Biomedical subjects

S Muurling

Publications and source records attributed to S Muurling.

5 recordsLinked to original sources

PubMed1997

Coagulation activation in patients undergoing directional coronary atherectomy.

Restenosis is a major problem of percutaneous transluminal coronary angioplasty (PTCA) and related procedures. To better understand the underlying pathophysiologic mechanisms, coagulation and fibrinolytic variables were analysed prospectively in 35 patients after directional coronary atherectomy (DCA) and in 20 control patients undergoing diagnostic heart catheterisation and coronary angiography. Blood samples were taken before and 1 h, 24 h and 48 h after the procedure. No subacute thrombosis or unstable angina were documented in any patient. In 8 out of these 35 patients late restenosis was diagnosed during follow-up angiography 3-6 months after DCA. In these 8 patients prothrombin fragments (F1 + 2) rose from 0.7 to 0.9 nmol/l (P < 0.01) and thrombin-antithrombin III complexes (TAT) from 2.9 to 6.0 micrograms/l (P < 0.01), but not significantly in 27 patients without restenosis and in the control patients. In patients with late restenosis plasminogen activator inhibitor (PAI-1) also increased from 2.4 to 4.9 U/ml (P < 0.05) 24 h after DCA while there were no significant changes in patients without restenosis and in control patients. D-Dimer/TAT ratio reflecting the balance between clotting activation and fibrinolysis was significantly lower after 24 h in restenosis patients. The findings suggest that coagulation activation and hypofibrinolysis during 48 h after DCA might be associated with the development of late restenosis.

Adult↗

PubMed1997

[Endomyocardial biopsy--helpful in differential diagnosis between myocarditis and dilated cardiomyopathy. A case report].

Endomyocardial biopsy is an established technique to distinguish between myocarditis and dilated cardiomyopathy. Even when clinical symptoms for myocarditis are lacking, immunohistologic findings may establish a clear diagnosis. For treatment, however, an early diagnosis is mandatory. We report on a 44 year old patient who was admitted with the echocardiographic diagnosis of dilated cardiomyopathy. He underwent diagnostic angiocardiography and endomyocardial biopsy. The latter demonstrated an active myocarditis. At the time of read-mission, 2 weeks later, the patient had deteriorated. Now, additional to a symptomatic therapy, prednisolone, azathioprine and human immunoglobulin G were given and patient conditions improved dramatically. The use of endomyocardial biopsy seems recommendable in order to define patients diagnosis and their results may be necessary to decide patients therapy.

Adult↗

PubMed1997

Dynamic on-line quantification of biventricular function with acoustic quantification (AQ). Validation, reproducibility and normal values of a new echocardiographic approach.

OBJECTIVES: Acoustic quantification (AQ), a recently developed ultrasonic integrated backscatter imaging system providing on-line measurements of ventricular cavity areas and their functional indexes, was validated in comparison to angiography and Doppler derived systolic dP/dt. Normal AQ-reference values were established. METHODS AND RESULTS: 1. In 45 patients undergoing heart catheterization, AQ derived areas in end-diastole (EDA), end-systole (ESA) and the resulting fractional area change (FAC) in apical 2- and 4-chamber view were compared to the corresponding biplane angiographic data. All correlations yielded significant values (p < 0.0001; EDA: r = 0.90, SEE = 2.6 cm2; ESA: r = 0.91, SEE = 2.2 cm2; FAC: r = 0.90, SEE = 4.1%). However, AQ-areas were underestimated by about 25%. 2. In 36 patients with mitral regurgitation AQ-FAC and AQ derived systolic dA/dt were compared to the Doppler derived systolic dP/dt, yielding significant correlations with r = 0.91 and r = 0.87; p < 0.0001. 3. In 50 healthy subjects, AQ derived EDA, ESA and FAC averaged 25.7 +/- 4.9, 14.7 +/- 3.3 cm2 and 43.2 +/- 4.8% for the left, and 17.1 +/- 3.8, 9.0 +/- 2.9 cm2 and 47.3 +/- 9.2% for the right ventricle. For EDA normalized peak filling (PFR) and ejection rates (PER) yielded 2.7 +/- 0.28 and -2.4 +/- 0.42 EDA/sec for the left and 3.4 +/- 0.74 and -2.9 +/- 0.62 EDA/sec for the right ventricle. The interobserver and day-to-day variability of AQ in healthy subjects and cardiac patients was low for EDA, ESA and FAC (< 12%) and higher for PFR and PER (< 20%). CONCLUSION: In comparison to angiography AQ reliably quantitates on-line left ventricular fractional area change, although AQ-areas are underestimated. AQ offers reproducible values of systolic and diastolic function and a new approach to cardiac patients.

Coronary Angiography↗

PubMed1997

Detection of diastolic dysfunction: acoustic quantification (AQ) in comparison to Doppler echocardiography.

OBJECTIVES: To evaluate the potential of acoustic quantification (AQ) in detection of diastolic dysfunction in comparison to Doppler analysis, we investigated, as a model of restrictive filling pattern, nonrejecting heart transplant recipients early postoperatively. BACKGROUND: AQ, an ultrasonic backscatter imaging system, enables instantaneous calculation of cavity areas and thus provides a new approach to diastolic function. METHODS: Of 27 pts who have undergone heart transplantation, echocardiography has been performed at the day of biopsy. During a time course of 8 weeks echocardiographic data have been analysed at 3 different time points (early, mid and late) in 16 nonrejecting pts. Indexes of the area-change waveform and its 1. derivative (dA/dt) obtained by AQ were opposed to usual Doppler indexes. RESULTS: In comparing data of the early and late time point of investigation, significant changes of early diastolic filling were detectable by AQ as well as by Doppler: End-diastolic areas have increased (p < 0.001), while peak filling rate (p < 0.0001), slope of area change during rapid filling (p < 0.001) and amount of relative area change during rapid filling (p < 0.001) have decreased. Complementary, Doppler derived pressure half-time (p < 0.0001) and isovolumic relaxation time (p < 0.0001) have increased while the peak early filling velocity (p < 0.0001) and its time velocity integral (p < 0.001) have decreased. CONCLUSION: An initial restrictive filling pattern has improved 8 weeks postoperatively. Since multiple indexes, obtained from the area change waveforms, in particular the for end-diastolic area normalized peak filling rate, seem to be highly sensitive in detecting changes of diastolic function, AQ may play an important complementary role in non-invasive evaluation of restrictive filling pattern.

Adult↗

PubMed1995

[Pseudo-stenosis caused by vessel wall invagination during interventional treatment of 2 coronary vessels in a patient].

We report on a 59-year-old man who underwent a combined procedure of directional coronary atherectomy (DCA) and PTCA of significant lesions of the right coronary artery (RCA) and the left circumflex artery (LCX). Already after positioning of a standard guide wire in the right coronary artery a new excentric "pseudo-stenosis" was observed in the proximal part of the right coronary artery. Since the patient remained symptom free, a 7F DCA catheter was introduced to the stenotic area in the mid RCA, which led to an extension of the narrowing, involving the total segment proximal to the DCA catheter. Directional coronary atherectomy was performed without complications. Removal of the catheter, after successful DCA, and administration of intracoronary nitroglycerin did not relieve the proximal narrowing, which disappeared spontaneously after the guide wire was pulled out. During PTCA of the left circumflex using a standard guide wire and a 3.0 mm Monorail balloon catheter, a similar tight narrowing of the origin of the LCX was observed, which could also not be influenced by vasodilator drugs, but relieved after wire removal. Until now, this phenomenon has only been described for the right coronary artery. The reason underlying intimal folding is a shifting of the intimal layer against the medial layer of the vessel wall. Our observation firstly describes this phenomenon of "pseudo narrowing" in two different vessels in one patient. We, like other authors before, recommend that interventional therapy of these pseudo-lesions should be avoided.

Angioplasty, Balloon, Coronary↗