Biomedical subjects
Publications and source records attributed to N Goebel.
False aneurysms of the left ventricle after myocardial infarction arae the result of perforation, which usually require early surgical treatment. The clinical features are not characteristic. The chest x-ray may provide important evidence for the diagnosis. Non-invasive diagnosis is possible by means of echocardiography and computer tomography; it is confirmed by angiocardiography. The authors experience with nine cases is described.
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In coronary angioplasty (PTCA) stenoses over 80% can usually be passed with very small catheters only. To pass stenoses with different catheters during one procedure may be dangerous because of dissection. We therefore developed an instrument with very small tip-diameter and two balloons of different diameters in series. In 9 cases primary success was achieved and the degree of stenoses reduced from 90% to 23%. The gradient was 58 mmHg and remained only 11 mmHg after PTCA. When used with caution, the advantage of this catheter in high degree coronary stenoses is obvious.
Pseudocoarctation is an anomaly of the aortic arch, in which the aorta extends abnormally far cranially and then passes caudally in a double curvature. At the level of the distal curvature the lumen is indentated in a variable extent. In contrast to coarctation, a hemodynamically relevant stenosis and a collateral circulation are absent. We have observed a pseudocoarctation in three adults. All three had a systolic ejection murmur. Pseudocoarctation was combined in three cases with a bicuspid aortic valve and left axis deviation in the ECG. Two cases had slight aortic valvular disease ad an aneurysm of the membranous septum with a left anterior hemiblock in the ECG. According to the chest x-rays the differential diagnosis includes especially coarctation, an aortic aneurysm and a tumor of the mediastinum. Isolated pseudocoarctation requires no specific treatment.
In a 25-year-old patient two large, peripherally calcified, cystic teratomas of the anterior mediastinum shifted and partially compressed the heart, the great vessels and the lung. An exact preoperative evaluation was possible with echocardiography and computerized tomography.
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After surgical resection in idiopathic hypertrophic subaortic stenosis, a ventricular septal defect was observed in one patient at a later date. The defects was closed in a second operation. - The hemodynamically relevant changes in the vascular bed of the lung with preoperative congestion and postoperative shunt found their expression in discrete changes only of the chest x-ray.
The shortterm results (mean follow-up 0.9 years) in 61 patients with single vessel disease (1-VD) who had undergone percutaneous transluminal coronary angioplasty (PTCA) were compared with those in 33 patients with 1-VD treated medically and in 36 patients with 1-VD treated by bypass surgery. All medically and surgically treated patients had coronary artery stenoses which were classified in a retrospective analysis as suitable for PTCA. Initially there were no significant differences between the three groups with respect to functional impairment (NYHA class), incidence of prior myocardial infarction, left ventricular ejection fraction and localization of the coronary stenoses. Comparison of follow-up results at the end of the first year showed (1) that the NYHA class was reduced to a similar extent both in patients treated surgically and in those treated by PTCA, (2) that the NYHA class in the medically treated group was significantly greater than in the other two groups, and (3), that there was no difference among the three groups with respect to infarct and mortality rate.
In a 53-year-old woman with cardiomegaly and atrial fibrillation, cineangiography revealed idiopathic enlargement of the right atrium and mitral valve prolapse. Two-dimensional echocardiography was carried out in the entire family, which lives in the northeastern part of Switzerland. In 2 of the 4 siblings of the proposita, idiopathic enlargement of the right atrium, mitral valve prolapse and supraventricular rhythm disturbances were found. In one child of the patient with the largest right atrium, idiopathic enlargement of the right atrium associated with mitral valve prolapse was also present. To our knowledge this is the first report on familial occurrence of idiopathic enlargement of the right atrium accompanied by mitral valve prolapse.
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Cranial and caudal projections are a simple method for improving the diagnosis of coronary stenoses. In 20 cases out of 100 unselected coronary angiograms, the cranial projection showed stenoses to be more severe than had been demonstrated by the standard projection, or revealed them for the first time.
Normally, systolic movement of the coronary arteries results in, 1) shortening in length, thereby increasing tortuosity, and 2) movement of the arteries towards each other. In ten patients with constrictive pericarditis, several sections of the vessels were fixed. Vascular fixation was also observed in nine out of ten patients after aorto-coronary bypass operations, but only in right ventricular branches. Decreased movement of the coronary arteries was found in occasional cases of congestive cardiomyopathy with large ventricles and reduced ejection fractions, and sometimes in akinesia of the myocardium, due to coronary sclerosis. Fixation of several coronary branches can therefore contribute to the diagnosis of constrictive pericarditis.
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Postoperative angiography was performed in 222 patients who had undergone aorto-coronary bypass grafting. Double sequential grafts show the highest patency rate (90%), followed by single (77%) and multiple (65%) sequential grafts.
92 patients with severe chronic aortic regurgitation underwent surgery between 1973 and 1977. Patients with coronary artery disease and significant postoperative prosthesis dysfunction were excluded from the study. The overall mortality during the follow-up (1.5-7 years, average 3.5 years) was 8.7%. It was not higher in patients undergoing reoperation or additional operation for aneurysm of the aorta ascendens. The preoperative left ventricular ejection fraction, end-diastolic volume index and end-diastolic pressure, and the cardiac index and cardio-thoracic ratio in chest roentgenogram, did not reliably predict a fatal late outcome. The late postoperative outcome in patients with severely impaired left ventricular ejection fraction (less than 40%), high enddiastolic pressure (greater than 25 mm Hg), low cardiac index (less than 2.2 l/min/m2) and high cardio-thoracic ratio (greater than 0.60) was not worse than in the entire group of patients. Higher postoperative mortality was seen only in patients with a severely elevated left ventricular end-diastolic volume index (greater than 220 ml/m2).
Percutaneous transluminal dilatation of an atherosclerotic stenosis of the superior mesenteric artery was done in a 65-year-old woman with abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation.