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Biomedical subjects

N G Meijne

Publications and source records attributed to N G Meijne.

At least 19 recordsLinked to original sources
PubMed1991

[Rupture of the intra-aortic balloon during mechanically assisted circulation].

An intra-aortic balloon pump catheter may be used for mechanical support of insufficient heart function. A possible complication is rupture of this balloon. In the last few years, a substantial increase of such ruptures has been observed. In the period between 1 January 1989 and 30 September 1990, 14 balloon ruptures in 10 patients were seen in the University Medical Centre of Amsterdam. The total number of patients treated with an intra-aortic balloon in that period was 101. In most cases the balloon rupture was revealed by the appearance of blood in the connecting tube of the balloon catheter. Rupture frequency was twice as high in females as in males. In none of the patients was the rupture followed by clinical signs of gas embolism. Most ruptures occurred in the distal part of the balloon near or in the abdominal aorta. At examination of the balloons it was found that all perforations had occurred in an area that was scraped, probably by a calcium plaque. The fact that balloon ruptures nowadays occur more often than formerly is probably due to the fact that more patients are operated at advanced ages, with a long history of disease and more aortic sclerosis.

Adult↗
PubMed1987

Myocardial metabolism, catecholamine balance, and left ventricular function during coronary artery surgery: effects of nitroprusside and nifedipine.

The effects of nitroprusside and nifedipine on myocardial oxygen consumption (MVO2), catecholamine release, and left ventricular (LV) function (using 2D transesophageal echocardiography) were compared. Thirty-seven patients undergoing coronary artery surgery, anesthetized with fentanyl, 100 micrograms/kg, were studied. All had good LV function and had been receiving long-term oral beta-blocking therapy. Patients were randomly allocated to one of three groups. Group C (n = 12) received no vasodilator and served as control. Group S (n = 13) received nitroprusside at an initial rate of 1 microgram/kg/min. Group N (n = 12) received nifedipine at an initial rate of 0.7 microgram/kg/min. Baseline measurements were obtained ten minutes after intubation. Vasodilator therapy was then started in groups S and N. Infusion rates were adjusted to maintain systolic blood pressure (SBP) between 80% and 120% of baseline values. Additional measurements were made ten minutes after the start of the infusion, ie, before surgery (in group C immediately before surgery), and after sternotomy when the pericardium was opened. The mean (+/- SD) total dose requirements were 1.9 +/- 0.5 micrograms/kg/min for nitroprusside and 1.1 +/- 0.2 micrograms/kg/min for nifedipine. The mean (+/- SD) total infusion time was 31 +/- 5 minutes for nitroprusside and 32 +/- 11 minutes for nifedipine. After sternotomy, heart rate increased in all groups. At this time arterial blood pressure and systemic vascular resistance (SVR) increased in group C. SVR was decreased after the first ten minutes of nitroprusside infusion and after sternotomy in group S. Coronary sinus blood flow, MVO2, and myocardial norepinephrine release increased in group N, but not in groups C or S. After sternotomy, LV percentage area reduction increased in groups S and N, but not in group C. In group N there was a significant correlation (r = 0.65; P less than .05) between the increases in MVO2 and LV percentage area reduction, an estimate of myocardial function. Lactate production occurred in two patients in group C after sternotomy. This was not associated with ECG changes, but in one patient regional wall motion abnormalities developed. No evidence of myocardial ischemia was observed in groups S and N. However, in contrast to nitroprusside, the use of nifedipine was associated with increases in MVO2, myocardial norepinephrine release, and inotropy.

Blood Pressure↗
PubMed1983

The definition of myocardial infarction during aortocoronary bypass surgery.

In a study of 392 aortocoronary bypass (CABG) patients, we found 16 patients with a postoperative new Q wave, 29 patients with new intraventricular conduction disturbance, 17 patients with cardiogenic shock, and 14 patients with excessive CK-MB activity. Those criteria were considered as diagnostic of perioperative acute myocardial infarction (AMI). Listing the 392 patients in a Venn diagram: five patients had three positive criteria, eight had two, 43 had one, and 336 had none. Ventricular arrhythmia, supraventricular arrhythmia, or ST-T changes occurred in decreasing frequency in patients with a decreasing number of positive criteria. Five patients died postoperatively and in four a postmortem examination was available. Diagnostic criteria partly predicted autopsy findings. We conclude that the diagnostic criteria of perioperative myocardial infarction have a low diagnostic performance.

Adult↗
PubMed1983

Risk of operative mortality in surgery for coronary heart disease (a multiple regression analysis of perioperative hemodynamic and electrocardiographic data).

Using multiple regression analysis, we examined perioperative hemodynamic and electrocardiographic variables as predictors of operative mortality in surgery for coronary heart disease. Data were first analyzed as univariates and, if significantly related to mortality, they were subjected to stepwise logistic multivariate regression analysis. The preoperative predictor variables were: heart rate, ventricular arrhythmia and ST-T shift. The intraoperative predictor variables were: ventricular arrhythmia and ST-T shifts; and the postoperative predictor variables were: left ventricular stroke work index, blood pressure, mixed venous oxygen content and intrapulmonary shunt. When only electrocardiographic data were analyzed, the preoperative variables were: ventricular arrhythmia, ST-T shift and anterior wall infarction. The intraoperative variables were: ventricular arrhythmia and ST-T shift. The postoperative electrocardiogram did not give additional information. The common denominator of the relevant hemodynamic and electrocardiographic variables appears to be an accumulation of pre- and perioperative myocardial damage, which leads to operative mortality.

Cardiac Surgical Procedures↗
PubMed1982

Myocardial protection with cold cardioplegia in a patient with cold autoagglutinins and hemolysins.

A technique is described for providing myocardial protection with cold potassium crystalloid cardioplegia in a patient with cold autoagglutinins and hemolysins. The patient was only mildly cooled systemically. The coronary system was perfused with a normothermic cardioplegic solution to remove the blood before the cold cardioplegia was started. The heart was rewarmed with a normothermic cardioplegic solution before the blood was reintroduced. With this technique, the patient underwent an uneventful coronary bypass operation.

Aged↗
PubMed1978

[Surgical interruption of the accessory pathway in a case of WPW-syndrome with persistent supraventricular tachycardia provoked by sinus node suppression (author's transl)].

This is a case report of a 60-year-old woman with a WPW-syndrome Type A developing persistent supraventricular tachycardia refractory to medical treatment. The re-entry mechanism was based on av-junction escape beats leading to retrograde conduction through the accessory pathway in presence of sinus node dysfunction i.e. long periods of sinus arrest probably enhanced through antiarrhythmic drug therapy and/or digitalis. With the aid of electrophysiological examinations and intraoperative epicardial mapping the accessory pathway was located in the upper lateral region of the left ventricle and interrupted by an incision in the av-groove from inside of the lfet atrium. Although an additional accessory pathway, not interrupted by surgery was suggested by the postoperative electrophysiological study, the patient remained free from tachycardia over more than 18 months, except for one episode terminated promptly by overdrive pacing from the right atrium. Postoperatively sinus bradycardia and av-junctional escape rhythm prevailed.

Accessory Nerve↗
PubMed1975

Results of aortic valve replacement with the Starr-Edwards and Björk-Shiley prostheses.

A study has been made of the last 50 patients subjected to aortic valve replacement with a Starr-Edwards or a Björk-Shiley prosthesis. The surgical mortality was 6%, the late mortality was 4%. Postoperatively the vast majority of the patients were symptom-free. Paravalvular leakage was believed to be present in two patients, both of them free from symptoms.

Adolescent↗