasm in other vascular beds, migraine and Raynaud's phenomenon support this hypothesis. The literature is reviewed with special emphasis on clinical picture, prognosis, etiology and management of myocardial infarction during pregnancy.

Adult↗
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↗
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↗
PubMed1987

Does exercise-induced myocardial ischaemia cause enhanced platelet activation and fibrin formation in patients with stable angina and severe coronary artery disease?

In this study, betathromboglobulin (BTG) and fibrinopeptide A (FPA) in peripheral venous blood were measured in 20 patients with stable angina pectoris before and immediately after exercise-induced myocardial ischaemia; in 5 of the 20 patients stable angina was associated with typical peripheral artery disease. A total of 10 patients with angiographically documented peripheral artery disease without angina and 10 normal volunteers were taken as control groups. BTG and FPA in the 15 patients with stable angina before exercise were 41 +/- 14 ng ml-1 and 2.3 +/- 0.9 ng ml-1 and were not statistically different from the values in normal controls; after exercise-induced myocardial ischaemia no significant increase occurred in these patients. Conversely, in the 5 patients with stable angina associated with peripheral artery disease BTG and FPA before exercise were 61 +/- 10 ng ml-1 and 3.5 +/- 0.8 ng ml-1 and increased to 114 +/- 14 ng ml-1 (P less than 0.001) and 4.1 +/- 0.5 ng ml-1 (P less than 0.01): These results were similar to those found in the 10 patients with isolated peripheral artery disease. We conclude that BTG and FPA in peripheral venous blood in patients with stable angina are not elevated either at rest or after exercise-induced myocardial ischaemia. Elevated values of BTG and FPA in patients with stable angina may reflect a major interaction between blood and atherosclerotic vessel wall, suggesting the presence of associated atherosclerotic lesions in peripheral artery disease.

Angina Pectoris↗
PubMed1987

The need for coronary artery surgery: expand or restrict? A European view.

I have been solicited by the organizers not to present a final solution to the problem, but to comment on controversial issues. For the indications for aorto-coronary bypass, consensus has been reached by most medical men that angina pectoris and, in selected patients, prognostic considerations are important. Controversy starts when we ask how much angina or what pattern of clinical and angiographic risk factors are required for the operative indication. It remains to be seen, whether other forms of mechanical revascularisation, such as balloon dilatation can replace surgery in large numbers of patients, who are presently treated by aortocoronary bypass. An effort has been made by physicians to make greater use of cost-benefit analysis estimates in their medical decisions, and to provide policy makers with this information. The number of aorto-coronary bypass operations in European countries varies considerably. The trend of these figures, however, is rising throughout Europe and therefore my personal answer to the crucial question in the title is: expand.

Combined Modality Therapy↗
PubMed1986

[Vocational rehabilitation after an aortocornary bypass operation].

To elucidate the influence of coronary bypass surgery on vocational status we studied 238 male patients operated upon for stable angina (mean age 53.3 +/- 7.4 years). The postoperative follow-up was 3.7 +/- 0.7 years. 33 patients died or had to be excluded because they had retired. 113 (55%) of the remaining 205 patients participated in a formal rehabilitation program (group A), whereas 92 (45%) patients did not (group B). There was no significant difference between the two groups with regard to pre- or postoperative clinical and angiographic data, except a higher rate of preoperative unemployment and of patients unfit to work for more than 6 months before operation in group B. The overall preoperative employment rate was 48%, whereas 3.7 years after operation 62% of all the patients were working (p less than 0.005), a net gain of about 30%. Return to work was significantly influenced by the NYHA classification after operation, exercise capacity in the bicycle stress test, duration of preoperative unemployment, type of work and age at operation. In group A the postoperative employment rate was higher than in group B (72% vs. 51%), especially in patients who had not worked before operation (62% vs. 32%). It is concluded that after coronary artery bypass surgery a net gain in employment rate can be expected and a formal rehabilitation program may help the patients to resume work postoperatively. However, definite conclusions cannot be drawn because of the retrospective, nonrandomized design of the study.

Adult↗
PubMed1986

[Acquired heart valve diseases--state of the art 1985].

Over the last two decades a change in the etiology of acquired valvular heart disease and a continuous further development of its treatment has been observed. In this article the following topics are addressed: The pathology as it presents today, newer aspects in drug treatment, optimal timing and choice of surgery, the problem of concomitant coronary artery disease and hypertension, and management after surgery. Present experience answers some of the questions whereas others still remain unsolved.

Aortic Valve↗
PubMed1985

[Remote results of mitral valve surgery in mitral valve insufficiency, 1972-1982].

Between 1972 and 1982 315 patients were operated on for isolated or predominant mitral insufficiency at Surgical Clinic A, University of Zurich. The etiology was rheumatic in 51 patients and degenerative in 133. Of these 164 patients, 42 underwent a reconstructive procedure and 122 mitral valve replacement. Patients who underwent mitral valve reconstruction were younger and had a longer average postoperative observation time than patients who had mitral valve replacement. Operative mortality of the total series was 2.4%. Late postoperative survival was very similar in the patients with rheumatic and degenerative mitral incompetence. Seven-year survival after mitral valve reconstruction was 87 +/- 5%, compared to 76 +/- 6% after mitral valve replacement. Mitral valve reconstruction patients required more reoperations than those with mitral valve replacement. On the other hand, the incidence of late embolism and endocarditis was lower after mitral valve reconstruction. Age of patients at operation and a preoperative reduction of ejection fraction and cardiac index were predictors of a less favourable postoperative course. From these observations we conclude that surgery should be carried out before irreversible impairment of left ventricular function, even where symptoms are less than severe. If possible, reconstructive surgery for mitral incompetence is justified in view of the lower postoperative risk of embolism and endocarditis and in spite of the higher incidence of recurrences requiring reoperation.

Adolescent↗
PubMed1985

Platelet inhibitors versus anticoagulants for prevention of aorto-coronary bypass graft occlusion.

The effects of the antiaggregant substance ticlopidine and of the anticoagulant acenocoumarol on patency rates of aorto-coronary bypass grafts were compared in a prospective randomized trial. Ticlopidine, 250 mg b.i.d. was administered orally from the first postoperative day till angiography, while anticoagulation with acenocoumarol was initiated on the second to third postoperative day. Side-effects of ticlopidine were rare and patient management with the standard dosage of this drug was easier than oral anticoagulation. From an initial group of 166 randomized patients 149 completed the trial by coronary angiography three months postoperatively. The 78 patients in the ticlopidine group showed a compliance of 85%. The average prothrombin time in the 71 patients receiving acenocoumarol was 26.9%. Detailed statistical analysis of the two study groups revealed no reason to doubt the correctness of randomization. Coronary angiography showed an average patency rate per patient of 84% with ticlopidine and of 82% with acenocoumarol. This and various other measures of graft occlusion did not reveal any substantial difference in graft patency of patients receiving ticlopidine or acenocoumarol. It is concluded that ticlopidine may well be used instead of anticoagulants for prevention of postoperative occlusion of aorto-coronary bypass grafts.

Acenocoumarol↗
PubMed1984

[Long-term postoperative course and surgical indications in patients with hypertrophic obstructive cardiomyopathy].

Operative results and late follow-up of 63 patients undergoing surgery for hypertrophic obstructive cardiomyopathy (HOCM) were analyzed in relation to the surgical indication. There were 64 postoperative follow-ups because one patient had two myectomy operations. 27 patients without limiting symptoms (group A) were operated on because of a pressure gradient of more than 50 mm Hg. 31 patients (group B) underwent myectomy operation because of limiting symptoms, and 5 patients (group C) required additional surgery because of mitral incompetence or left ventricular aneurysm. Comparison of preoperative clinical and hemodynamic data indicate that patients of group B were in a more advanced stage of disease than patients of group A. Operative mortality was low, with one perioperative death. Operative complications were rare, and after adequate treatment caused no significant morbidity. The left ventricular systolic pressure gradient was relieved in almost every case, with simultaneous reduction of left ventricular enddiastolic pressure. With a few exceptions the patients experienced longstanding improvement of symptoms. Durability of symptomatic improvement and survival were significantly better in patients of group A. Late results in patient group C were unfavorable, mainly because of the additional lesions requiring surgery. Atrial fibrillation and congestive heart failure were relieved by surgery, but recurrence was frequent in late follow-up. Ventricular arrhythmia during postoperative follow-up was common in both group A and group B, without obvious prognostic significance. In the light of these results the operative indications were reconsidered. Surgery is indicated in patients with limiting symptoms not responding to medical therapy, if a left ventricular pressure gradient of more than 50 mm Hg is present. Simultaneous mitral incompetence of severe degree requires primary mitral valve replacement by low profile prostheses. Risk factors, such as reanimation for ventricular fibrillation or a family history of sudden death, may militate in favour of surgical treatment. The operative indication is doubtful in patients with a high left ventricular pressure gradient but without consistent symptoms and without additional risk factors.

Adolescent↗
PubMed1984

[Aortic valve replacement with simultaneous aorto-coronary bypass operation 1969-1980].

Between 1969 and 1980, 62 patients underwent aortic valve replacement with simultaneous aorto-coronary bypass implantation. Three patient groups were formed, namely patients with predominant aortic valve disease, patients with predominant coronary heart disease and patients with simultaneous severe aortic valve disease and coronary heart disease. The results were analyzed separately for the three patient groups. The operative risk of patients with severe aortic valve disease was not greatly increased by the simultaneous implantation of aorto-coronary bypass. On the other hand, patients with predominant coronary disease and aortic valve replacement for mild to moderate aortic valve disease had an increased operative mortality and rate of perioperative infarctions. The unfavorable results in the latter patient group can most probably be explained by patient selection. Late mortality appears to increase with the severity of coronary heart disease. Prognosis of the total patient group was less favorable than that of isolated aortic valve replacement or aorto-coronary bypass operation. The implantation of aorto-coronary bypass did not completely prevent the reappearance of angina pectoris or myocardial infarction in the late postoperative follow-up. Several risk factors for a less favorable course were identified.

Aged↗
PubMed1983

[Prognosis for patients following surgical correction of transposition of great vessels].

Without surgical help, 90% of patients with transposition of the great arteries (TGA) will die during the first year of life. After repair of TGA, 90% of patients reach adult life. A number of hemodynamic complications and arrhythmias may occur and must be recognized, because some require reoperation or pacemaker implantation. Nearly 8 years postoperatively the vast majority of patients were symptom-free and over 90% were attending an ordinary school or pursuing a profession. Dysfunction of the right (systemic) ventricle and its atrio-ventricular valve may become progressive in the late follow-up and could limit the reported success-rate in the future.

Arrhythmias, Cardiac↗