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P Hanrath

Publications and source records attributed to P Hanrath.

At least 19 recordsLinked to original sources
PubMed1995

Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus.

BACKGROUND: The standard surgical approach to hypertrophic obstructive cardiomyopathy (HOCM) was modified in the present series with a combination of extended myectomy with partial excision and mobilization of the papillary muscles. METHODS AND RESULTS: Between 1979 and 1992, 58 patients (38 men and 20 women; mean age, 49 +/- 24 years) with HOCM were operated on with the use of this different technique. Their intraventricular gradients were 79 +/- 33 (+/- SD) mm Hg at rest and increased to 147 +/- 48 mm Hg with provocative maneuvers. Mild-to-moderate mitral regurgitation was present in 60% of the patients, and severe regurgitation was present in 5%. Ten patients required additional aortocoronary bypass graft surgery. Follow-up (mean, 84 months) was complete (100%). Hemodynamic improvement was documented by a significant (P < .01) decrease in left ventricular end-diastolic pressure from 19 +/- 9 to 14 +/- 6 mm Hg and reduction of basal outflow tract gradients to 5 +/- 7 mm Hg at rest and 16 +/- 24 mm Hg after provocation. Late mortality was 1.4% per patient-year, and no sudden cardiac deaths occurred during follow-up. Functional status was excellent for 84% of the patients; 8 patients were in New York Heart Association functional class III, and none were in class IV. Echocardiography revealed no outflow tract obstruction. CONCLUSIONS: Extended myectomy and reconstruction of the subvalvular mitral apparatus in HOCM result in excellent functional improvement with relief of outflow tract obstruction. The technique can be performed safely despite its more aggressive surgical nature and allows an individualized strategy depending on the patient's extent and distribution of left ventricular hypertrophy.

Adolescent↗
PubMed1995

Incremental value of biplane and multiplane transesophageal echocardiography for the assessment of active infective endocarditis.

In 41 patients with clinical evidence of active infective endocarditis, transesophageal echocardiography was performed in a stepwise manner, starting with evaluation of the monoplane views, followed by the longitudinal plane, and finally by the intermediate planes. Number, location, length, area, density, extent, and mobility of vegetations and abscesses were assessed in the monoplane, biplane, and best intermediate planes to identify and quantify the incremental value of the longitudinal and intermediate planes. Eighty-three vegetations and 6 abscesses were found. In 4 patients (10%) monoplane evaluation yielded false-negative results. There were no false-negative results using the biplane evaluation. However, when compared with multiplane evaluation, additional vegetations were missed in 23% of patients after monoplane and in 9% of patients after biplane evaluation. Three abscesses were missed using the monoplane and 1 was missed using the biplane technique. The area was underestimated in 60% of all vegetations (mean underestimation, 37% +/- 23% [SD] of maximal area) and length in 49% of cases (mean underestimation, 38% +/- 23% [SD] of maximal length) of all vegetations when biplane was compared with multiplane evaluation. Also, with monoplane and biplane evaluation, mobility and density were misinterpreted in 6% and 5% and 17% and 9% of all vegetations, respectively. Thus, multiplane transesophageal echocardiography is more accurate than the monoplane and biplane techniques in assessing patients with active infective endocarditis.

Abscess↗
PubMed1995

Effect of captopril on myocardial beta-adrenoceptor density and Gi alpha-proteins in patients with mild to moderate heart failure due to dilated cardiomyopathy.

In end-stage heart failure due to idiopathic dilated cardiomyopathy beta 1-adrenoceptors are downregulated and Gi alpha-proteins are upregulated. The aim of the present study was to investigate the influence of the angiotensin-converting enzyme inhibitor captopril on beta-adrenoceptor density and Gi alpha-proteins in sequential endomyocardial biopsies. Nineteen patients with mild to moderate congestive heart failure due to idiopathic dilated cardiomyopathy (NYHA Class II-III) were studied before and after 8-11 weeks of therapy. Patients were randomised into a captopril and a control group; 9 patients received captopril 12.5-50 mg per day, (divided in 2-3 doses) p.o. in addition to "conventional" therapy with digoxin and diuretics, and 10 controls received "conventional" therapy only. Echocardiography, spiroergometry, right heart catheterisation and endomyocardial biopsies were performed before (baseline) and after treatment. Compared to baseline, captopril increased total beta-adrenoceptor density by selectively increasing beta 1-adrenoceptors (31.6 vs 41.2 fmol.mg-1; p < 0.05) but had no significant effect on Gi alpha-proteins. The results indicate that treatment with angiotensin-converting enzyme inhibitors partly restores myocardial beta 1-adrenoceptor density, and this action effect may contribute to the clinical improvement of patients with idiopathic dilated cardiomyopathy treated in this way.

Adenosine Diphosphate Ribose↗
PubMed1995

Effects of blood pressure reduction on the elastic profile of the aortic tree in patients with coronary heart disease.

Decreased arterial compliance of large arteries in coronary heart disease has been reported. Using intravascular ultrasound it was demonstrated that arterial compliance decreases with increasing distance from the heart. Until now changes in the elastic profile have not been investigated after a stepwise blood pressure (BP) reduction induced by antihypertensive agents. The local viscoelastic properties of the aortic tree were analyzed before and after a mean arterial BP reduction of about 5 and 15 mm Hg below baseline by the steady-state infusion of increasing doses of nisoldipine in 15 patients with coronary artery disease. Intravascular ultrasound imaging combined with arterial pressure measurements were performed at five sites along the aortic tree to determine the viscoelastic profile before nisoldipine administration and again after the 5 and 15 mm Hg nisoldipine-induced blood pressure reductions. The elasticity parameters varied depending on the distance from the heart and on the BP level. At both BP reduction levels nisoldipine infusion led to an increase in arterial compliance at the abdominal aorta and at the aortic bifurcation. A dissociation between the 5 and the 15 mm Hg BP reduction was found at the common iliac artery and at the external iliac artery. Our results provide direct quantitative evidence that stepwise BP reductions exhibit different and, in part, contrary effects on the elastic profile, depending on the aortic tree location. The results also suggest that nisoldipine infusion can significantly ameliorate local viscoelastic properties at the abdominal aorta and at the aortic bifurcation, an effect that was associated or caused by a change in BP attributable to a decrease in peripheral resistance.

Adult↗
PubMed1995

Preexcitation in hypertrophic cardiomyopathy: a case of a fasciculoventricular Mahaim fiber.

A patient with hypertrophic cardiomyopathy (HCM) who presented with preexcitation pattern on the surface ECG suggestive of the Wolff-Parkinson-White (WPW) syndrome is described. Intracardiac electrophysiological study revealed a fixed anomalous QRS complex and a short-fixed His-ventricular interval indicating a fasciculoventricular Mahaim fiber. As this specific form of accessory connection does not cause reentrant tachycardias, no treatment was required. It is important to distinguish this entity from atriofascicular or nodoventricular Mahaim fibers or the WPW syndrome in patients with HCM showing a preexcitation pattern in the surface ECG, as these may cause life-threatening arrhythmias in this patient population.

Adult↗
PubMed1995

Occurrence of transcranial Doppler high-intensity transient signals in patients with potential cardiac sources of embolism. A prospective study.

BACKGROUND AND PURPOSE: Cerebral emboli can be recognized by typical "high-intensity transient signals" (HITS) in the transcranial Doppler (TCD) spectral curves. Patients with potential cardiac sources of embolism are at higher risk for stroke. METHODS: We examined the frequency of HITS in the left middle cerebral artery (MCA) with TCD over periods of 30 minutes in 100 patients having potential cardiac sources of embolism, as indicated by transthoracic or transesophageal echocardiography. RESULTS: Thirty-six (36%) of the patients presented with HITS. Sex, age, sufficient anticoagulation level, antiplatelet therapy, neurological symptoms, and a history of thrombosis had no influence on the prevalence and number of HITS. The patients with a single echocardiographic diagnosis were separated into eight echocardiographically defined groups: patients with (1) atrial fibrillation, (2) coronary artery disease plus ejection fraction of more than 30% including at least three wall segments of hypokinesia/akinesia, (3) coronary artery disease with less than 30% ejection fraction, (4) dilated cardiomyopathy, (5) infectious endocarditis, (6) aortic stenosis, (7) mitral stenosis, and (8) patent foramen ovale. A significant difference in HITS occurrence could not be found in any of the defined groups. Only patients with infectious endocarditis showed a tendency for a higher HITS prevalence. CONCLUSIONS: HITS are common phenomena in patients with potential cardiac sources of embolism. The clinical relevance of these HITS remains unclear.

Adolescent↗
PubMed1995

[Beta receptor blockers in chronic heart failure].

Recently published data of the controlled MDC- and CIBIS-trials confirm the favorable effect of beta-blocker therapy on the hemodynamics and clinical course of patients with chronic heart failure due to dilatated and/or ischemic cardiomyopathy. However, mortality remains unchanged. The mechanisms by which beta-blocker therapy improves hemodynamics in chronic heart failure are not known reliably. It is postulated that the negative chronotropic effect of beta-blockers improves the cellular calcium metabolism and thereby increases myocardial contractility. Further effects of beta-blockers are protection of myocardial cells from enhanced catecholamine concentrations. This prevents cell necrosis and economizes the use of cell energy. The reversion of down-regulation of beta-1-receptors in beta-blocker therapy is most probably only an epiphenomenon. Major randomized clinical trials are ongoing to investigate whether improved hemodynamics and clinical course are correlated with decreased mortality. It also still remains open which substance is most beneficial (e.g., selective beta-blockers, beta-blockers with additional vasodilatatory effect).

Adrenergic beta-Antagonists↗
PubMed1995

[Chronic frequency-adaptive pacemaker therapy in patients with heart failure].

Twenty patients (complete AV block n = 13, sick sinus syndrome n = 4 (replacement of a VVI system), bradyarrhythmia n = 3) with rate-adaptive pacemakers (respiration volume guided n = 10, QT-driven n = 1, dual sensor (QT/activity) system n = 9) were randomly assessed by ergospirometry after 4 weeks of VVI- (70 bpm), VVIR1-(70-110 bpm, low upper rate) and VVIR2-pacing (70-130 bpm, high upper rate). Oxygen uptake (VO2), work load (W), and heart rate were determined at peak exercise (max) and at the anaerobic threshold (AT). In the whole population, rate adaptation led to a significantly higher VO2-max than VVI-pacing for both VVIR1- (15.5 +/- 5.1/12.6 +/- 4.1 ml/kg/min, 28 +/- 37%, p < 0.01) and VVIR2-pacing (14.8 +/- 4.4/12.6 +/- 4.1 ml/kg/min, 20 +/- 23%, p < 0.01). At the AT, however, VO2 was significantly improved only by the VVIR1 mode (low upper rate, 9.8 +/- 2.5/8.0 +/- 2.1 ml/kg/min, 28 +/- 36%, p < 0.01). Regarding only patients with moderately limited exercise capacities (Weber class C, n = 11), rate adaptive VVIR1 and VVIR2 pacing could not produce a significant increase of VO2-max and VO2-AT. In contrast, patients with severely reduced exercise capacities (Weber class D, n = 9) significantly profited from the rate adaptation, but only in the VVIR1 mode (VO2-max 48 +/- 45%, VO2-AT 51 +/- 38%, p < 0.01). Thus, in the whole population an increase of oxygen uptake and of exercise workload at the anaerobic threshold could only be achieved by pacing with the low upper rate of 110 bpm. By this, particularly patients with heart failure and a severely limited exercise tolerance (Weber D) had a significant benefit. Therefore, the upper rate should be programmed in a lower range in patients with heart failure, at least for rate-adaptive ventricular pacemaker systems.

Aged↗
PubMed1995

[Three-dimensional reconstruction of heart valves].

The reconstruction of three-dimensional data sets from two-dimensional echocardiographic images offers several fundamental advantages: 1. more complete data than present in the few standard 2D-view; 2. off-line generation of any desired plane, cut, or perspective after the data set has been acquired; 3. access to quantitative parameters like surface areas (e.g., of valve leaflets or portions of leaflets), volumes, and others, without geometric assumptions. The mitral valve has been the focus of several studies using various techniques of reconstruction of transthoracic or transesophageal images. These studies have shown the mitral annulus to be a non-planar, "saddle-shaped" structure, with an average distance of highest to lowest points of 14 mm in normals. This recognition of mitral annular non-planarity has led to a more stringent echocardiographic definition of mitral valve prolapse. Further studies have shown systolic shrinkage of mitral annular area by about 30% and systolic apico-basal translation of the annulus by approximately 1 cm in normals. In patients with dilated cardiomyopathy, the annulus is flattened, and both cyclic change in annular area and apico-basal translation are significantly reduced. 3D-studies of the left ventricular outflow tract in hypertrophic obstructive cardiomyopathy allow measurement of outflow tract and leaflet surface areas and dynamic spatial visualization of systolic anterior motion of the anterior mitral leaflet. Automated techniques to reconstruct the full grey value data set from a high number of parallel or rotational transesophageal planes allow impressive visualization of normal and diseased mitral and aortic valves or valve prostheses, with special emphasis on generating "surgical" views and perspectives, which cannot be obtained by conventional tomographic imaging.(ABSTRACT TRUNCATED AT 250 WORDS)

Aortic Valve↗
PubMed1995

[3-dimensional reconstruction of multiplanar transesophageal echocardiography images: a methodologic report with case examples].

First experience with the dynamic three-dimensional reconstruction of transesophageal echocardiographic images in more than 100 patients with various cardiac diseases are reported. Ninety different two-dimensional image planes were acquired for each reconstruction using a conventional multiplanar transducer, connected to a stepper motor and controlled by a computer-based image acquisition system with special software. Acquisition time for one data set was 2.3 +/- 0.9 min, and calculation time to achieve three-dimensional images was 20-45 min. Several cardiac structures were reconstructed and analyzed qualitatively and quantitatively (measurements of distances and areas, volume calculation by Simpson's rule). Image sequences showing three-dimensional depth by gray scale modification were generated. After image acquisition one can select any desired cut plane to achieve perspectives that cannot be obtained by two-dimensional technique. Advantages of three-dimensional echocardiography are the display and potential quantification of pathomorphology of the left ventricle and mitral valve, atrial septal defects, intracardiac masses (i.e., myxomas, vegetations), and direct spatial imaging of complex congenital heart diseases. In principle, three-dimensional data sets have advantages for the quantitative evaluation of irregular formed cardiac structures, since the three-dimensional data set is more complete than cross-sections used in conventional two-dimensional echocardiography. Currently, however, these advantages are limited by the necessity of human interaction to segment the structures of interest.

Adolescent↗
PubMed1995

[Improved evaluation of prosthetic heart valve regurgitation with multiplanar transesophageal echocardiography].

UNLABELLED: To study the value of the newly introduced multiplane transesophageal transducer technology for the assessment of prosthetic valve regurgitation, 63 consecutive patients with 35 mitral and 33 aortic prostheses (23 bioprostheses and 45 mechanical prostheses) were examined. Transvalvular, paravalvular, and, in mechanical valves, normal or pathological transvalvular regurgitation were identified using first 0 degrees (transverse) and 90 degrees (longitudinal) planes combined with flexion of the echoscope tip and then additionally using multiple intermediary planes by transducer rotation. In a subgroup of 20 patients interobserver variability was evaluated. Both methods showed regurgitation in 56/58 valves; one additional case of regurgitation was seen by multiplane imaging only. However, there were 19 cases of regurgitation not clearly classifiable by biplane technique compared to only three using multiplane technique. Grading of severity was concordant by both modalities in 66 and discordant in only two cases. Observers disagreed on severity in 2/20 cases based on biplane imaging, but in none based on multiplane imaging; classification of regurgitation differed in 6/20 biplane and 1/20 multiplane images respectively. CONCLUSION: Multiplane transesophageal imaging improves classification of prosthetic regurgitation, but has little effect on severity grading.

Adult↗
PubMed1995

[The management of adolescents and adults with congenital heart defects: 3 years experiences with interdisciplinary consultation].

UNLABELLED: Since September 1991, 204 patients (pts), 109 male and 95 female, mean age 27.3 +/- 10.6 years, were followed in a newly established interdisciplinary outpatient clinic combining both adult and pediatric cardiologists. 61 pts predominantly presented with left-to-right shunt congenital heart disease (CHD), 32 with valvar CHD, 20 with aortic coarctation, 23 with complex acyanotic, and 49 with cyanotic CHD. The population included 19 pts with Marfan syndrome. 106 pts had had previous cardiac surgery, 32 of them with up to three reoperations. Deficits and needs in medical and social care were analyzed in 100 pts using a standardized questionnaire at the time of first examination: One-third of pts were not or only incompletely informed about their CHD, previous surgical procedures and need for antibiotic prophylaxis of endocarditis. Only a minority of pts had had vocational advice (34%) or counseling concerning contraception (40%) or pregnancy (30%). Cardiac catheterization was performed in 37 pts (18%) after being first seen in our outpatient clinic, followed by a primary surgical intervention in 19 and reoperation in eight cases. Overall, 30 pts (15%) underwent surgery (28) or interventional procedures (one closure of the arterial duct, one AV node ablation after Mustard-operation) as a consequence of admission to our unit. Successful late Fontan operations were performed in four adults aged 21 to 35 years. There was 1/30 postoperative death (M. Ebstein, thrombosis of the mechanical prosthesis). The population includes five pts with severe pulmonary vascular disease (one waiting for lung transplantation) and two pts with pulmonary artery arborisation malformations not amenable to surgery. CONCLUSION: In a population of 204 adolescents and adults with CHD, we clearly found deficits in medical and social care and, in addition, an unexpected high percentage of necessary invasive investigations (18%) and surgical or interventional procedures (15%). Interdisciplinary management of these patients is mandatory combining the special facilities of adult and pediatric cardiologists.

Activities of Daily Living↗
PubMed1995

[Shock].

Explore the source record for details and available documents.

Humans↗
PubMed1995

[High-frequency current ablation of a Mahaim fiber at the tricuspid annulus].

The Mahaim syndrome is a rare variant of accessory pathways. Typically, a normal surface ECG and paroxysmal tachycardias with left bundle branch block morphology are found. The anatomic correlate is an atrioventricular or atriofascicular fiber with decremental conduction properties. Criteria for intracardiac mapping of the atrial insertion of such a fiber include: 1) maximal preexcitation and a short stimulus-QRS interval with differential pacing from the atrial aspect of the tricuspid annulus, and 2) recording of an accessory pathway potential ("M" potential). We report a case of a patient that underwent successful radiofrequency ablation of a Mahaim fiber at the tricuspid annulus.

Bundle-Branch Block↗
PubMed1995

Three-dimensional reconstruction of cardiac structures from transesophageal echocardiography.

Although tomographic imaging has been very successful in cardiology,the quantitation of volumes, surfaces, and masses,as well as understanding of complex morphologies would improve by three-dimensional imaging. This review focuses on approaches to 3-D reconstruction from transesophageal echocardiography. In the past, several attempts using either stepwise parallel translation or stepwise rotation of the transducer have been made. In vitro and, to a limited extent, in vivo studies have confirmed high accuracy in calculating left ventricular volumes in such manner. Complex cardiac structures and their motion, such as the mitral annulus, mitral leaflets, atrial septal defects, and others have been reconstructed from patient studies. Although potentially a powerful tool for cardiac imaging with promising quantitation capabilities, progress is needed in particular in the field of border detection to make 3-D imaging practical enough for clinical use.

Computer Graphics↗
PubMed1994

Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.

The prevalence of a patent foramen ovale was assessed by simultaneously performing transesophageal contrast echocardiography and transcranial contrast Doppler sonography (TCD) in 137 subjects (mean age 36 years) with stroke of unclarified etiology (n = 41), clarified etiology (n = 33), and in normal subjects (n = 63; mean age 32 years). Patent foramen ovale was found significantly more often in patients with unclarified than clarified strokes or in normal subjects (66% vs 33%, or 43%). Massive paradoxical embolism through a patent foramen ovale, identified by TCD, occurred significantly (p < 0.01) more often in patients with unclarified (64%) than clarified (27%) strokes or in normal subjects (3%). However, minimal shunts were typical in normal subjects (79%). Patent foramen ovale was detected indirectly by TCD when calculated on the basis of transesophageal contrast echocardiographic findings (sensitivity 89%, specificity 92%). Thus, TCD reliably detects paradoxical cerebral embolism through a patent foramen ovale, and provides important additional information for evaluating its clinical relevance by semi-quantification of embolic contrast material.

Adult↗
PubMed1994

Comparison of thallium-201 single-photon emission tomography after rest injection and fluorodeoxyglucose positron emission tomography for assessment of myocardial viability in patients with chronic coronary artery disease.

This prospective study in 42 patients with chronic coronary artery disease and severe wall motion abnormalities (sWMA) on cineventriculography (24 patients with previous myocardial infarction; ejection fraction, 45% +/- 13%) was designed to compare myocardial thallium-201 uptake after rest injection and normalized fluorodeoxyglucose (18FDG) uptake (after oral glucose load) for assessment of a rest 201Tl protocol to evaluate myocardial viability. The left ventricle was divided into the supply territory of the left anterior descending coronary artery (LAD) and the lateral wall and posterior territory (inferior, posterior and posteroseptal segments) because of the high variability of left circumflex and right coronary artery supply territories. Segmental 201Tl uptake in single-photon emission tomography (SPET) and segmental normalized 18FDG uptake (13 segments per patient) showed a close linear relationship in the LAD territory (r = 0.79) and in the lateral wall (r = 0.77), while the correlation in the posterior territory was considerably lower (r = 0.52). 201Tl/18FDG concordance was defined as an 18FDG uptake exceeding 201Tl uptake by < 20%. Discordance was assumed if 18FDG exceeded 201Tl uptake by at least 20%. Concordant results were shown by 81% (439/541) of segments. In segments with severe 201Tl reduction (< or = 50% of peak, n = 78) discordance was observed in 10% of segments in the LAD territory and lateral wall (n = 62) and in 44% of segments in the posterior territory (n = 16).(ABSTRACT TRUNCATED AT 250 WORDS)

Artifacts↗