PubMed Health⌕ Search

Biomedical subjects

M Rothlin

Publications and source records attributed to M Rothlin.

At least 19 recordsLinked to original sources
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

[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↗
PubMed1979

[Familial bradycardia: a family with sick sinus and atrioventricular block].

A kindred is described in which several members have evidence of sick sinus syndrome and of conduction disturbance. The data suggest that in this family the rhythm disturbances were transmitted as an autosomal dominant trait whose penetrance increase with age. The occurrence of Adams-Stokes episodes required pacemaker implantation in 6 patients. In one case the arrhythmia is associated with a cardiomyopathy of unknown origin. No pathological studies were conducted. In one case the His bundle electrogram was recorded.

Adams-Stokes Syndrome↗
PubMed1979

The effect of dopamine on hepatic-splanchnic blood flow after open heart surgery.

Dopamine (3,4 dihydroxyphenylethylamine) increases cardiac output and in particular the renal blood flow at the expense of other regional vascular beds not yet defined. Since the results of dopamine-induced changes in splanchnic perfusion are inconsistent, the effect of 6 mcg/kg/min dopamine was studied in 9 patients early after open heart surgery. Estimated hepatic blood flow (EHBF) was calculated from the concentration-time slopes of Indocyanine Green (ICG, Cardiogreen) in arterial and hepatic venous blood following single intravenous injection. Blood volume was measured using 51Cr tagged red cells. Cardiac output was determined according to the Fick method. 6 mcg/kg/min dopamine caused a mean EHBF-increase of 82%, from 492 +/- 64 to 824 +/- 80 ml/min/m2 (P less than 0.001). Related to the corresponding increase in cardiac index (CI) from 2.6 +/- 0.2 to 3.8 +/- 0.3 1/min/m2 (P less than 0.001), the EHBF/CI-ratio changed from 18.5 to 21.7% (P less than 0.025). The arterial-hepatic venous oxygen difference was reduced from 7.40 +/- 0.53 to 4.91 +/- 0.60 Vol% (P less than 0.001). It was concluded that splanchnic perfusion does not contribute to the preferential increase of renal blood flow under dopamine under the above mentioned conditions. Dopamine had the most beneficial effect on EHBF in two cases where the latter was severely reduced.

Adult↗
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↗
PubMed1979

Pre- and postoperative left ventricular contractile function in patients with aortic valve disease.

In 43 patients left ventricular micromanometry and cineangiography were performed preoperatively and and 20 months after aortic valve replacement. A score of left ventricular functional impairment, derived from 5 to 8 haemodynamic variables, was calculated as: number of pathological indices x 100/total number of determined indices. Preoperatively the score of left ventricular functional impairment amounted to 35 per cent in group 1 (aortic stenosis: n = 19), to 61 per cent in group 2 (combined lesion:n = 15) (P less than 0.05), and to 87 per cent in group 3 (aortic regurgitation: n = 9) (P less than 0.001). In contrast, the functional classification according to the NYHA showed similar impairment in the 3 groups. Postoperatively the score of left ventricular functional impairment decreased significantly in all 3 groups to 10, 16, and 27 per cent, respectively, but the score of group 3 remained raised (P less than 0.05) as compared with that of group 1. The patients with residual left ventricular dysfunction had a higher preoperative left ventricular muscle mass than the patients with normal or near normal postoperative left ventricular function. It is concluded that (1) at similar functional impairment according to the NYHA classification left ventricular contractile function is more severely impaired in aortic regurgitation and in aortic regurgitation + aortic stenosis than in aortic stenosis alone, (2) left ventricular function improves significantly after valve replacement in all three forms of aortic valve disease, (3) residual functional impairment is greater in aortic regurgitation than in aortic stenosis or aortic stenosis + aortic regurgitation, and (4) persistent postoperative left ventricular functional impairment is found in the patients with severe preoperative hypertrophy.

Adult↗
PubMed1978

[The Bjoerk-Shiley and the Lillehei-Kaster valve in aortal position. A hemodynamic comparison].

Thirty-two patients with tilting disc valves in the aortic position were evaluated by left heart catheterization and cineangiography. 24 patients had Björk-Shiley valves (B-S group) and 8 Lillehei-Kaster valves (L-K group). At the postoperative hemodynamic evaluation, left ventricular peak systolic pressure was significantly (p less than 0.001) higher in the L-K group (174 +/- 22 mm Hg) than in the B-S group (140 +/- 22 mm Hg). The mean systolic pressure gradient across the prosthesis was significantly (p less than 0.001) higher in the L-K group (34 mm Hg) than in the B-S group (12 mm Hg). The calculated valve area at a similar average tissue annulus diameter was significantly smaller in the L-K group (0.9 cm2) than in the B-S group (1.5 cm2). It is concluded (1) that in the aortic position at similar external prosthesis dimensions the B-S valve exhibits superior hemodynamic performance of the L-K valve and (2) that aortic valve replacement by L-K valve is associated with significant postoperative left ventricular pressure load.

Aortic Valve↗
PubMed1978

[Surgical treatment of active infective endocarditis (author's transl)].

Between 1965 and 1976 40 patients underwent valve replacement for active, infective endocarditis. The overall mortality rate was 32,5 per cent. Six patients died early (within 30 days) and 7 within the following 8 years. 11 patients developed paravalvular leckage. Eight of these 11 patients required reoperation. We suggest that all patients with active infective endocarditis who develop progressive heart failure, intractable sepsis or recurrent embolization should be subject to immediate valve replacement despite higher operative risk.

Adult↗
PubMed1977

[Surgical treatment of myocardial aneurysms. Indications and results].

The long term results of 95 left ventricular aneurysmectomies are presented. In 47 patients simultaneous aorto-coronary bypass surgery was performed. 53 patients presented preoperatively with congestive heart failure; 8 out of these died within the first postoperative month, while 5-year survival rate (actuarial method) was 52%. Two thirds of this patient group improved. None of the 42 patients without preoperative congestive heart failure died early. 5-year survival rate was 93% and subjective improvement was recorded in one half of this subgroup. Comparison of pre- and postoperative angiograms (40 patients) revealed an increase in left ventricular ejection fraction reflecting the removal of the non-contracting segment. The ejection fraction of the contracting segment of the left ventricle improved after aneurysmectomy, especially in patients with preoperative congestive heart failure. In conclusion, aneurysmectomy improves left ventricular function and the symptoms of heart failure; moreover, it prevents perforation of false aneurysms. Its effect on arrhythmias could not be determined conclusively. Angina may be improved by simultaneous aorto-coronary bypass surgery.

Angina Pectoris↗
PubMed1977

[Liver circulation during dopamine therapy].

Intravenous dopamine (4 and 8 microgram/kg/min) causes an increase of hepatic flow and cardiac index, while the ratio hepatic flow:cardiac index remains unchanged. The increase of renal flow after dopamine therefore does not occur at the expense of hepatic flow.

Cardiac Output↗
PubMed1977

[Hemolysis after aortic valve replacement (author's transl)].

Hemolysis after isolated aortic valve replacement using Björk-Shiley and Starr-Edwards (series 1260) prostheses as well as unstented Fascia-lata valves has been determined in 50 patients. A battery of hemathologic and blood-chemical tests were performed in all patients but LDH has proved to be the most reliable parameter. Survival of erythrocytes was measured in a small group of patients. Patients with Björk-Shiley prosthesis have shown lower average rate of hemolysis (LDH 201 IU, Haptoglobin 45 mg %) than patients with Starr-Edwards prosthesis (LDH 273 IU, Haptoglobin 35 mg %). When functioning regularly neither prosthesis results, however, in clinically significant hemolysis. In patients with unstented Fascia-lata valve the degree of hemolysis reflects directly the functional status of the valve.

Adult↗
PubMed1976

[Life expectancy and frequency of infarct after aorto-coronary bypass].

Survival rate and incidence of myocardial infarction after aortocoronary bypass operation in 274 patients are presented. Mortality was 5.1% within the first postoperative month and the 5-year-survival rate was 86%. There were 24 perioperative myocardial infarctions and another 21 infarctions over the next 5 years. Comparison of these data with the natural history of coronary heart disease suggests a possible prolongation of survival after bypass surgery. The incidence of myocardial infarction appears to be unchanged.

Angina Pectoris↗
PubMed1976

[Work load hemodynamics before and after aortocoronary bypass].

Left ventricular enddiastolic pressure (LVEDP) was studied during exercise in 22 patients pre- and postoperatively under an identical work load. 13 patients showed improvement of LVEDP (normalization in 5), LVEDP was unchanged in 5 (w.n.l. in 2), and had deteriorated in 4. These results suggest that improvement or normalization of LVEDP under exercise following aortocoronary bypass surgery can be assumed if there is complete revascularization, if all grafts are functioning well, if there is no progression of the underlying disease, and if preoperative LV angiography is normal or shows only ischemic (reversible) hypokinesis.

Angina Pectoris↗
PubMed1976

["Impending infarct". Clinical, ergometric and angiographic pre- and postoperative results in 12 emergency operated patients. Preliminary report].

Pre- and postoperative results are presented in 12 patients who underwent emergency aortocoronary bypass. Operative mortality was zero. 1 patient died 8 months after surgery. Postoperative follow-up averaged 12.5 months (2-37 months). Postoperatively, 7 patients were totally angina-free, 1 was considerably improved and 3 were unchanged.

Coronary Artery Bypass↗
PubMed1976

[Heart disease and pregnancy].

The normal cardiovascular adjustments to pregnancy and the hemodynamic disorders attendant on various acquired and congenital cardiac defects is pregnancy are reviewed. The incidence of the various cardiovascular complications during pregnancy is discussed in relation to each individual type of heart disease. The modern diagnostic and therapeutic possibilities offered by cardiology mean that an increasing number of patients with cardiac defects can look forward to safe pregnancy and childbirth.

Adaptation, Physiological↗
PubMed1976

[Surgery for atrial septal defect in patients over 40 years of age (author's transl)].

Between 1961 and 1972, 354 patients with atrial septal defect ware treated surgically. Of these 80 patients were aged over 40 years at the time of operation. The hospital mortality was 5%. 2 of these patients had a increased preoperative pulmonary artery systolic pressure (50-75 mmHg), the other 2 had a mitral or tricuspid incompetence. At late follow-up 82% of patients were symptomfree, 18% had slight clinical signs of breathlesness on exertion. The heart size decreased in 37 of 40 patients, the electrocardiographis signs of right ventricular hypertrophy in 23 patients. There was no influence on preexistant dysrhythmias by the operation. It is concluded that patients with atrial septal defect in this age group benefit from surgical closure of the defect.

Adult↗