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Biomedical subjects

M Lengyel

Publications and source records attributed to M Lengyel.

At least 19 recordsLinked to original sources
PubMed1992

[Clinical use of biplane transesophageal echocardiography].

The clinical value of biplane transesophageal echocardiography (TEE) was assessed on basis of the experience of the first 100 cases. All studies were performed in awake patients, there was no complication or failure. There wee 43 males and 57 females, aged between 13 and 82 years. The indication of TEE was infective endocarditis in 33, congenital heart disease in 25, suspected tumor or thrombus in 18, search for source of embolism in 9, thoracic aortic pathology in 9, prosthetic valve dysfunction in 3 and other problems in 3 cases. Biplane technique provided additional information as compared to single plane TEE in the diagnosis of infective endocarditis (by the visualization of small vegetations and of mitral valve fenestration, and by the differentiation of mitral vegetation from prolapse or aneurysm), in the identification of source of embolism (by easier visualization of patent foramen ovale and of the left atrial appendage thrombus), in the imaging of ascending aorta, of right ventricular outflow tract and of the left ventricular endocardium. Biplane technique enhanced therapeutic decision making particularly in the indications of anticoagulant treatment and in planning certain cardiac operations. Biplane TEE is an easily acquired technique and it will replace single plane TEE in a number of indications.

Adolescent↗
PubMed1992

[Delayed diagnosis of infectious endocarditis].

Three cases are presented to show examples of mistakes in the diagnosis and treatment of infective endocarditis which led to serious complications. The role of echocardiography in the early diagnosis and in the recognition of complications, the importance of bacteriologic diagnosis in the choice of antibiotic treatment and the need of timely surgical treatment are emphasized.

Adult↗
PubMed1992

Regression of cardiac hypertrophy in hypertensive patients by long-term treatment with isradipine.

The aim of this study was to assess the effects of long-term (9-month) treatment with isradipine, alone or combined with bopindolol, on blood pressure, left ventricular hypertrophy (LVH), and diastolic function. Thirty-five hypertensive patients with LVH and supine diastolic blood pressures (DBPs) greater than or equal to 100 and less than or equal to 120 mm Hg received increasing doses of isradipine (1.25, 2.5, and 5 mg twice daily); if blood pressure was not controlled, bopindolol (0.5-2 mg once daily) was added to the treatment. Clinical and laboratory investigations were carried out after placebo for baseline values, and after 5 and 9 months of isradipine treatment alone (n = 11) or combined with bopindolol (n = 24). At the end of the study, blood pressure was significantly decreased while heart rate did not change with isradipine alone, but decreased significantly after the addition of bopindolol. Although the DBP was normalized (less than or equal to 90 mm Hg) in 28 patients (80%), complete reversal of the left ventricular mass index (LVMI) was seen in only 7 patients (20%). The ratio of early to atrial filling did not change, but the deceleration time was significantly decreased after 9 months. No laboratory abnormalities or important side effects were observed. Although isradipine alone or combined with bopindolol was effective in controlling blood pressure and significantly reduced the LVMI after 5 months, improvement in diastolic function was seen only after 9 months of active treatment.

Adolescent↗
PubMed1991

[The role of transesophageal echocardiography in atrial septal defect detected in adults].

UNLABELLED: To assess the value of combined transesophageal echocardiography (TE) and transthoracic echocardiography (TTE) in the preoperative evaluation of atrial septal defect (ASD) 59 consecutive patients (aged 15-62, mean 38 yrs) with clinically or echocardiographically suspected ASD underwent TE and complete noninvasive hemodynamic study by TTE. ASD was found by TE in 48: fossa ovalis (FO) type in 36, sinus venosus (SV) type in 11 and primum type in 1. For FO and SV defect the sensitivity of clinical judgement was 83 and 0%, the specificity 39 and 100% resp., the sensitivity of TTE was 78 and 9%, the specificity 78 and 100%. The most frequently associated anomaly by TE was mitral valve prolapse (25%). SV defect was always associated with anomalous right upper pulmonary venous drainage, and left superior vena cava was found in 27% of SV defects. There was significant correlation between Qp/Qs measured by TTE and by catheterization (r = 0.64), but the Qp/Qs was not related to defect size. An excellent correlation was found between pulmonary artery systolic pressure measured by CW Doppler and catheterization (r = 0.98). IN CONCLUSION: 1) TTE combined with TE is reliable in the preoperative assessment of ASD in adults, 2) TE is not necessary if there are unequivocal clinical and TTE signs of an FO defect with significant left-to-right shunt, 3) TE is indicated in patients with signs of right ventricular overload or pulmonary hypertension if an ASD cannot be ruled out by TTE, 4) catheterization is necessary if all 4 pulmonary veins cannot be visualized by TE.

Adolescent↗
PubMed1991

[Hypereosinophilia syndrome of unknown origin].

The authors describe the case of a 19-year-old man with hypereosinophilic syndrome. At first the clinical picture suggested a localized eosinophilic gastrointestinal disease which rapidly progressed to the fatal disseminated form. The spectrum of hypereosinophilic syndrome is discussed and current thoughts on diagnosis, pathology and treatment presented.

Adult↗
PubMed1990

[Clinical use of transesophageal echocardiography].

Transoesophageal echocardiography (TE) presents a new window in echocardiography. Experience obtained in the first 70 TE studies performed in 66 patients is reported. The patients' age ranged between 15 and 75 years, there were 36 females and 30 males. Sixty studies were done in awake patients and 10 studies in anesthetized or intubated patients. TE indications included suspected mitral prosthetic valve dysfunction: 20, tumor or thrombus: 11, search for source of embolism: 10, infective endocarditis: 5, congenital heart disease: 8, intraoperative decision-making: 7, acute postoperative hypotension: 3, suspected aortic dissection: 3 and others. There was no unsuccessful intubation or complication. The most important results: the differentiation of left atrial tumor and thrombus by the presence or absence of spontaneous echocontrast, the role of TE in the intraoperative and early postoperative decision making and the diagnosis in rare clinical situations (multiplex myxoma; tricuspid prosthetic valvular regurgitation caused by pacemaker electrode dislocation). It is concluded that TE is a unique diagnostic technique which provides invaluable clinical informations and facilitates therapeutic decision making. It is a safe procedure both in awake and anesthetized patients therefore in certain indications it should supplement standard echocardiographic technique in routine clinical practice.

Echocardiography↗
PubMed1990

[Diagnosis and treatment of thromboembolic diseases of the right heart].

Right heart thrombosis (RHT) was found by 2D-echocardiography in 8 cases. Clinical suspicion of RHT could be documented in only 3 patients, while in the other 5 cases syncope, low output syndrome, essential pulmonary hypertension, cerebral embolism or congestive heart failure was the clinical diagnosis on first presentation. Out of the 4 cases of mobile RHT of extracardiac origin 1 patient had an emergency operation, 2 patients died shortly after the 2D-echo diagnosis before treatment could have been started and 1 patient improved on anticoagulant treatment. RHT of intracardiac origin was due to a central line or a ventriculoatrial shunt in 3 cases and no source could be found in 1 patient. Complete recovery was achieved in 2 cases by medical, in one case by surgical management and in 1 patient medical and surgical treatment resulted in clinical improvement. In conclusion authors 1. consider 2D echocardiography necessary in the clinical setting of acute or chronic pulmonary embolism or "primary" pulmonary hypertension and 2. they recommend emergency operation in case of mobile large RHT detected by 2D-echocardiography.

Adult↗
PubMed1990

[A case of surgically treated septum perforation associated with acute myocardial infarct].

The authors present the case-history of an elderly female patient with acute myocardial infarction complicated by ventricular septal defect (VSD). She was operated on in order the VSD to be corrected but--probably because of sutural insufficiency--it temporarily reopened, later closed spontaneously. The significance of certain tests in the differential diagnosis of systolic murmur after acute myocardial infarction is discussed, and the importance of these findings compared to the clinical picture is emphasized.

Aged↗
PubMed1990

[Diagnosis of femoral pseudoaneurysm using 2-dimensional and Doppler echography].

Femoral artery pseudoaneurysm was found by combined 2D, pulsed and continuous wave Doppler echography in 10 out of 16 patients with hematoma formation following cardiac catheterization. The typical features included an echofree area communicating with the femoral artery through a narrow neck. There was a low velocity systolic flow in the pseudoaneurysm and a high velocity systolic and reverse diastolic flow in the neck.

Aneurysm↗
PubMed1989

[Heart tumors in adults].

Together with an overview of classification and incidence of cardiac tumors, author presents 31 cases of cardiac tumors diagnosed in adults by echocardiography during the last 15 years. Out of 24 myxoma cases 3 had an atypical echocardiographic appearance (small or non-prolapsing tumors) and there were 8 complex myxomas: it was multicentric in 3, localised outside the left atrium in 1, familiar in 1, it occurred below 40 years age in 1 and it was associated with an extracardiac tumor in 2 cases. There was no recurrence of the myxoma in any of the 20 survivors during the 5-6 year echocardiographic follow-up, other primary benign tumor was found in 1 patient, primary malignant tumors in 2 cases, secondary malignant tumors of the heart occurred in 4 cases. There were two unique cases: the primary mesothelioma of the pericardium and the rhabdomyosarcoma of the mitral valve.

Adult↗
PubMed1989

[Value of Doppler echocardiography in the indications for correction of tricuspid valve insufficiency in the course of mitral valve implantation].

To assess the postoperative reversibility of functional tricuspid regurgitation (FTR) and its relation to preoperative pulmonary artery systolic pressure (PASP) 103 patients were studied by Doppler echocardiography (DE) in whom at the time of mitral valve replacement the correction of the FTR was not considered to be necessary by the surgeon. Moderate or severe FTR was found in 36% of patients preoperatively, and it diminished or disappeared early after operation if the preoperative PASP was more than 60 mmHg, while the improvement of FTR was found only in the half of patients with PASP less than 60 mmHg. Persistent FTR was still unchanged in 7 of 10 patients at 1 year follow-up. It is concluded that DE should be performed prior to mitral valve replacement and severe FTR found by DE should be surgically treated even in case of negative surgical findings if the PASP is less than 60 mmHg.

Echocardiography, Doppler↗
PubMed1989

[The incidence of endocarditis caused by a prosthetic valve and its risk factors].

UNLABELLED: To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacement from January 1, 1981 through December 31, 1985, for 1 to 6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): p less than 0.25. PVE developed in 19 out of 329 patients with bioprostheses (5.8%) and in 8 out of 583 patients with mechanical valves (1.4%): p less than 0.005. Actuarially at 5 years follow-up 90.7% of the bioprosthetic group and 98.4% of the mechanical valve group was free of PVE (p less than 0.01). Bioprosthetic valve replacement in infective endocarditis further increased the risk of PVE compared to valve replacement by mechanical prostheses. IN CONCLUSION: in order of importance antecedent endocarditis, bioprostheses, male sex and aortic position are risk factors in the development of PVE. In patients requiring operation for infective endocarditis, mechanical valves are recommended. As the outcome of PVE is still very grave, authors stress the importance of prophylaxis, early diagnosis and timely operation.

Bioprosthesis↗
PubMed1989

Surgical treatment of infective endocarditis in the active stage.

The study summarizes the results of surgical treatment of active infective valvular endocarditis (IE) in two cardiac surgical centres in Hungary and the Soviet Union between 1969-1987. Most (92.9%) of the 241 patients operated on were in severe condition pre-operatively (NYHA Class III and IV), their mean age was 38.2 years. The infectious process was localized predominantly on the aortic valve (169 patients), and developed on previously normal valves in 151 patients. Hospital mortality was 17%, the underlying cause of death was often heart failure, sometimes associated with sepsis. Late mortality was 12.5% (25 patients), only six of these patients died of recurrent infection. The authors stress the high efficacy of surgical treatment of active valvular IE.

Actuarial Analysis↗
PubMed1988

Incidence and risk factors of prosthetic valve endocarditis.

UNLABELLED: To study the incidence and risk factors of prosthetic valve endocarditis (PVE) we followed 99.5% of 912 patients who had valve replacements from 1 January 1981 to 31 December 1985 for 1-6 (mean 3) years. PVE occurred in 27 patients (2.96% or 0.98% per patient-year). The incidence of PVE in the aortic position (3.9%) was significantly higher than in the mitral position (1.5%): chi-square = 6.1, P less than 0.025. PVE developed in 19 of 329 patients with bioprostheses (5.8%), and in 8 of 583 patients with mechanical valves (1.4%): chi-square = 14.48, P less than 0.005). Actuarially at 5-year follow-up, 90.7% +/- 2.16% of the bioprosthetic group and 98.4% +/- 0.56% of the mechanical valve group was free of PVE (P less than 0.001). Antecedent endocarditis increased both the incidence and relative risk of PVE 7-fold compared to patients without antecedent endocarditis (chi-square = 32.0, P less than 0.0001). Bioprosthetic valve replacement in infective endocarditis increased the risk of PVE 12-fold compared to valve replacement by mechanical prostheses. IN CONCLUSION: in the order of importance, antecedent endocarditis, bioprostheses and aortic position are risk factors in the development of PVE. Bioprostheses implanted in patients with antecedent endocarditis further enhance the risk of PVE.

Adolescent↗