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Biomedical subjects

R H Strasser

Publications and source records attributed to R H Strasser.

At least 19 recordsLinked to original sources
PubMed2006

Evaluation of pulmonary vascular response to inhaled iloprost in heart transplant candidates with pulmonary venous hypertension.

OBJECTIVE: Chronic left-heart failure is often associated with the development of pulmonary venous hypertension. In heart transplant candidates this is of great significance because the healthy donor heart has to compensate the increased right-ventricular afterload. Right-ventricular dysfunction is still responsible for 19% of all early deaths after orthotopic heart transplantation. Careful preoperative assessment of pulmonary vascular resistance by right-heart catheterization is essential. Reversibility testing is generally carried out to clarify therapeutic options for the post-transplant period. The objective of this case series is to report our institutional experience with inhaled iloprost compared to the common used oxygen/nitroglycerin method for reversibility testing. METHODS: Right-heart catheterization was performed in 23 patients with severely impaired left-ventricular function (EF < or = 25%, pVO2 < or = 14 ml/kg/min, NYHA III or IV) with combined pulmonary venous hypertension (TPG > 12 mm Hg and or PVR > 250 dyn x s x cm(-5)). An intraindividual comparison was performed between of the hemodynamic effect with oxygen/nitroglycerin s.l. and inhaled iloprost. RESULTS: The transpulmonary gradient fell significantly from an initial 16 mm Hg to 13 mm Hg on oxygen/nitroglycerin s.l. compared to 10 mm Hg on inhaled iloprost. Pulmonary vascular resistance fell significantly from an initial 344 dyn x s x cm(-5) to 270 dyn x s x cm(-5) on oxygen/nitroglycerin s.l. compared to 209 dyn x s x cm(-5) on inhaled iloprost. On inhaled iloprost a moderate systemic effect was noticed. CONCLUSION: In heart transplant candidates with pulmonary venous hypertension reversibility testing with inhalation of iloprost is a save method and significantly more effective than the combination of inhaled oxygen plus nitroglycerin s.l.

Administration, Inhalation↗
PubMed2006

Apoptosis of human macrophages by Flt-4 signaling: implications for atherosclerotic plaque pathology.

BACKGROUND: Neointimal inflammation and angiogenesis are important contributors of progression and destabilization of the atherosclerotic plaque. While the role of vascular endothelial growth factor (VEGF) and its receptors VEGF-R1 (Flt-1) and VEGF-R2 (Flk-1) in this process has clearly been defined, expression of the VEGF-R3 (Flt-4) has only been documented on lymphatic and tumor endothelium. This study examined Flt-4 expression in human atherosclerotic plaque and explored its implications for atherosclerotic disease. METHODS AND RESULTS: Carotid artery thrombendartherectomy specimens from 10 patients with unstable plaque were stained for Flt-4 and its specific growth factors VEGF-C and VEGF-D. Microvascular endothelial cells (MVEC) stained positive for VEGF-C and -D, but not for Flt-4. Interestingly, macrophages within inflammatory perivascular regions coexpressed Flt-4, VEGF-C and VEGF-D. In vitro studies confirmed the expression of Flt-4, VEGF-C and VEGF-D in human monocytes and cultured macrophages. Treatment of macrophages with VEGF-D induced apoptosis as determined by annexin V staining, by immunoblotting of activated caspase 3, and by the ratio of Bcl-2/Bax as well as by DNA fragmentation. Immunohistochemical studies of advanced human carotid atherosclerotic plaque confirmed the coexpression of Flt-4 with activated caspase 3 and TUNEL staining in macrophages, indicating an ongoing apoptotic process. CONCLUSION: Human monocytes/macrophages express VEGF-C and -D and their receptor Flt-4 in vitro and in vivo within advanced atherosclerotic lesions. Flt-4, in turn, mediates monocyte/macrophage apoptosis and may this way alter plaque stability.

Aged↗
PubMed2005

Transcatheter closure of atrial septal defects improves right ventricular volume, mass, function, pulmonary pressure, and functional class: a magnetic resonance imaging study.

OBJECTIVE: To characterise prospectively by magnetic resonance imaging (MRI) changes in right ventricular (RV) volume, function, and mass after transcatheter closure of atrial septal defects (ASDs) and to evaluate the course of pulmonary pressure and functional class criteria. METHODS: In 20 patients with secundum-type ASD and dilated RV diameter, MRI was performed to quantify RV end diastolic (RVEDV) and end systolic volumes (RVESV), RV mass, tricuspid annular diameter, and RV ejection fraction before and 6 and 12 months after transcatheter closure of the ASD. RV systolic pressure was measured during follow up by transthoracic echocardiography. RESULTS: Functional class improved in the majority of patients after ASD closure. RVESV (from 81 (18) ml/m2 to 53 (15) ml/m2, p < 0.001), RVEDV (from 127 (17) ml/m2 to 99 (18) ml/m2, p < 0.001), and RV mass (from 79 (10) g to 63 (8) g, p < 0.01) decreased significantly during follow up, although tricuspid annular diameter did not. RV ejection fraction improved (by 9% compared with baseline, p < 0.05) and RV systolic pressure decreased significantly (from 33 (8) mm Hg to 24 (6) mm Hg, p < 0.001) after closure. CONCLUSION: MRI studies showed significant improvement of RV volumes, mass, and function after transcatheter closure of ASDs. Restoration of the RV leads to decreased pulmonary pressure resulting in a better functional class in the majority of patients.

Adult↗
PubMed2005

[Bacterial pericarditis].

HISTORY AND CLINICAL FINDINGS: A 65-year-old previously healthy man was referred because of high fever, progressive dyspnea and retrosternal pain for 2 days. On admission, the patient was already in a reduced general condition, blood pressure was 120/70 mmHg, heart rate irregular at 75/min and temperature at 39.7 degrees C. Auscultation of the heart revealed distant heart sounds, murmurs were not present, but mild rales were heard over both lung bases. Jugular veins were congested. INVESTIGATIONS: ECG showed a generalized ST-segment elevation with preserved R-waves, slightly depressed PR-segment and atrial bigemini. Chest X-ray revealed an enlarged cardiac silhouette with signs of a pneumopericardium. Transthoracic echocardiography showed a circular pericardial effusion and haemodynamic impairment. Percutaneous pericardiocentesis revealed a purulent effusion with microbiological proof of pneumococci. The primary infectious focus was a maxillary sinusitis caused by pneumococci. DIAGNOSIS: Bacterial pericarditis due to by haematogenous spread of pneumococci. TREATMENT AND COURSE: Antibiotic therapy consisted of intravenous ceftriaxon and gentamicin. To rinse the pericardial space and drain the thick, purulent effusion subxiphoidal, pericardiocentesis and insertion of a drainage tube were done. Physiological saline was put into the pericardial space several times a day, drained and analysed microbiologically. In the meantime rinsing of the infected maxillary sinus was performed. Transthoracic echocardiography was done repeatedly to rule out complications of bacterial pericarditis, especially constrictive pericarditis. The pericardial tube was removed after proof of a sterile drainage 9 days after insertion. The patient was discharged after 4 weeks of hospitalization without clinical or echocardiographic signs of diastolic dysfunction. CONCLUSION: Suspected bacterial pericarditis must be treated as an emergency and confirmed or ruled out by percutaneous pericardiocentesis.

Aged↗
PubMed2005

[Thyroid hormone and the cardiovascular system].

Thyroid hormone has many effects on the heart and vascular system. In hyperthyroidism changes in cardiovascular hemodynamics explain many of the clinical manifestations induced by thyroid hormones. In hypothyroidism the cardiovascular effects are opposite to those observed in hyperthyroidism, although the clinical manifestations are less obvious. This review will focus on the cardiovascular system in hyperthyroidism and hypothyroidism. In particular the subclinical dysfunctions of the thyroid gland, which occurs especially in older age, will be discussed. The clinical relevance and the necessity of diagnostic and therapy in subclinical thyroid disease are not clarified yet. In the United States an expert group has published a scientific review and guideline for the diagnosis and management of subclinical thyroid disease in 2004, which will also be outlined.

Electrocardiography↗
PubMed2005

Myocardial infarction as complication of left atrial myxoma.

Although cardiac myxomas are histologically benign, they tend to form emboli and cause intracardiac obstruction, so that they must be classified as potentially fatal tumors of the heart. The probability of arterial embolism is closely correlated with the morphology of the tumor. Thus, villous myxomas are more fragile and form emboli more often. Nuclear spin tomography and echocardiographic cine-mode sequences provide impressive images of the potential for embolism. It appears that coronary embolism may be more frequent in the group of myxoma patients than generally is assumed. These may present as acute myocardial ischemia with the typical clinical symptoms of acute myocardial infarction, as a silent infarct, shock, syncope or as sudden cardiac death. Besides our case report this paper will give an overview on published data on coronary embolism in patients with atrial myxoma. Interestingly there is a tendency for spontaneous recanalization of the obstructed coronary vessels, perhaps because of the tumors' tissue composition. Therefore it is reasonable to perform transoesophageal echocardiography to check out embolic sources like myxoma, when pathogenesis of myocardial infarction remains unclear after coronary angiography.

Acute Disease↗
PubMed2005

Microwave ablation of an ischemic sustained ventricular tachycardia during aortocoronary bypass, mitral valve and tricuspid valve surgery guided by a three-dimensional non-fluoroscopic mapping system (CARTO).

Postinfarct patients with malignant ventricular tachyarrhythmias (VTs) are prone to an increased risk for sudden cardiac death and implantation of an internal cardioverter-defibrillator (ICD) often is recommended. In cases where the VTs are incessant or refractory to medical treatment, disruption of the macro-reentry circuit, which represents the arrhythmogenic substrate for postinfarct VTs, is a major therapeutical goal for electro-physiologists. The precise identification of this underlying macro-reentrant circuit depends on conventional mapping techniques (i.e. diastolic potentials, entrainment) and more recently by a three-dimensional non-fluoroscopic electro-anatomical mapping system (CARTO), which integrates anatomical and electrophysiological information to reconstruct a three-dimensional activation and propagation map of the relevant VT. This reports describes on a patient with recurrent, drug-refractory, hemodynamically stable monomorphic VTs on the basis of a 2-vessel coronary artery disease, reduced left ventricular ejection fraction, who was scheduled for coronary artery bypass graft operation combined with mitral valve replacement and reconstruction of the tricuspid valve. Preoperatively, the underlying mechanism of the VT was identified by CARTO mapping with a slow conduction zone and a wide exit site at the inferoapico-basal portion of the left ventricle. In close cooperation between the cardiologists and the surgeons the decision for a simultaneous ablation approach during the subsequent operation was made. Successful ablation of the VT using microwave energy was confirmed by non-inducibility of the VT in the perioperative electrophysiologic study. This case report highlights the use of CARTO mapping to identify postinfarct VTs as well as the application of microwave energy as a useful tool to cure postinfarct ventricular arrhythmias.

Aged↗
PubMed2005

Long term biventricular resynchronisation therapy in advanced heart failure: effect on neurohormones.

OBJECTIVE: To assess prospectively the effect of cardiac resynchronisation therapy (CRT) on New York Heart Association (NYHA) functional class, cardiac function, cardiopulmonary exercise performance, and neurohormonal activation during 24 months' follow up. DESIGN: Controlled study. PATIENTS AND RESULTS: 124 patients with severe congestive heart failure (ejection fraction < 35%, NYHA III-IV) and left bundle branch block (QRS duration > 150 ms) were enrolled (control group, n = 59; CRT group, n = 65) and followed up at 1, 3, 12, and 24 months. Compared with the control group, CRT led to significant short and long term improvements in functional NYHA functional class (mean (SEM) 2.1 (0.4) v 2.8 (0.4) at 24 months, p < 0.05), mean ejection fraction (25.7 (4)% v 21.1 (5)% at 24 months, p < 0.05), peak Vo(2) (16.8 (3.9) v 12.6 (3.5) ml/kg x min at 24 months, p < 0.01), and Vo(2) at anaerobic threshold (14.4 (3.7) v 10.8 (3.2) ml/kg x min at 24 months, p < 0.05). In addition, CRT for one and 12 months significantly decreased the plasma concentrations of noradrenaline (norepinephrine) and N-terminal fragment of pro-brain natriuretic peptide, whereas no changes were observed for other neurohormones such as antidiuretic hormone, aldosterone, and endothelin. CONCLUSION: Long term CRT (<or= 24 months) results in significant improvement of NYHA class and cardiopulmonary exercise capacity and a short term decrease in neurohormonal activation.

Bundle-Branch Block↗
PubMed2004

Neovascularization in left atrial myxoma.

Myxoma is the most common benign tumor of the heart. Tumor neovascularization at the angiographically detectable level is thought to be rare. We report on a 78-year-old female patient with a left atrial myxoma showing marked tumor vascularity. This observation had consequences to the therapeutic management: during tumor excision, the large supplying artery had to be ligated.

Aged↗
PubMed2004

Transcatheter closure of patent foramen ovale (PFO) in patients with paradoxical embolism. Periprocedural safety and mid-term follow-up results of three different device occluder systems.

AIMS: Interventional PFO closure has previously been reported to reduce the risk for recurrent thromboembolic events. The aim of the present study was to evaluate three different occluder systems in respect to (a) the safety and practicability and (b) the mid-term risk of recurrent thromboembolic events. METHODS AND RESULTS: Since 08/98 until 12/02, 307 consecutive patients (138 women, 169 men, mean age 43 years) with a symptomatic PFO underwent PFO closure using the PFO-Star ( n=177), Amplatzer PFO occluder ( n=69) and CardioSeal/Starflex ( n=61 ). Implantation was successful in all patients. Periinterventional complications occurred in 9 patients (5x ST-segment elevations, 1x arteriovenous fistula, 2x TIA, 1x device dislodgement). All of them were reversible and not associated with a specific type of device. During the median follow-up of 24 months (25/75th percentiles: 14/37 months), the annual risk of recurrence was 0.6% for TIA, 0% for stroke and 0.2% for peripheral embolism (PFO-Star: 0.8%, Amplatzer PFO occluder: 0.7% and CardioSeal/Starflex: 1.0%). CONCLUSION: Interventional PFO closure appears to be safe and a promising technique in symptomatic PFO patients with a low incidence of periinterventional complications and recurrent thromboembolic events using three different devices (PFO-Star, Amplatzer PFO occluder or the CardioSeal/Starflex).

Adult↗