[The intramural esophageal hematoma].
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Biomedical subjects
Publications and source records attributed to N Goebel.
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A correlation was attempted in 106 patients with myocardial insufficiency between linear and volume parameters of the laevocardiogram and the corresponding parameters on plain chest films, as well as between pressure measurements and the degree of pulmonary congestion. Measurements on the plain radiograph provide only limited information on the function of the myocardium and the severity of myocardial lesion respectively. Nevertheless, they are of some value during the course of the disease.
The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.
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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.
Between 1968 and 1977 5000 angiocardiographies revealed an aneurysm of the membranous septum (AMS) in 20 patients. In 11 patients the AMS was accompanied by a usually minor ventricular septal defect, in 4 by aortic valve disease, in 3 by coronary heart disease and in the remainder by some other rare heart disease. The diagnosis of AMS was established by angiocardiography, but in 3 patients it was detected by echocardiography. In one case a sepsis lenta with cerebral embolization was observed.
An echinococcus cyst in the ventricular septum is described, which produced an infundibular pulmonary stenosis. Following angiography, surgical intervention could be accurately planned and proved successful. The incidence, course, radiological features and diagnosis of cardiac echinococcus are reviewed.
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Three patients with coronary fistulae are described, including one patient with a rare coronary-pulmonary double fistula. The clinical features, diagnostic aspects and radiological signs are reviewed.