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Biomedical subjects

R Körfer

Publications and source records attributed to R Körfer.

At least 91 records · Page 5Linked to original sources
PubMed1997

Surgical repair of pulmonary stenosis with intact ventricular septum in a 68-year-old woman.

Patients with mild pulmonary stenosis after infancy rarely have symptoms or develop increasing obstruction. We experienced a 68-year-old woman with severe pulmonary valvar and infundibular stenosis (peak to peak pressure gradient = 80 mmHg). She had been pointed out heart disease at the age of six. Endocarditis at the age of 17 might induce calcification of valve and affect the progression of pulmonary stenosis, and moreover, which might gradually develop severe subvalvar obstruction and poststenotic aneurysm of pulmonary trunk. She refused operative intervention because of mild clinical symptoms (NYHA class II), but we recommended surgical repair due to repeated transient ischemic attacks, which were suspected paradoxical embolism through persistent foramen ovale. She underwent pulmonary valvotomy and infundibular resection and is doing well.

Aged↗
PubMed1996

Significance of human cytomegalovirus DNA detection in immunocompromised heart transplant patients.

Peripheral blood samples (n= 1240), obtained at variable intervals from 483 heart transplantation (HTx patients under immunosuppressive therapy, and blood samples (n=1013) obtained upon blood donation from 1013 healthy anti-human cytomegalovirus (HCMV) positive blood donors, were tested for HCMV DNA by nested polymerase chain reaction (PCR). The detection limit of the nested PCR was determined to be less than 10 copies of the plasmid pRR 47, containing the HCMV immediate early gene. HCMV DNA was detected in 79 of 483 HTx patient (17%). To the contrary' HCMV DNA was only detected in 1 of 1013 anti-HCMV positive, healthy blood donors (0.1%). This PCR positive donor had recently contracted a primary HCMV infection. The rate of HCMV PCR positive immunosuppressed HTx patients in our study was lower than the rate of HCMV PCR positive healthy blood donors in previous reports in the literature. Blood samples (269 from 117 HTx patients) were assayed for HCMV DNA in peripheral blood leukocytes, HCMV DNA in plasma, and HCMV tegument protein 65 kDa (pp 65 antigen). Three laboratory diagnostic patterns were observed and related to clinical findings: (1) HCMV DNA only in leukocytes was observed in 26 patients, 7 of whom had HCMV disease, 5 of whom had graft rejection, and 14 of whom had no specific symptoms; (2) HCMV DNA both in leukocytes and in plasma (viremia) was observed in 3 patients, who were all symptomatic with HCMV disease; (3) HCMV DNA in leukocytes and in plasma (viremia) and pp 65 antigen were observed in 13 patients, all of whom were symptomatic (10 patients had HCMV disease, and 3 patients had graft rejection). A similar sequence of diagnostic patterns was observed in all symptomatic HCMV infections and reactivations in this study: HCMV DNA appeared first in peripheral blood leukocytes, then also in plasma, followed by pp 65 antigen detectable in peripheral blood leukocytes. Upon clinical recovery, these findings disappeared in reverse order. However, HCMV DNA remained detectable in peripheral blood leukocytes for several weeks. The detection of HCMV DNA in the peripheral blood is an exception, not the rule, even in severely immunosuppressed HTx patients. It indicates a pathological condition, albeit without clinical symptoms in some patients, and it is the earliest signal of HCMV replication. Of 42 patients in whom HCMV DNA was initially detected only in peripheral blood leukocytes, 16 patients progressed into viremia. Thus, HCMV-specific PCR performed on nucleic acid extracts from lysed peripheral blood is an appropriate method for the monitoring of HCMV infections in immunosuppressed HTx patients.

Antibodies, Viral↗
PubMed1996

Mechanical circulatory support with the Thoratec assist device in patients with postcardiotomy cardiogenic shock.

BACKGROUND: In spite of modern cardiac surgical techniques, severe cardiogenic shock not responding to pharmacologic therapy and intraaortic balloon pumping develops in about 0.2% to 1.2% of patients undergoing cardiac operations. METHODS: From September 1987 to September 1994, 184 patients were supported with different mechanical circulatory support systems. Nine patients with postcardiotomy cardiogenic shock were supported with the Thoratec ventricular assist device. Four patients suffered early postcardiotomy cardiogenic shock, and 5 patients suffered late postcardiotomy cardiogenic shock. In 6 patients the Thoratec device was applied exclusively, in 2 patients both Bio-Medicus and Thoratec, and in 1 patient both ABIOMED and Thoratec devices were used. Duration of support ranged from 5 to 46 days with a mean duration of 15 days. RESULTS: Four patients (44%) survived and were discharged. Main complications and causes of death were multiple organ failure and sepsis. CONCLUSIONS: The results justify the use of Thoratec assist device in patients with severe preoperative cardiogenic shock.

Adult↗
PubMed1996

Longitudinal monitoring of latent and active human cytomegalovirus infections in peripheral blood of heart transplant recipients by single-tube nested RT-PCR.

PCR is a sensitive diagnostic tool for the detection of human cytomegalovirus (HCMV) DNA in the peripheral blood of immunosuppressed transplant recipients. However, its specificity as a prognostic marker for clinical disease is unclassified, because infections considered to be latent may be detected by this method. In order to diagnose active viral infections, we used reverse transcription-PCR (RT-PCR) to identify HCMV mRNA in blood. We developed a single-tube nested RT-PCR with preformed PCR mixtures embedded in a trehalose matrix. Blood samples of 48 heart transplant recipients were investigated for HCMV DNA. 8 patients detected to be HCMV DNA positive after transplantation were investigated in longitudinal monitoring for at least 6 months. HCMV mRNA was found in 5 patients who developed HCMV related symptoms during the period of RNA detection. There was no clear relation between the onset of DNA detection and the first demonstration of mRNA. In 2 patients HCMV DNA could be detected 74 and 81 days before the appearance of mRNA, suggesting long persistence until active infection is started. In 3 patients HCMV mRNA disappeared during or immediately after the end of ganciclovir therapy. In contrast, HCMV DNA was detectable continuously for prolonged periods after therapy, indicating that the persistence of HCMV DNA is not influenced by ganciclovir treatment. In summary, HCMV DNA detection seems to be a reliable early marker for the differentiation of persistent and active HCMV infections in immunosuppressed patients. Our data show that viral mRNA detection is probably a better predictor of the effectiveness of antiviral therapy than viral DNA detection.

Antibodies, Viral↗
PubMed1996

Transport of hemodynamically unstable patients by a mobile mechanical circulatory support team.

Advances in medical technology have made it possible to use emergency femoro-femoral bypass (FFB) for transport of hemodynamically unstable patients. In this study, we report on our experience of transport of patients with refractory heart failure by a special mobile mechanical circulatory support team (MMCST) using an intraaortic balloon pump (IABP) or FFB. A total of 22 patients (14 men, 8 women) were supported by the MMCST and transported to our clinic for further diagnostic or therapeutic procedures. The diagnoses in 12 patients was acute myocardial infarction, in 7 patients, dilatative cardiomyopathy (DCM), and in 3 patients, acute fulminant myocarditis. In 15 cases, FFB was implanted (5 in combination with IABP), and in 5 cases, IABP only was implanted. Two patients received maximal dosages of catecholamines. After arrival at our clinic, 11 patients received implants of a more sophisticated support system. From the myocardial infarction group, 3 patients received coronary artery bypass grafting, 1 patient received percutaneous transluminal coronary angioplasty, and 1 patient received heart transplantation as final therapy. In the myocarditis and DCM groups, 7 patients underwent heart transplantation. Finally, 11 patients (50%) survived, and 11 patients died of multiorgan failure or septicemia.

Adult↗
PubMed1996

Management of acute fulminant myocarditis using circulatory support systems.

Although the natural history of acute myocarditis leads to complete recovery in the majority of patients, rapid and irreversible cardiac decompensation resulting in death is known to occur. One possible therapy to improve the poor prognosis of this patient group may be the implantation of circulatory support systems that allow myocardial recovery or bridging to heart transplantation. Therapeutic protocols have been suggested, but clinical experiences in this area are few. In this paper we report on our clinical experiences in cardiogenic shock after acute fulminant myocarditis using different types of circulatory support systems. Three different systems were used: a biomedicus centrifugal pump as a ventricular assist device (VAD) or femoro-femoral bypass (FFB) including oxygenator; Abiomed BVS 5000, and Thoratec ventricular assist device. Hemodynamic criteria for implantation of support systems were cardiac index < 2.0 L/min/m2. SVR = 1000 dyne-s-cm-5, central venous pressure (CVP) or left atrial pressure (LAP) > 20 mm Hg, and urine output < 20 ml/h despite maximal pharmacological therapy. Age total of 5 patients (mean age 29 years, range 15-55 years) in cardiogenic shock after acute fulminant myocarditis were included. Two patients initially were supported for stabilization and transportation from an outside hospital by FFB. Both patients died after a support time of 24 h because of multiorgan failure or neurological disorders after longer periods of resuscitation in the referral hospital. The third patient (55 years) received the Biomedicus pump as CVAD. Myocardial function recovered after a support time of 120 h, and the patient could be weaned. Unfortunately, 2 days after weaning, he developed malignant arrhythmias and died. The 2 remaining patients (15 years and 27 years) with diagnosis of acute fulminant virus myocarditis were supported by biventricular assist device (1 x Thoratec/111 days, 1 x Abiomed/7 days). During the entire time of support, there were no signs of myocardial recovery. The patients were accepted for the heart transplantation (HTX) program. In both cases, HTXs were performed without any complication. The postoperative course was uneventful. The results of mechanical circulatory support in patients with acute fulminant myocarditis are encouraging and justify the resources.

Adult↗
PubMed1996

Mechanical circulatory support: lessons from a single centre.

Over recent years, a number of different mechanical circulatory support (MCS) products have been developed to a stage where they are no longer investigational devices. Registry data provide some information, but this is limited by the mix of historical and contemporary data and the voluntary nature of the contributions. As yet, there are no clear guidelines for patient selection, the differential application of generically different devices or for optimal patient management. Ours is a busy centre offering a comprehensive cardiovascular service. This review details our experience since 1987 and 189 patients supported with five different types of device, used in all of the common applications. Our experience has permitted the formulation of some general principles and guidelines. Data published by registries and by individual manufacturers are, as yet, not standardized. We hope that our experience will be of interest to those centres wishing to establish a mechanical assist service.

Academic Medical Centers↗
PubMed1996

Predictors of unsuccessful outcome after percutaneous mitral valvulotomy including a new echocardiographic scoring system.

BACKGROUND AND AIMS OF THE STUDY: Percutaneous mitral valvulotomy has been shown to be an accept able alternative to surgery as treatment for selected patients with severe mitral stenosis. Uncertainty still exists regarding predictors of unsuccessful outcome. MATERIALS AND METHODS: 308 patients with severe mitral stenosis underwent Inoue single balloon valvulotomy over a 48-month period and were followed up for a mean of 14.5 +/- 16.8 months (range one to 64 months). Two hundred and sixty-seven (Group I) improved clinically and remained stable throughout the follow up, while subsequent surgery was required in 41 (Group II) after 38.2 +/- 143.5 days (range one to 1,212). Clinical and echocardiographic parameters of the two groups were compared to find significant predictors of an unsuccessful outcome. RESULTS: Significant differences between the groups were observed for NYHA class (2.7 +/- 0.6 vs. 2.9 +/- 0.6, p < 0.05), mitral valve area (1.0 +/- 0.3 vs. 0.9 +/- 0.2 cm2, p < 0.01), left atrial end-systolic dimension by echo (51.3 +/- 8.0 vs. 55.4 +/- 10.2 mm, p < 0.01) and an echocardiographic scoring system including grading for eccentricity of the mitral orifice and distribution of commissural calcification (7.5 +/- 2.0 for Group I and 8.7 +/- 2.0 for Group II, p < 0.001). CONCLUSIONS: Mitral valves that are more likely to have an unsuccessful outcome can be identified by hemodynamic, clinical and echocardiographic criteria, including grading for eccentricity of the mitral orifice and distribution of commissural calcification.

Adult↗
PubMed1996

Pathomorphological characteristics of resected mitral valves after unsuccessful valvuloplasty.

OBJECTIVE: Percutaneous mitral valvuloplasty has been shown to be an acceptable alternative to surgery as treatment for selected patients with severe mitral stenosis. We examined hemodynamic, echocardiographic, and pathomorphologic findings in a series of 308 patients undergoing balloon valvuloplasty, 41 of whom underwent subsequent surgery, in search of possible predictors of an unsuccessful outcome. INTERVENTION AND RESULTS: Patients with severe mitral stenosis underwent Inoue single ballon valvuloplasty over a 48-month period and had follow-up for a mean of 14.5+/-16.8 months (range 1 to 64 months). Of the 308 patients, 267 (Group I) were clinically improved and stable throughout follow-up, while subsequent surgery was required in 41 (Group II) after 38.2+/-143.5 days (range 1 to 1212). Significant differences between the groups were observed for NYHA class (2.7+/-0.6 vs 2.9+/-0.6, p<0.05), mitral valve area (1.0+/-0.3 vs 0.9+/-0.2 cm2, p<0.01) and left atrial endsystolic dimension by echo (51.3+/-8.0 vs 55.4+/-10.2 mm, p<0.01). Two of the 41 Group II patients underwent surgery for left to right shunting, 1 for tamponade and 2 were lost to follow-up. The excised mitral valves of the remaining 36 patients all showed calcification and/or fibrosis: 9 homogenous, 5 non-homogenous; 19 were classified as having a funnel-shaped deformity, and 3 did not fit into a discrete category. Among the funnel-shaped valves, 13 had a tear versus 6 where dilation was primarily accomplished by stretching. Only one of 9 valves with homogenous calcification was torn, whereas a tear was noted in 3 of the 5 with non-homogenous calcification. CONCLUSION: Funnel-shaped valves and those with non-homogenous distribution of calcification and/or fibrosis appear to be least suitable for balloon valvuloplasty.

Adult↗
PubMed1996

[What treatment expectations does the elderly patient have from surgery and what can surgery achieve--from the viewpoint of heart surgery].

In the west the elderly population is constantly increasing. Consequently, the percentage of old and very old patients is also increasing among cardiac surgical cases. Almost all cardiac diseases which can be treated surgically can be corrected nowadays with good results even in very old patients. Prerequisites are the correct judgement of individual risk and possible individual gain for the patient. This has to be weighted against the surgeon's and the institution's results. Today, no patient requiring a cardiac operation should be refused on the grounds of age.

Aged↗
PubMed1995

Mechanical circulatory support: the Bad Oeynhausen experience.

From September 1987 to February 1994, we treated 147 patients ranging between 11 and 82 years old with different mechanical circulatory support systems. The applied devices were the Bio-Medicus centrifugal pump in 61 patients, the Abiomed BVS System 5000 in 49 patients, the Thoratec ventricular assist device in 42 patients, and the Novacor left ventricular assist device in 7 patients. On the basis of indication for mechanical circulatory support, the patients were divided into three groups: group 1 consisted of 72 patients with postcardiotomy cardiogenic shock; group 2, 50 patients in whom mechanical support was used as a bridge to cardiac transplantation; and group 3 (miscellaneous), 25 patients in cardiogenic shock resulting from acute myocardial infarction (n = 14), acute fulminant myocarditis (n = 3), primary graft failure (n = 2), right heart failure after heart transplantation (n = 3), and acute rejection (n = 3). Time of support ranged from 1 hour to 97 days (mean duration, 10.8 days). Seventy-five patients (51%) were discharged from the hospital. The best survival rate was achieved in group 2 with 72%, followed by group 1 with 44% and then group 3 with 28%. The most frequent complications in group 1 were bleeding (44%), multiple-organ failure (24%), neurologic disorders (18%), and acute renal failure (15%). In group 2, the major complications were bleeding (34%) and cerebrovascular disorders (22%) and in group 3, multiple-organ failure and sepsis (60%) and bleeding (32%).

Adolescent↗
PubMed1995

[Non-Hodgkin's lymphoma with heart, mediastinum and lung hilar involvement].

We performed an exploratory thoraco-, pericardio- and cardiotomy in a 70-year-old male patient suffering from a biatrial tumor after a thorough diagnostic procedure had failed to reveal the correct diagnosis. Histologically, the tumor proved to be a centrocytic-centroblastic non-Hodgkin-lymphoma. This case demonstrates the diagnostic difficulties in cardiac involvement of lymphomas and presents the therapeutic options.

Aged↗
PubMed1995

Left ventricular function in heart valve surgery: a multidisciplinary challenge.

Between January 1988 and December 1994, 4,097 patients underwent heart valve replacement at the Heart Center North Rhine-Westfalia, Bad Oeynhausen, 1,388 (33.8%) of them suffered from impaired left ventricular (LV) function. Overall hospital mortality was 2.3% (n = 95). In the poor LV function group it was 1.8% (n = 25). There was a significant increase of mortality from 1.5% in patients younger than 60 years to 4.9% in patients 80 years of age and older. Reoperations and emergency operations showed an additional increase of mortality each: 6.2% and 18.2%, respectively. Medium term survival (maximum 48 months) was assessed in a group of 2,006 patients operated between January 1991 and December 1993. The cumulative mortality for patients with poor LV function (n = 148) was 12.8%, whereas for those with normal LV function it was 6.1%. Our data suggest that left ventricular function is of minor importance as far as primary operative results are concerned. In long term follow up patients with valve replacement and poor LV function show an increased mortality mainly due to cardiac causes.

Adolescent↗
PubMed1995

[Inpatient length of stay and physical capacity after aortocoronary bypass operation, after heart valve replacement and myocardial infarct].

The present investigation was performed to determine the dependence of the length of stay in community hospitals and rehabilitation clinics from patient characteristics and physical activity at the end of treatment. Comparing age, end-diastolic volume index, left ventricular ejection fraction, number of stenosed coronary arteries, number of bypass grafts, levels of physical exercise, body mass index and the ratio total cholesterol/HDL-cholesterol, no significant differences were found in patients, who reached the rehabilitation clinic in the early postoperative period (7.4 +/- 2.0 days, n = 98), after 15-28 days (n = 74) or later than 28 days (n = 156) after bypass-surgery. Similar results were observed in 103 patients after heart-valve replacement, who arrived at the rehabilitation clinic after a corresponding length of hospital care like the bypass patients. Also, no significant differences in the clinical characteristics and physical activity appeared in patients who were admitted in the early phase (9.2 +/- 4.5 days) after transmural myocardial infarction (n = 37) and those entering the rehabilitation clinic after 26.7 +/- 9.4 days of hospital stay (n = 32). The absence of any relationship between the length of stay in hospitals on the one hand and severity of the heart disease on the other hand points out that the whole duration of stay in community hospitals and rehabilitation clinics after surgical intervention and also after transmural myocardial infarction could be drastically shortened by an optimal cooperation of both, hospitals and rehabilitation clinics, without any impairment of clinical results.

Activities of Daily Living↗
PubMed1994

Emotional adjustment and perceived locus of control in heart transplant patients.

Orthotopic heart transplantation has been established as a routine clinical operation. In this study, we were interested in: (a) how patients cope emotionally with the situation pre- and postsurgically, especially with regard to anxiety and depression; and (b) whether the patient's perceived locus of control is related to emotional adjustment before and after heart transplantation. Twenty patients who were on the waiting list for heart transplantation with highest priority provided complete psychological questionnaires presurgically and 20 days after surgery when intensive care was no longer required. During the waiting period, patients rated high on depression, state and trait anxiety in comparison with healthy references while ratings on perceived locus of control scales were within the norm ranges. After surgery, heart transplant patients experienced significantly less state/trait anxiety and depression reaching levels which were no longer statistically different from health references. While postsurgical ratings of anxiety (state and trait) and depression were not significantly correlated with presurgical ratings, both were closely related to ratings of locus of control. Belief in powerful others was positively correlated with pre- and postsurgical anxiety and depression. Chance control orientation was related only to presurgical emotional disturbances. It can be concluded that emotional adjustment after heart transplantation is more likely to be predicted by presurgical ratings of locus of control than by presurgical emotional adjustment.

Adaptation, Psychological↗