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Biomedical subjects

M Emmel

Publications and source records attributed to M Emmel.

14 recordsLinked to original sources
PubMed2007

[Sensorineural loss of hearing in lower registers as the main symptom of Lyme disease].

In a 9-year-old boy with sudden sensorineural loss of hearing in the lower registers in both ears, serology showed elevated levels of antibodies against Borrelia burgdorferi and examination of the CSF revealed a positive antibody index against Borrelia burgdorferi. The boy was treated with antibiotics for 2 weeks. Audiometry performed 4 weeks after treatment was completely normal. Inner ear involvement in Lyme disease has often been discussed. Treating these patients with antibiotics may lead to an improvement in some.

Child↗
PubMed2006

Transhepatic approach for catheter interventions in infants and children with congenital heart disease.

UNLABELLED: We report on our experience with transhepatic access for catheter interventions in six children (age range 2.5 months-9 years). Three had systemic venous anomalies, and one infant a femoral venous occlusion. In two further patients with bradyarrhythmia after a Fontan operation with an intraatrial Gore-Tex tunnel, transhepatic access was chosen to achieve a perpendicular orientation of the transseptal needle to the atrial baffle, allowing puncture of the Gore-Tex membrane. Two of the patients underwent ablation of an accessory pathway; in one an atrial septal defect was closed. A 2.5 month old baby after Norwood I operation, underwent balloon dilation of the pulmonary arteries. Two patients after prior Fontan surgery underwent DDDR pacemaker implantation. The size of the introducer sheath ranged from 4 F up to two 9 F introducers in the same vein for pacemaker insertion. At the end of the procedure, hemostasis was achieved by external compression. RESULTS: Transhepatic access could be established in all six patients (using a mirror image approach in children with left atrial isomerism) and the interventional procedures could be performed as planned. In one patient with implantation of a permanent pacemaker, a subcutaneous hematoma occurred, requiring blood transfusion. CONCLUSION: In selected pediatric patients, transhepatic access for catheter intervention can easily be achieved.

Angioplasty, Balloon↗
PubMed2005

Experience with an ambulatory 12-lead Holter recording system for evaluation of pediatric dysrhythmias.

BACKGROUND: The 12-lead electrocardiogram demonstrates noninvasively many details concerning cardiac arrhythmias and their mechanism, but only for a limited period. A Holter system can record heart rhythm for a longer period, but shows 2 or 3 leads only. An ambulatory 12-lead Holter recording system combines the advantages of both. We report on our experience with the 12-lead Holter system in children. STUDY POPULATION: Twenty-four patients (age range, 3-22 years) underwent one or more 12-lead Holter recordings. Twelve patients had suspected or documented tachyarrhythmia, and 12 patients had suspected or proven long QT syndrome (LQTS). RESULTS: In the tachyarrhythmia group, 4 patients had supraventricular tachycardia and 7 ventricular tachycardia (VT). In the supraventricular tachycardia, group 1 patient had intra-atrial reentrant tachycardia with a single reentrant circuit, whereas another had multiple P-wave morphologies, suggesting multiple circuits. Two others had evidence for concealed atrioventricular accessory pathways. One patient had isolated supraventricular ectopy. In the VT group, 4 patients had uniform VT, and 3 patients had polymorphic VT. One patient with LQTS had macroscopic T-wave alternans. Two others showed intermittent extreme QT prolongation and T-wave notching during 12-lead Holter recording. THERAPEUTIC IMPLICATIONS: Patients with uniform VT underwent catheter ablation, guided in 2 instances by intracardiac pace mapping and comparison with the 12-lead Holter QRS morphology. All reentrant supraventricular arrhythmias with single P-wave morphology were ablated. One patient with intra-atrial reentrant tachycardia and multiple circuits received an antitachycardia pacemaker. In the LQTS group, the neonate with T-wave alternans received mexiletine in addition to beta-blocker therapy. CONCLUSION: In individual patients, the 12-lead Holter system provides important additional information about the arrhythmia and helps to plan appropriate therapy. Intermittent T-wave morphology changes can be diagnosed using 12-lead Holter recordings in patients with LQTS, allowing dynamic T-wave changes to be monitored. In specific cases, this may help identify patients with LQTS and also influence pharmacological therapy.

Adolescent↗
PubMed2005

Catheter ablation of junctional ectopic tachycardia in children, with preservation of atrioventricular conduction.

BACKGROUND: Idiopathic junctional ectopic tachycardia is a rare arrhythmia in children. Several studies have demonstrated that drug therapy is often ineffective and sometimes the only achieved effect is rate control. Early presentation and frequent recurrence are associated with adverse outcome. PATIENTS AND METHODS: Three consecutive children, aged 9, 7 and 12 years respectively, underwent radiofrequency catheter ablation for junctional ectopic tachycardia, after having failed antiarrhythmic drug therapy. The entire His bundle was plotted out and marked, using the Localisa navigation system. The arrhythmia was readily and repeatedly inducible using intravenous isoprenaline infusion and the site of earliest retrograde conduction during tachycardia could be assessed. Ablations were performed in sinus rhythm, empirically targeting the site of earliest retrograde conduction during tachycardia. RESULTS: This approach was successful in abolishing tachyarrhythmia in the first two patients, in whom the successful ablation site was located superoparaseptally. In the third patient, junctional ectopic tachycardia was inducible, despite abolishing retrograde atrial activation, in a septal location on the tricuspid valve annulus. Further ablations in the superoparaseptal region, closer to the His bundle, were successful in rendering tachyarrhythmia noninducible. Over a median follow-up of 10 months, none of the patients has had recurrence of arrhythmia, despite discontinuing all antiarrhythmic medications. CONCLUSIONS: Radio frequency catheter ablation of junctional ectopic tachycardia is feasible with preservation of atrioventricular conduction.

Atrioventricular Node↗
PubMed2005

Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in childhood.

Two patients, a 5 year old boy with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms despite appropriate pharmacologic therapy and an 11 year old girl with symptoms of tiredness and peak instantaneous LVOT gradient of 80 and 90 mmHg respectively were considered for radiofrequency catheter septal ablation, to relieve the left ventricular outflow tract obstruction. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions was placed in the hypertrophied septum, commencing distally in the ventricle and proceeding towards the aortic valve, taking care to stay away from the His bundle. The procedure was deemed to be completed when the entire extent of the hypertrophied septum had been treated. In the boy the procedure was complicated by two episodes of ventricular fibrillation, requiring DC cardioversion, but without any neurologic sequelae. The peak to peak gradient between left ventricle and aorta was 50 mmHg and 60 mmHg respectively pre-ablation, and remained unchanged immediately after. Both patients were discharged from the hospital 48 hours later. Serial measurement of serum Troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography at 7 days and at 6 weeks post-ablation respectively confirmed a beneficial hemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. In young children, in whom alcohol induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.

Cardiomyopathy, Hypertrophic↗
PubMed2005

Slow pathway ablation in children with documented reentrant supraventricular tachycardia not inducible during invasive electrophysiologic study.

UNLABELLED: Radiofrequency catheter ablation (RFA) has become the procedure of choice for permanent therapy of atrioventricular nodal reentrant tachycardia (AVNRT). This report presents our experience with atrio-ventricular node (AVN) modification in patients with documented narrow complex reentrant SVT, but no evidence for an accessory pathway, and no inducible tachyarrhythmia during invasive electrophysiology (EP) study. METHODS: The study population consists of nine children, age range 6-13 years (median 9) with previously documented SVT who had no tachyarrhythmia inducible during EP study (at baseline and following isoprenaline infusion). Eight of the 9 EP studies were performed under general anesthesia, and one under conscious sedation. An accessory pathway was excluded in all patients by appropriate atrial and ventricular extrastimulus pacing techniques. Eight of the nine patients had dual AV nodal physiology, and one had single AV nodal echo beats. The slow AV nodal pathway was empirically ablated, by applying RF lesions in the right inferoseptal AV groove, achieving catheter tip temperature of 50 degrees C. The appearance of an accelerated junctional rhythm during RF application was deemed to denote a successful application site. AV conduction during RF application was confirmed by incremental atrial pacing. The catheter position, and its relation to the compact AV node was constantly monitored using the LocaLisa navigation system. The end-point was absence of dual AVN physiology, and/or AV nodal echo beats. RESULTS: Successful slow pathway ablation was achieved in all patients. One patient appeared to have two separate slow pathways with different locations and two AH-jumps, which were both successfully ablated. None of the patients had evidence of temporary or permanent AV block at follow-up (median duration 9 months, range 4 to 36 months); none has had recurrence of symptoms or documented tachyarrhythmia. CONCLUSIONS: In children with structurally normal hearts, a previously documented SVT, absence of an accessory pathway and noninducibility of SVT during EP study, empirical slow pathway ablation appears to be justified.

Adolescent↗
PubMed2005

[Electrical heart diseases--therapy during childhood and adolescence].

With increasing experience, radiofrequency catheter ablation of tachyarrhythmia substrates has become first choice therapy for children >4 years of age with recurrent tachyarrhythmia. In younger patients, the risks associated with the procedure (typically procedure-related AV block or possible coronary artery damage) have to be weighed against the natural history of the tachyarrhythmia substrate, and the degree of control achieved with pharmacologic agents. Ablation for postoperative arrhythmias is more complicated, and associated with lower success rates and a higher rate of recurrence (of the same or a new tachyarrhythmia) despite acute procedural success. In this setting, catheter ablation has to be considered in conjunction with further surgery or the use of a defibrillator as a backup device to prevent arrhythmia-related sudden death. Also in inherited arrhythmias as in long QT syndrome and Brugada syndrome, implantable defibrillators have to be considered as a possible therapeutic option for patients with a higher risk for sudden cardiac death, irrespective of age.

Adolescent↗
PubMed2005

VDD-pacemaker in children--a long-term therapy?

AIMS: Transvenous AV-synchronous pacing in children started with the invention of smaller sized VDD leads and miniaturization of pacemakers. Whether or not this is a favourable long-term therapy was retrospectively investigated by us based on data from our records. METHODS: From May 1977 to July 2001 we implanted pacemakers in 104 children younger than 15 years of age. In 55 patients transvenous leads were implanted. Twelve of these (21.8 %) received a VDD pacemaker for hemodynamic reasons. RESULTS: Ages ranged from 11 months to 14.5 years (mean 7.7 +/- 4.3 y). Sizes of the children ranged from 67 to 141 cm (mean 105.9 +/- 15.5 cm) and body weight ranged from 5.3 to 62.0 kg (mean 22.5 +/- 9.8 kg). The mean follow-up period was 47.5 +/- 15.1 months. In 86.3 % of the time during follow-up pacemakers of which we obtained data were working in the VDD mode. Five of the twelve VDD patients (41.7 %) had to be reoperated because of severe traction on the leads. In all five patients the VDD systems were explanted and the patients changed to dual chamber pacemakers. The period of time between implantation and VDD lead explantation ranged from 24 to 74 months (48.6 +/- 18.5). CONCLUSIONS: VDD pacemakers can be implanted safely even in children with a low complication rate perioperatively. 41.7 % of our VDD patients had to be reoperated within the surveillance time because of severe lead tension due to thoracic growth. In our experience VDD pacemakers in smaller children seem to be a temporary solution to bridge AV-synchrony from a young age to DDD pacing in young adulthood.

Child↗
PubMed2004

Combined transhepatic and transjugular approach for radiofrequency ablation of an accessory pathway in a child with complex congenital heart disease.

We report on a boy with recurrent drug resistant atrioventricular reentrant tachycardia. The patient had complex structural heart disease consisting of right atrial isomerism, systemic venous anomaly (mirror image orientation of the intrathoracic veins, hemiazygos continuation to the left-sided superior vena cava, with separate drainage of the hepatic veins into the left-sided atrium, congenitally corrected transposition (ccTGA), pulmonary atresia (PA), ventricular and atrial septal defects (VSD and ASD). At the age of 22 months RF ablation was performed. Access to the heart was obtained by percutaneous puncture of a hepatic vein, the left internal jugular vein, and femoral artery. Earliest retrograde atrial conduction during tachycardia was localized to the free wall of the left-sided AV groove, and ablation in this area was successful. There were no procedure-related complications. RF ablation of accessory pathway is feasible in young children with complex structural heart disease and abnormal systemic venous return. In such patients access to the heart must be planned with the knowledge of the anatomy and judicious use of the hepatic venous approach, which should be done only by experienced investigators.

Catheter Ablation↗
PubMed2004

Paradoxical increase of pulmonary vascular resistance during testing of inhaled iloprost.

The case of a 14 month old girl with primary pulmonary hypertension treated with domiciliary oxygen is described. After invasive evaluation and testing of nitric oxide with very good response, the testing was repeated to study the effect of inhaled iloprost on pulmonary vascular resistance (PVR). An unexpected and severe increase of PVR was observed, rising from 392 dynes x s x cm(-5) with oxygen to a maximum of 1192 dynes x s x cm(-5) with oxygen and iloprost. Underlying ventilatory and technical problems were excluded. While inhaled iloprost has been described to be highly effective in the treatment of primary pulmonary hypertension, the possibility of contrary "paradoxical" reactions in isolated patients is emphasised, with a dramatic increase of PVR and a possible adverse outcome.

Administration, Inhalation↗
PubMed1996

Neurogenic lesions after posterolateral thoracotomy in young children.

In follow-up examinations of young patients we often noticed upward displacement of the left shoulder in cases where left-sided posterolateral thoracotomy had been carried out. Finding little discussion of this side-effect in the literature, we undertook the present study. The shoulder girdle of 69 patients who had undergone surgery for coarctation of the aorta between 1964 and 1984 was carefully examined to assess displacements and dysfunctions. In addition, in 24 of the patients electrodiagnostic examination was carried out of the associated muscles and nerves which were affected by the operation. We found disturbances of the muscular apparatus of the shoulder girdle in 80% of the cases: upward displacement of the shoulder (55%), downward displacement of the shoulder (8.7%), deviation of the scapula at rest (72.5%) and maximal elevated arms (40.6%), scapula alata (56.5%), and alterations of the posterior axillary line (39.1%). When considering only the cases of distinct upward or downward displacement of the shoulder, at least 25% of the operated children were affected. Children operated early (surgery during the first year of life) had more distinct alterations (47.6%) than those with later surgery (14.6%). Electromyographic examinations indicate that mainly disorders of the peripheral nerves caused by the operation led to these alterations of the shoulder girdle musculature. Although, except for one patient, no functional disorders were found, there were several cases in which the alteration caused quite severe cosmetic problems. One should pay more attention to positioning for surgery and do careful preparation to reduce these sequelae.

Age Factors↗
PubMedDate not supplied

Left-side pulmonary vein obstruction after arterial switch operation in infants with D-transposition of the great arteries.

We describe two cases of left-side pulmonary vein obstruction observed after the arterial switch operation (Jatene) for D-transposition of the great arteries. This appears to be related to left-sided pulmonary vein obstruction occurring coincidently with D-transposition of the great arteries, rather than a consequence of arterial switch operation.

Child, Preschool↗