Biomedical subjects

R G Grabitz

Publications and source records attributed to R G Grabitz.

27 records · Page 2Linked to original sources

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↗

PubMed1994

Complement, leukocytes, and leukocyte elastase in full-term neonates undergoing cardiac operation.

In 13 neonates undergoing cardiac operations for congenital cardiac defects, complement, leukocytes, and leukocyte elastase were studied during and after cardiopulmonary bypass. All but two neonates received prostaglandin E1 before the operation. The C3d/C3 ratio rose significantly during cardiopulmonary bypass from 0.86 +/- 0.55 to 1.40 +/- 0.56 (mean +/- standard deviation; p < 0.0001). Abnormally elevated C5a levels (18.6 +/- 7.3 micrograms/L) were measured at the end of cardiopulmonary bypass. C4 was not overtly consumed during the procedure. Leukocytes fell from a preoperative value of 10.06 +/- 3.15 x 10(9)/L to 3.21 +/- 0.64 x 10(9)/L after beginning of cardiopulmonary bypass (p < 0.0001) and rose at the end of the procedure from 2.33 +/- 0.67 x 10(9)/L to 7.19 +/- 1.84 x 10(9)/L, after protamine administration (p < 0.0001). Neutrophils fell from a preoperative value of 5.14 +/- 1.18 x 10(9)/L to 1.46 +/- 0.35 x 10(9)/L after beginning of cardiopulmonary bypass and rose at the end of extracorporeal circulation from 1.00 +/- 0.31 x 10(9)/L to 4.10 +/- 1.18 x 10(9)/L, after protamine administration (p < 0.005). Elastase release occurred in all neonates during cardiopulmonary bypass and averaged 331.5 +/- 175.7 micrograms/L. Complement activation and leukocyte stimulation did not correlate with postoperative complications or outcome. This study demonstrates complement activation and leukocyte stimulation in neonates undergoing cardiac operation.

Alprostadil↗

PubMed1993

Multiple system organ failure after open heart surgery in infants and children.

Between January 1985 and March 1989 we retrospectively observed multiple system organ failure (MSOF) in 16 of 460 children (3.5%) who underwent cardiac surgery with cardiopulmonary bypass for congenital heart disease. MSOF was arbitrarily defined as a clinical entity with failure of two or more vital organ systems associated with high fever, thrombocytopenia, and cardiocirculatory insufficiency and occurring within the first postoperative week. In 13 children the first clinical manifestations of MSOF were evident on the first post-operative day and in the other 3 on the second or third post-operative day. All children showed acute renal failure, acute hepatic failure, high fever, and thrombocytopenia. Most of them showed respiratory insufficiency and neurological involvement. Seven of the 16 children died. Four of the 9 surviving patients had neurological sequelae still present 6 months after the operation, and the others recovered completely.

Cardiac Surgical Procedures↗

PubMed1993

Evaluation of aortic coarctation after surgical repair: role of magnetic resonance imaging and Doppler ultrasound.

OBJECTIVE: To compare the usefulness of magnetic resonance imaging (MRI) and Doppler ultrasound with that of cross sectional echocardiography and oscillometric blood pressure measurement for the evaluation of aortic coarctation after surgical repair. DESIGN: Prospective study. Aortic diameters measured by cross sectional echocardiography, MRI, and angiography (selected cases) and functional data determined by physical examination, oscillometric blood pressure measurement, and continuous wave Doppler. SETTING: Tertiary referral centre. PATIENTS: 40 patients aged 2-28 years (mean 10.6 years) who had had surgical correction of aortic coarctation (mean follow up 5.7 years). RESULTS: In all patients MRI gave diameter measurements of the aortic arch and the thoracic aorta whereas in half of them cross sectional echocardiographic measurement of the isthmic region failed. The correlation coefficient for aortic diameters measured by MRI and angiography was 0.97 and that between MRI and echocardiography was 0.89. Peak velocities in the descending aorta correlated better with residual narrowing of the aortic isthmus or distal aortic arch or both than systolic blood pressure gradients between the upper and lower limbs. A peak velocity of < 2 m/s in the descending aorta during systole excluded important restenosis. Prolongation of anterograde blood flow during diastole always indicated a morphological abnormality--either important restenosis or aneurysmal dilatation. CONCLUSIONS: MRI was better than cross sectional echocardiography for imaging the aortic arch after coarctation repair and measuring its diameter. Peak velocity in the descending aorta correlated better with residual stenosis than did the systolic blood pressure gradient between the upper and lower limbs and this index could be used to indicate a need for MRI.

Adolescent↗

PubMed1993

Complement activation during cardiopulmonary bypass in infants and children. Relation to postoperative multiple system organ failure.

Twenty-nine children 3 months to 17 years of age undergoing operations for congenital heart disease were included in this prospective study. Complement activation, activation of the plasma contact system, leukocytes, leukocyte elastase release, and C-reactive protein were studied during and after cardiopulmonary bypass for the first postoperative week and related to multiple system organ failure occurring in eight (27.5%) of the 29 children. During cardiopulmonary bypass complement activation via the alternative pathway as indicated by significant conversion of C3 (expressed by C3d/C3) and abnormally high C5a values at the end of cardiopulmonary bypass without consumption of C4 was shown in all children. At the end of cardiopulmonary bypass, C3 conversion was significantly higher in the eight patients with multiple system organ failure than in the others (p < 0.05), whereas no difference in C5a level was shown. All children had a significant increase in leukocyte count directly after protamine administration (p < 0.0001) and elastase release during cardiopulmonary bypass that was significantly higher in patients with multiple system organ failure than in those without (p < 0.05). Consumption of prekallikrein as an indicator of activation of the Hageman system was not detectable during cardiopulmonary bypass in any child. After cardiopulmonary bypass, in patients without multiple system organ failure, C3d/C3 decreased and reached preoperative values within the first postoperative week, whereas, in patients with multiple system organ failure, C3d/C3 increased further, reaching a maximal value on the third postoperative day. In comparison with patients without multiple system organ failure, patients with multiple system organ failure showed a severe decrease of C4 (with minimal values on the third postoperative day), suggesting consumption by activation of the classic pathway of the complement system or a hepatic synthesis deficiency. Prekallikrein values were also significantly lower in patients with multiple system organ failure than in the others, with a maximal difference on the third postoperative day (p < 0.005). C-reactive protein was significantly lower in patients with multiple system organ failure than in the others for the first 2 postoperative days (p < 0.05), probably because of severe hepatic failure in patients with multiple system organ failure. This study demonstrates that, in children, cardiopulmonary bypass induces complement activation principally via the alternative pathway. It suggests a relationship between complement activation and multiple system organ failure observed in the postoperative period. Furthermore, it points out the role of multiple system organ failure itself on the C3 conversion and on the synthesis of the markers of the inflammatory response in children after heart operations.

Adolescent↗

PubMed1992

Internal mammary artery bypass graft for impaired coronary perfusion after neonatal arterial switch operation.

Myocardial ischaemia caused by perfusion impairment of translocated coronary arteries is the major cause of perioperative mortality after neonatal arterial switch operation for transposition of the great arteries. We report the successful use of the right internal mammary artery as a bypass graft to a dominant right coronary artery to treat insufficient perfusion of this artery in a newborn. Eight months later, coronary angiography showed a full blood supply of the right coronary artery across the internal mammary anastomosis. After a follow-up period of more than 30 months, somatic development, electrocardiogram and echocardiographically determined contractility of both ventricles are practically normal indicating regular function of the bypass graft.

Coronary Angiography↗

PubMed1988

Congenital heart disease: incidence in the first year of life. The Alberta Heritage Pediatric Cardiology Program.

The Heritage Pediatric Cardiology Program is a regional study of patients with congenital heart disease in northern and central Alberta, Canada. Cases of congenital heart disease were confirmed by clinical examination by a pediatric cardiologist plus echocardiography (noninvasive criteria) with or without cardiac catheterization, cardiac surgery, or autopsy (invasive criteria). From 1981 to 1984 inclusive, 573 confirmed cases of congenital heart disease occurred in a population of 103,411 livebirths (5.54 and 3.36/1,000 livebirths using the noninvasive and the invasive criteria, respectively). This is significantly higher (p less than 0.0001) than the rates found in the Baltimore-Washington Infant Study (3.69 and 2.38/1,000 livebirths for the noninvasive and invasive methods, respectively) or the New England Regional Infant Cardiac Program (2.20/1,000 livebirths using invasive methods). Although some lesions occur at rates similar to those found in these other registries, there are 4.4 times more double outlet right ventricles and 2.9 times more atrial septal defects in northern and central Alberta than were found in the New England Regional Infant Cardiac Program (p less than 0.001). The overall congenital heart disease rate has increased 47% between 1981 and 1984, and the rate of ventricular septal defects has doubled during the same period in northern and central Alberta. No methodological bias was found to explain these higher and increasing rates.

Alberta↗

PubMedDate not supplied

[Congenital pulmonary vein stenosis as a rare cause of pulmonary hypertension].

We report on the history, the diagnostic, and the operative procedure in an infant with congenital stenosis of all pulmonary veins. First symptoms such as failure to thrive, tachydyspnea, tachycardia and hepatomegaly occurred in the eighth week of life. Electrocardiography, 2-dimensional echocardiography and radiography of the chest were unspecific. After recurrent episodes of pulmonary oedema cardiac catheterization was performed: bilaterally elevated pulmonary artery wedge pressure and a normal left atrial pressure proved pulmonary venous obstruction. Severe stenosis of all pulmonary veins was apparent cineangiographically only by selective injections into the right and left pulmonary artery branches in wedge position. The operation (excision of the stenotic area and reimplantation using autologous pericardium) was unsuccessful as in most cases described in the literature. Congenital stenosis of all pulmonary veins is a rapidly progressive malformation. Death occurs usually in the first year of life with and without operation.

Cardiac Catheterization↗

PubMedDate not supplied

[Intrauterine therapy of fetal supraventricular tachycardia with digoxin and verapamil].

Fetal supraventricular tachycardia may cause intrauterine heart failure and thus require transplacental treatment. During a period of nine years, we treated nine of eleven fetuses (gestational age ranging from the 26th to the 36th week) suffering from paroxysmal supraventricular tachycardia (10) or atrial flutter (1). The remaining two fetuses did not receive antiarrhythmic therapy because of only short lasting supraventricular tachycardia. Two fetuses were hydropic at the onset of therapy. Diagnosis of the rhythm disorder was established by m-mode echocardiography. All nine fetuses treated received digoxin after diagnosis of supraventricular tachycardia. Three of these reverted to sinus rhythm, one remained in supraventricular tachycardia which, however, was well tolerated. Five fetuses (three because of failure of digoxin alone and two because of a severely symptomatic supraventricular tachycardia) were treated with a combination of digoxin and verapamil. All five fetuses responded to the combined treatment, two of them, however, were delivered prematurely because of recurrence of supraventricular tachycardia in one and amnion-infection syndrome in the other. All patients survived and no severe fetal or maternal side effects were observed. Our experience confirms that digoxin and verapamil are usually effective in treating fetal supraventricular tachycardia. Some fetuses with short lasting and self limiting supraventricular tachycardia may not need any treatment, and a few not responding to digoxin and verapamil may require other antiarrhythmic drugs.

Cardiotocography↗