PubMed Health⌕ Search

Biomedical subjects

O Pachinger

Publications and source records attributed to O Pachinger.

At least 37 records · Page 2Linked to original sources
PubMed1999

Short- and long-term outcomes of Wiktor stent implantation at low versus high pressures. Austrian Wiktor Stent Study Group.

A prospective, randomized, multicenter trial was conducted to evaluate whether high-pressure postdilation of the Wiktor stent provides short- and long-term benefits compared with the conventional low-pressure implantation technique. From June 1995 through May 1996, 181 patients were randomly assigned to either low-pressure (6 to 12 atm, group A, n = 94) Wiktor stent placement or to high-pressure postdilation (> or = 13 atm, group B, n = 87) after stent deployment. All patients were followed up clinically for 7 +/- 3 months, with an angiographic follow-up in 154 patients (85%). After stent implantation, neither minimal lumen diameter (MLD) nor percent diameter stenosis (%DS) differed significantly between the 2 groups (MLD, 2.8 +/- 0.5 vs 2.9 +/- 0.5 mm; %DS, 17 +/- 8% vs 16 +/- 9% for groups A and B, respectively). However, a trend toward a larger mean lumen diameter within the stent was observed in group B (3.3 +/- 0.6 vs 3.5 +/- 0.5 mm for groups A and B, respectively; difference between means 0.14 mm, 95% confidence interval -0.01 to 0.29, p = 0.08). Angiographic follow-up revealed similar MLD and %DS in both treatment groups (MLD, 2.1 +/- 0.7 vs 2.2 +/- 0.8 mm; %DS, 31 +/- 17% vs 30 +/- 24% for groups A and B, respectively, p = NS). Acute stent thrombosis occurred in 2 patients (1%) (1 patient in each group), and subacute thrombosis in 1 patient (0.6%) in group A. There was 1 death in group A, and target lesion restenosis (> or = 50% DS) was observed in 15% of patients with no differences between the groups. In conclusion, this study demonstrated favorable short- and long-term results of Wiktor stent implantation. Despite a trend toward additional initial lumen gain by high-pressure postdilation, this did not translate into a measurable improvement in long-term outcome.

Aged↗
PubMed1999

Thallium-201 gated single-photon emission tomography for the assessment of left ventricular ejection fraction and regional wall motion abnormalities in comparison with two-dimensional echocardiography.

Simultaneous assessment of myocardial perfusion and function by gated single-photon emission tomography (GS) after a single tracer injection provides incremental information and is feasible with technetium-99m sestamibi. The present study validated the use of GS with thallium-201 for the assessment of left ventricular ejection fraction (LVEF) and regional wall motion by comparison with two-dimensional (2D) echocardiography (echo), which has not been done before. After injection of 111 MBq 201Tl at peak bicycle exercise (n = 55) or pharmacological stress (n = 17), GS was acquired 15 (post stress) and 120 min post injection (rest) on a double-head camera. An automatic algorithm (QGS) was used for processing. Echo (Acuson Sequoia C256) was performed immediately after rest GS. LVEFs assessed by GS and echo were correlated. The overall and segmental sensitivity and specificity of GS for the detection of regional wall motion abnormalities (WMAs) were calculated, echo serving as the gold standard. Perfusion abnormalities were scored. The success rate of the automatic algorithm was 100%, and visually assessed image quality was good to excellent in 88% of cases. Post-stress and rest LVEF as assessed by GS were highly correlated (r = 0.91). Good correlations were obtained between post-stress LVEF (GS) and rest LVEF (echo) and between rest LVEF (GS) and rest LVEF (echo) (r = 0.76 and 0.86 respectively). In patients with a reduced LVEF of less than 50% (n = 23), these correlations were even better (r = 0.84 and 0.89 respectively). Regional wall motion abnormalities (WMAs) were identified by GS with high sensitivity and specificity (88%-100% and 82%-98% respectively) and were directly related to the extent and severity of stress as well as of resting perfusion defects. It is concluded that GS with 201Tl is a feasible and reliable tool for the evaluation of patients with compromised left ventricular function in the context of coronary artery disease, and thus improves diagnosis and prognostic stratification. Regional WMAs were identified with high diagnostic accuracy and the method may prove helpful for the detection of myocardial viability.

Female↗
PubMed1998

[Effects of limited mouth opening capacity (trismus) on lung function].

In the present study pulmonary function test data were obtained from 15 healthy volunteers and 15 patients with slightly impaired ventilation during both normal and maximally reduced opening of the mouth (trismus, intercuspid position). The aim of the study was to examine the effects of complete trismus on pulmonary function using objective and subjective parameters. In maximally reduced mouth opening, both groups showed an impairment of all subjective and objective pulmonary function test data. In healthy volunteers, the significant changes in the test data (p < 0.05) simulated mild to moderate pulmonary impairment, whereas patients with an already impaired pulmonary function showed a marked deterioration of their initial respiratory condition. The results of the subjective and objective parameters examined indicate that an intercuspid position (trismus) further aggravates pulmonary functional impairments. Complete trismus can be considered a risk factor to pulmonary function in patients using mouth-breathing as primary or supportive mode of respiration.

Adult↗
PubMed1998

[AL amyloidosis--a hematologic disease with initial cardiac manifestation. 2 case reports].

Cardiac involvement in AL-amyloidosis due to a multiple myeloma is present in up to 90% of cases. We present two patients with cardiac symptoms in whom a hematologic disease could be diagnosed because of suspicious cardiac finding. The leading symptom was dyspnea. The routinely performed laboratory tests, especially the erythrocyte sedimentation rate and the electrophoresis, were normal. After exclusion of coronary artery disease an infiltrative cardiomyopathy was suspected because of the echocardiographic examination with marked left ventricular hypertrophy, the restrictive flow pattern at the mitral valve and the electrocardiogram with a low voltage in limb leads and absent R waves in left precordial leads. Further, hematologic workup confirmed the production of light chains due to a myeloma. If the echocardiographic examination and the electrocardiogram raises the suspicion of an infiltrative cardiomyopathy as the cause of dyspnea, an immunofixation should be done in spite of normal laboratory tests to confirm or rule out the presence of a light chain disease due to a myeloma.

Amyloid↗
PubMed1997

[Pathophysiological mechanisms of the renin-angiotensin system and its pharmacologic modification by ACE inhibitors or angiotensin II (type 1) receptor blockers in cardiovascular diseases].

As a net effect of ACE-inhibitors and AT1-receptor antagonists on the renin-angiotensin system (RAS) cardioprotection due to vasodilative (reduction of blood pressure, afterload reduction), antiproliferative (reduced cell growth, reduction of "vascular" and/or "ventricular remodeling", reduced formation of extracellular matrix), as well as antiadrenergic actions and due to the stimulating effect on natriuresis, reduction of blood pressure, preload reduction can be expected. These aims of therapy have mostly been confirmed for the action of ACE-inhibitors by experimental and clinical studies but except for the treatment of arterial hypertension and few preliminary reports concerning the treatment of cardiac dysfunction, no comparable data are available for AT1-receptor antagonists. To date, an antithrombotic and profibrinolytic action could only be demonstrated for ACE-inhibitors. This effect has been discussed to be responsible for the improvement of long-term prognosis in patients with coronary artery disease. Despite the similar spectrum of action there exist important differences between ACE-inhibitors and AT1-receptor antagonists that might underline the need of an individual use of these drugs: the dual action of ACE-inhibitors on the RAS and the kinin system bears many benefits but has been also shown to be accompanied by side-effects, mainly chronic dry cough, in a relatively high percentage of patients thus leading to discontinuation of therapy in 8-14%. This respective side-effect can be prevented by the use of AT1-receptor antagonists. It has been discussed whether the incomplete action of ACE-inhibitors on AT1-receptor-mediated effects is at least in part responsible for the efficacy of this drug which is relatively high (75-80%) as compared to other substances. Due to their direct action, AT1-receptor-blockers might also be of high effectiveness for the treatment of severe heart failure. A combination of the ACE-inhibitor-mediated activation of the kinin-system with the more specific blockade of AT1-receptors by AT1-receptor antagonists might be of benefit and is currently under investigation. Finally, it has been discussed that the increased AT II concentration in case of AT1-receptor-blockade activates AT2-receptor-mediated mechanisms thus leading to an additive vasoprotective effect.

Angiotensin Receptor Antagonists↗
PubMed1996

[Ventricular septal rupture after blunt chest trauma].

HISTORY AND CLINICAL FINDINGS: Case 1: a 20-year-old previously healthy man sustained multiple nonvascular injuries without visible chest trauma in a car accident. Four days later a loud systolic murmur was heard over the heart. Case 2: a 21-year-old man similarly sustained in a car accident multiple injuries without visible chest involvement but causing haemorrhagic shock. A loud systolic heart murmur was heard and after shock treatment he developed left heart failure requiring catecholamine infusions. INVESTIGATIONS: Echocardiography demonstrated posttraumatic ventricular septal rupture in both patients. Cardiac catheterisation revealed a small left to right (1 : 1.6) shunt in case 1, and a large one, 1 : 3, with markedly elevated pulmonary artery pressure in case 2. COURSE: In case 1, no treatment was needed as the intracardiac shunt was small and there were no symptoms. But in case 2 the large shunt with pulmonary hypertension required operative closure with a Dacron patch 2 days after the diagnosis had been established. CONCLUSION: Ventricular septal rupture after blunt trauma to the chest is a rare occurrence. Even though in general the prognosis is good, a large intracardiac shunt may require early surgical repair.

Accidents, Traffic↗
PubMed1996

Clinical presentation of rupture of the left-ventricular free wall after myocardial infarction: report of five cases with successful surgical repair.

Rupture of the left-ventricular free wall may not always result in immediate irreversible hemodynamic collapse. We report a series of five patients (4 male, 1 female; age 59-79 years) successfully operated for postinfarction free-wall rupture with good long-term results. Two patients presented with syncopy and acute tamponade three days after an acute myocardial infarction. In two patients with atypical chest pain and congestive heart failure, a large pericardial effusion and an extreme localized thinning of a myocardial scar region was seen several weeks after an uncomplicated myocardial infarct. In one patient a pseudoaneurysm was detected, which developed asymptomatically within three weeks after a posterior myocardial infarct. In all cases myocardial rupture was suspected after an echocardiographic examination. At surgery a hemopericardium and a localized rupture site were found. The surgical procedure included closure of the defect by direct suture or patch, CABG in 3 cases, and mitral valve replacement in one patient. The postoperative course was uneventful, only one patient needed IABP for 24 hours. Three patients returned to NYHA functional class I, one patient to class II, and one patient to class III. The latter patient died of heart failure 17 months postoperatively, and the other patients are still alive 4,18,24, and 26 months postoperatively. Thus clinical representation of left-ventricular free-wall rupture after myocardial infarction can be highly variable. But close cooperation between experienced echocardiographers and surgeons may allow successful corrections with good long term-results.

Aged↗
PubMed1996

[Dentogenic sources of infection in patients with awaiting heart valve replacement].

The detection of all teeth with periapical pathological conditions and optimal treatment of the affected teeth are a part of the evaluation program for patients who are scheduled to undergo cardiac value replacement. 48 patients (50 value replacement operations) were evaluated for the incidence of periapical pathological conditions, as well as for the different kinds of oral surgical interventions. A periapical pathological condition was present in 28 of 48 patients (58.3%). In general, the incidence of a dental focus was significantly higher in patients awaiting aortic valve replacement than in patients undergoing mitral valve replacement (69.7% vs. 23.1%; p < 0.01). Patients for aortic valve replacement presented significantly more periapical pathological conditions than patients for mitral valve replacement (1.7 vs. 0.8). Optimal timing of dental consultations is helpful in the oral rehabilitation of patients about to undergo a valve replacement procedure. Furthermore, close interdisciplinary cooperation is necessary to minimize the social and psychological problems following unexpected tooth extractions. Cardiologists and heart surgeons have an important role in the organisation of the oral rehabilitation of patients undergoing valve replacement procedures.

Adult↗
PubMed1996

[Comparison between ambulatory 24-hour blood pressure measurement and occasional blood pressure measurement in hemodialysis patients with left heart hypertrophy].

Since 24-hour blood pressure monitoring seems to be superior to occasional blood pressure measurement as far as risk stratification is concerned, we compared the two methods in patients with secondary hypertension and left ventricular hypertrophy. In 26 haemodialysis patients (12 male, mean age 54 +/- 13 years), the mean occasional blood pressure values during haemodialysis were 147 +/- 18/82 +/- 9 mmHg, the mean 24-hour blood pressure values were 145 +/- 21/ 85 +/- 13 mmHg, during the day 145 +/- 23/86 +/- 13, during the night 143 +/- 25/81 +/- 13 mmHg. The nocturnal reduction of mean blood pressure was -3.6 +/- 7%. Both methods of blood pressure monitoring showed a significant correlation with the relevant echocardiographic parameters of left ventricular hypertrophy, cardiac mass and interventricular septum diameter. Patients with and without a nocturnal reduction in blood pressure could not be differentiated by the mean occasional blood pressure values. Therefore, 24 h ambulatory blood pressure monitoring seems warranted in this high risk group, especially to monitor antihypertensive drug therapy.

Adult↗
PubMed1996

Short-term frequency and time domain analysis of heart rate variability in type I diabetic subjects.

Assessment of heart rate variability as a measure of sympathovagal balance has proven useful in the risk stratification of patients with coronary artery disease. Since diabetic subjects with autonomic neuropathy, carrying a high risk of cardiovascular events, have been shown to have reduced heart rate variability, we performed a short-term (600 RR-intervals) frequency and time domain analysis in type I diabetic subjects. 19 patients without clinical signs of autonomic neuropathy were compared with 11 age- and sex-matched control persons. At a comparable cycle length, diabetic subjects differed significantly from healthy controls in all calculated time domain parameters (standard deviation: 41 +/- 23 vs. 66 +/- 17 ms, p = 0.005; root mean square successive difference of normal RR-intervals: 25 +/- 17 vs. 41 +/- 17 ms, p = 0.02) and frequency domain parameters (low frequency: 58 +/- 67 vs. 158 +/- 97 ms2, p = 0.002; high frequency: 29 +/- 42 vs. 85 +/- 96 ms2, p = 0.03). Thus, short-term frequency and time domain analysis of heart rate variability can be used easily and quickly in an outpatient setting for estimation of changes in the sympathovagal balance in diabetic subjects. However, the prognostic significance and the influence of drugs on impaired heart rate variability in diabetic subjects have yet to be determined.

Adolescent↗
PubMed1996

[Inhibition of the renin-angiotensin system: ACE inhibitors and angiotensin II receptor blockers].

The renin-angiotensin system (RAS) plays an important role in blood pressure regulation and fluid homeostasis in people with and without hypertension. The ACE-inhibitors were the first of the RAS blocking agents to have a wide clinical acceptance. Several trials demonstrated their usefulness in the treatment of essential hypertension, congestive heart failure, post myocardial infarction and diabetic renal disease. The recent development of selective angiotensin II type 1 receptor II blockers offers the compelling concept of interfering on the receptor level without disruption of the prostaglandin and bradykinin biosystems. Losartan, the prototype of orally active angiotensin II type 1 receptor antagonists, has been shown to be safe and effective in control of elevated blood pressure and improvement of the abnormal hemodynamics in the patient with congestive heart failure. These early encouraging results have to be confirmed by studies translating the circulatory benefits into augmented end-organ protection and prolongation of life.

Angiotensin Receptor Antagonists↗
PubMed1996

[Ostium stenosis of the left coronary artery after aortic valve replacement--2 case reports].

The development of left main coronary artery stenosis is a rare complication arising after aortic valve replacement. We report the different clinical course of two cases. One patient developed typical exertional angina 3 months after uneventful aortica valve replacement. Coronary stenosis had been excluded on preoperative coronary angiography. One day before hospital admission for coronary angiography the patient died suddenly. The second patient reported symptoms typical of angina 6 months after aortic valve replacement. Coronary angiography revealed critical left coronary ostial stenosis, which was successfully treated by surgical revascularization. These cases demonstrate the rare, yet potentially fatal complication of left coronary ostial stenosis. Early coronary angiography seems warranted in the event of typical exertional angina, even after angiographic exclusion of relevant coronary artery stenosis before aortic valve replacement.

Aortic Valve Stenosis↗
PubMed1995

[Peripheral cranial nerve paralysis as a sequela of operations of the carotid artery].

265 carotid endarterectomies in 210 patients (all vein patch in the carotid bifurcation) were investigated postoperatively for the presence and reversibility of cranial nerve palsy especially for N. facialis, N. hypoglossus, and N. vagus paresis. Additionally, the anatomical relationship between the affected cranial nerve and the carotid artery and the influence of surgical case load on the incidence of cranial nerve paresis were investigated. Altogether 28 (10.5%) cranial nerve injuries were registered. In 6 (2.2%) cases the hypoglossus nerve was injured, in 13 (4.9%) the vagal nerve (N. laryngeus recurrens) and in 9 (3.4%) facial nerve paresis occurred. Cranial nerves VII and X, which are not directly connected with the area operated on, show significantly more injuries than the hypoglossal nerve (p < 0.01), which is located closer to the carotid artery. Significantly lower rates of cranial nerve injuries (p < 0.01) were recorded in cases operated on by surgeons with greater experience (> 30 cases) than by surgeons with a case load below this threshold. Although different reasons for cranial nerve injuries such as direct pressure, retraction or edema are known, all pareses show an excellent spontaneous recovery rate within the period of one year.

Aged↗
PubMed1994

Statistical analysis of invasive cardiology for Austria in 1992 as an approach to quality assessment.

Quality Control in Interventional Cardiology requires perfect documentation. We, therefore, report a mutual controlling system, which has been initiated in Austria 3 years ago. An all round inquiry within all the 28 Austrian catheterization laboratories was successful with a feedback rate of 100%, controlled by visiting the centers, random tests, and several phone calls. This year was the first time that an entire European country followed the guidelines for statistical documentation that the European Society of Cardiology has suggested. Within the year 1992, 3,780 percutaneous coronary angioplasties were performed in Austria, which is 19.7% more, compared to the year before. At the same time 18,806 coronary angiographies, 102 percutaneous valvuloplasties, and 138 electrophysiological ablations took place. Austria reached 84% of the number of angiographies and 50% of the percutaneous transluminal coronary angioplasty (PTCA) numbers, the World Health Organization (WHO) has provided for a country of 7.82 million inhabitants. One hundred and fifty-two "new devices" (stent/n = 89, atherectomy/n = 44, laser/n = 6, etc.) were used during this year, which was 4.0% of all PTCA procedures. Angioscopy (n = 11) and intracoronary ultrasound (n = 82) accounted for another 2.5% of "new devices". Complication rate was 0.48% hospital deaths, 0.93% emergency bypass surgery, and 1.88% myocardial infarction in 3,780 PTCAs. The individual data of each center were treated confidentially and anonymously and the evaluated questionnaire was sent back to the respective center only, including an individual recommendation for quality improvement.(ABSTRACT TRUNCATED AT 250 WORDS)

Angiography↗
PubMed1994

The influence of ACE-inhibition on myocardial mass and diastolic function in chronic hemodialysis patients with adequate control of blood pressure.

The objectives of this study were to evaluate the specific effect of the ACE-inhibitor lisinopril on myocardial mass and diastolic function in uremic patients using a protocol designed to leave blood pressure unchanged. Nineteen hemodialysis patients (7 males; mean age: 55 +/- 13 years; mean time on dialysis: 44 +/- 35 months) received lisinopril for 6 months in addition to their preexistent antihypertensive treatment regimens (mean: 1.4 +/- 0.8 drugs). Doses of antihypertensive drugs were adjusted to keep both systolic and diastolic blood pressure stable. Nine patients were withdrawn from lisinopril treatment after 43 +/- 33 days because of hypotension (n = 4), withdrawn consent (n = 3), stroke (n = 1) and cough (n = 1). Seven of them were further studied as controls. Ten patients received 6.4 +/- 4 mg lisinopril as a mean for 6 months. Mean myocardial mass, calculated by M-mode echocardiography, was 324 +/- 103 g before, and 313 +/- 79 g after 6 months of lisinopril treatment. In the control patients, myocardial mass was 318 +/- 110 g initially, and after 6 months, it was 334 +/- 159 g. Early and late transmitral diastolic flow velocities were not significantly influenced by lisinopril. Throughout the study, both the systolic and diastolic 24-h mean blood pressure levels remained stable (systolic: before: 145 +/- 19 mmHg, at 6 months: 147 +/- 17 mmHg; diastolic: before: 87 +/- 12 mmHg, at 6 months 87 +/- 10 mmHg). Thus, no specific effect of lisinopril on regression of myocardial hypertrophy or improvement of diastolic function could be observed within a 6-month period in this small group of hemodialysis patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Antihypertensive Agents↗
PubMed1994

The influence of aortic valve prosthesis diameter on the reversibility of pulmonary hypertension in isolated aortic stenosis.

Patients with pulmonary artery hypertension in the late course of isolated aortic stenosis are considered to have a poor prognosis. The aim of the following study was to determine the incidence of pulmonary artery hypertension, the postoperative course after valve replacement and the reversibility of pulmonary hypertension dependent on the valve prosthesis diameter. Seventy-six consecutive patients with symptomatic aortic stenosis undergoing isolated aortic valve replacement were studied. Preoperative right and retrograde left heart catheterization was performed in the cardiac catheterization laboratory. Three days after valve replacement, hemodynamic evaluation was repeated by a Swan-Gantz catheter. Patients with preoperative pulmonary hypertension (systolic pulmonary artery pressure > 30 mmHg, n = 53) differed significantly from patients without pulmonary hypertension (n = 23) with respect to systolic pulmonary pressure (52.4 +/- 17 vs. 24.3 +/- 4 mmHg), pulmonary capillary wedge pressure (22.3 +/- 10 vs. 8.8 +/- 2, p < 0.001), left ventricular end diastolic pressure (29.6 +/- 13 vs. 21.4 +/- 11) and valve area (0.64 +/- 0.10 vs. 0.79 +/- 0.11 cm2, p < 0.05). No difference was found with respect to age, maximum systolic transvalvular aortic gradient or cardiac output. Following valve replacement, the two groups did not differ significantly in fatal (2/53 vs. 1/23 or non-fatal (14/53 vs. 5/23) complications. In patients with pulmonary hypertension, systolic pulmonary pressure decreased from 52.4 +/- 17 to 38.9 +/- 6, diastolic pressure from 24.7 +/- 9 to 12.6 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3, pulmonary capillary wedge pressure from 22.3 +/- 10 to 12.1 +/- 3 mmHg.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗