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Biomedical subjects

P Schmidt-Habelmann

Publications and source records attributed to P Schmidt-Habelmann.

At least 19 recordsLinked to original sources
PubMed1997

Results after surgical repair of Ebstein's anomaly.

BACKGROUND: Ebstein's anomaly of the tricuspid valve is a complex malformation. Various operations have been undertaken with varying results. Because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties. METHODS: Between April 1974 and February 1995, 60 patients with Ebstein's anomaly underwent surgical repair. Age ranged from 5 months to 54 years. In 56 patients (93.3%), tricuspid valvuloplasty was feasible, mainly by creating a monocusp valve with the single-stitch technique. The other 4 patients had valve replacement with a bioprosthesis. Six reoperations were necessary (10.0%): four valve replacements and two repeat valvuloplasties. RESULTS: There were two hospital deaths (3.3%) and a late mortality rate of 10.0% (6 patients). Forty-nine (94.2%) of 52 survivors were followed for 5 months to 18.6 years (median follow-up, 5.0 years; mean follow-up, 6.9 years). The actuarial survival rate (Kaplan-Meier) was 96.5% +/- 2.4% at 1 year and 83.3% +/- 5.6% at 18 years. At follow-up evaluation, nearly all patients showed substantial improvement (93.9% were in functional class I or II) compared with their preoperative status. Doppler echocardiographic studies demonstrated good tricuspid valve function in most patients. CONCLUSIONS: Valvuloplasty using the single-stitch technique is a rewarding operation. It yields good long-term results with substantial improvement in functional performance and clinical status.

Actuarial Analysis↗
PubMed1985

Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.

Bioprosthesis↗
PubMed1984

[Surgically correctable complications of myocardial infarct].

Coronary artery bypass grafting is a straightforward solution to the problem of myocardial ischemia secondary to coronary artery disease. More recently, the complexities of complications following myocardial infarction have been elucidated with respect to various aspects. Disastrous sequelae, such as rupture of the ventricular septum, the left ventricular wall and the papillary muscle, impose many intricacies on the inevitable surgical treatment; this form of cardiac surgery is still a tour de force. Life-threatening ventricular tachycardias due to transmural myocardial infarction and/or left ventricular aneurysm remain a surgical challenge. An attempt is made to delineate the current state of surgery for acute and chronic complications of myocardial infarction.

Aged↗
PubMed1982

Fibrin seal application. Clinical experience.

Clinical experience with fibrin gluing in cardiovascular surgery now extends over 4 years. The adhesive has been employed prophylactically for preclotting of prostheses or sealing of various suture lines including those of the bronchial system of infants. Together with collagen fleece it has turned out to be most effective for control of superficial bleeding due to adhesions or sources of bleeding difficult to reach. Two clinical examples are presented demonstrating the life-saving application of the collagen patch and fibrin gluing method.

Adult↗
PubMed1982

[Heart transplantation: successful treatment of postoperative complications. Case report with 19 months' follow-up].

In March, 1981, a 37-year old patient underwent cardiac transplantation, the first to be performed in Germany since 1969. Subsequent to the successful procedure, the patient has now been followed for more than 19 months. The indication for the intervention was established on the basis of endstage coronary artery disease. The operation was performed according to the technique of Lower and Shumway. Immunosuppression, in the early postoperative phase, was carried out with antithymocyte globulin, azathioprine and corticosteroids with administration oriented on the T-lymphocyte and total leukocyte counts as well as analysis of myocardial biopsies. In the late postoperative course, dosage of immunosuppressive agents was based almost exclusively on biopsy findings. Within the course of immunosuppressive therapy for cardiac transplantation, in particular, initial experience was gained with the use of antithymocyte globulin which was given in dosages of up to 12 mg/kg daily. The antithymocyte globulin proved effective for more than six weeks postoperatively. The alterations in immunosuppressive treatment necessitated by two gastrointestinal complications (perforated gastric ulcer, perforation of the small intestine) enabled a comparative analysis of the results of therapy with cyclosporin A given orally, intravascularly and intravenously. The Patient continues to be maintained on a regimen of cyclosporin A and corticosteroids and his general condition is good. For future cardiac transplantations, in the early postoperative course, alternating treatment with antithymocyte globulin, azathioprine and corticosteroids, on the one hand, with cyclosporin A and corticosteroids, on the other hand, would seem meaningful both to minimize adverse reactions as well as to provide effective immunosuppression. The experience rendered would promise to facilitate management of patients after cardiac transplantation.

Adolescent↗
PubMed1981

Results of valvuloplasty for Ebstein's anomaly.

Sixteen patients, 8 males and 8 females were referred for surgery with the diagnosis of Ebstein's malformation of the tricuspid valve. The intervention was necessary because of deterioration of the clinical status. The age of the patients at the time of surgery ranged from 4 to 51 years. In 11 patients valvuloplasty was performed, in 5 patients the tricuspid valve was replaced with a bioprosthesis. One patient, with end-stage disease prior to surgery, died 2 days postoperatively rendering total mortality at 6.25%. Subsequent follow-up ranging from 8 months to 8 years was uneventful in the 15 survivors. Only 2 patients showed evidence of dysrhythmias, and demonstrated cardiothoracic ratios greater than 0.65. Cardiac catheterization in 3 patients, at one or 5 months postoperatively revealed normal pressure in the right heart. Provided the anterior tricuspid leaflet is of adequate size, surgical repair of Ebstein's anomaly through valvuloplasty appears to be feasible. The valvuloplasty consists of forming a monocusp valve with the anterior leaflet and plicating the atrialized portion of the right ventricle.

Adolescent↗
PubMed1980

Surgical treatment of transposition of the great arteries.

Between 1974 and 1979 171 patients with d-TGA were treated surgically, 109 had correcting operations. 77 patients with simple TGA had hemodynamic correction by atrial inversion techniques. 30 day survival rate was 96%. There were 3 late deaths. One patient had reoperation for superior vena cava obstruction. The methods of diagnosis, indication of surgery and the surgical procedure are described. Results of the Mustard technique (33 patients) technique in infants less than 2 years of age with simple TGA. Mortality was one patient in each group. The incidence of arrhythmia was greater with the senning technique. Better growth potential of the atria with the Senning technique warrants further use of this method.

Adolescent↗
PubMed1978

[Three years experience with biological heart valve prostheses (author's transl)].

Increasing clinical experience has led to a world wide expansion of glutaraldehyde fixed aortic heterografts for valve replacement in patients. The distinct advantage of this valve is a very low rate of thrombembolic complications during the postoperative course. In our hospital 324 such prostheses of the types Hancock and Carpentier have been implanted in 290 patients. In 154 cases follow-up 6 months to 3 years after the operation have been obtained. Thrombembolic complications occured in 1,4%. Other postoperative complications were hepatitis (13,4%), and valvular endocarditis (1,5%). Postoperative control of patients after isolated mitral or aortic valve replacement revealed improved clinical conditions in 90,9%. Dysfunctions of the valve have not been observed. For aortic valve replacement prostheses of a diameter of 27 and 29 mm have been used. In mitral and tricuspid position generally size 31 mm and 33 mm valves were implanted. The decision to use glutaraldehyde fixed biological valves requires the observation of long time results demonstrating reliable mechanical stability of such valves for some decades.

Aortic Valve↗
PubMed1978

[Surgery in newborns and infants with cyanotic cardiac malformations: indication and technique of emergency operations and urgent early surgical interventions (author's transl)].

Between April 1974 and September 1977, 368 infants underwent surgery at the German Heart Center. 287 were less than 1 year of age, and 81 were between the ages of one and two years. In 90 patients (= 24.4%) surgery was necessary because of cyanotic lesions. Within this group corrective procedures were performed in 36 infants during the first year of life, and in 33 during the second year of life, while palliative measures were carried out in these age groups in 15 and 6 infants, respectively. Urgent corrective surgery is indicated as a life-saving measure in neonates with total anomalous pulmonary venous connection (TAPVC) since this lesion is not amenable to either medical nor palliative interventions. Of 10 neonates and young infants who underwent corrective surgery for TAPVC, 3 died during the early post-operative period and 1 subsequently. Balloon atrial septostomy palliatively employed for transposition of the great arteries (TGA) may render only temporary improvement in the clinical status of young infants. In these infants, more favourable results can be achieved through early, functionally-corrective surgery (Mustard-Brom procedure). In 7 infants who underwent correction of TGA during the first year of life there was 1 post-operative death. There was no post-operative mortality in 18 infants whose age at the time of operation was between 1 and 2 years. In the presence of TGA combined with ventricular septal defect there were 3 deaths in 8 infants operated on during the first year of life and none in the 3 who underwent surgery during the second year of life. In the same age groups, early correction of tetralogy of Fallot (TOF) was performed in 11 infants (with 2 deaths) and in 10 infants (with one death), respectively. Thus, in the absence of preclusive, complex anomalies, early surgical correction of congenital cyanotic lesions in young infants consistently yields results superior to that of palliation or two-stage procedures.

Age Factors↗
PubMed1977

[Intraoperative control of revascularisation and indication for reintervention (author's transl)].

Among the procedures of intraoperative control of revascularisation the simple method of probe passage for determination of technical mistakes during anastomoses is very valuable. More informative is the measurement of bypass-flow using an electromagnetic flowmeter. We compared this method with the results of intraoperative angiography, which is performed in our hospital routinely for immediate control of revascularisation. A comparison of 214 veins demonstrated a good statistically significant correlation between run-off and bypass-flow. The quality of the anastomosis can only be judged by intraoperative angiography and does not correlate with a low bypass flow. According to these measurements it was necessary in four cases to perfrom an intraoperative reintervention.

Angiography↗
PubMed1976

[Open-heart surgery during deep hypothermia in infancy].

A total of 47 infants (2,7 to 9,6 kg in weight, 3 days to 21 months of age, 89% under one year) underwent early total correction of severe congenital heart defects in profound hypothermia of about 22degreesC and circulatory arrest (11 to 64 minutes). 8 patients were operated upon without extracorporeal circulation (ECC) (mortality 63%). 37 infants were additionally cooled and rewarmed with ECC (mortality 22%). The most common diagnosis were: Total atrioventricular canal (11), aortic stenosis with and without combined lesions (8), tetralogy of Fallot (7), ventricular septum defect (7) and transposition of the great arteries (4).

Aortic Valve Stenosis↗
PubMed1975

[Instantaneous blood flow velocity profiles before and after aortic valve replacement (author's transl)].

In 17 patients the instantaneous velocity profile was recorded before and after aortic valve replacement (Starr-Edwards, Björk-Shiley, Lillehei-Kaster). A single gated pulsed Doppler Ultrasonic flownmeter was used for analysis. Distal of these valves a flat flow profile was recorded showing high velocity gradients near the walls. As a main cause of this, numerous eddies and turbulent flow have been suggested. Downstream of a Starr valve a flat profile appears with a slowing down of forward flow just behind the ball. The disk valves Lillehei-Kaster and Björk-Shiley demonstrated a higher flow velocity in direction to the larger opening. The "in vivo" studies have been supported by "in vitro" measurements. The highest flow velocities were above 100 cm/sec and thus, according to Reynolds definition, in the turbulent range. The turbulent flow produces a washing effect, which is emphasized during the cardiac cycle. The importance of these data can be discussed by clinical results only.

Aorta↗