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Biomedical subjects

U Gleichmann

Publications and source records attributed to U Gleichmann.

At least 91 records · Page 5Linked to original sources
PubMed1991

[Right ventricular outflow obstruction due to accessory tricuspid valve tissue in corrected transposition of the great arteries with ventricular septal defect].

A 27-year-old man known to have corrected transposition of the great arteries (CTGA) associated with a ventricular septal defect (VSD) was admitted to our hospital with a suspected increase of the shunt volume. The patient is a first class bodybuilder. Heart catheterization confirmed the diagnosis of a "right-ventricular" mass obstructing the "right-ventricular" outflow tract, which had already been seen at echocardiography. The intraoperative finding showed the tumor to be accessory tissue of the anterior tricuspid leaflet prolapsing through the VSD into the subvalvular outflow tract of the right ventricle. The accessory tricuspid valve tissue was removed by transatrial access. The VSD was closed by a dacron patch using the same route. The postoperative course was uneventful.

Adult↗
PubMed1991

[Multivessel PTCA as an alternative to bypass operation: effect of complete revascularization on long-term follow-up].

In this study we examine the influence of the initial grade of revascularisation on clinical follow-up in patients with multivessel PTCA instead of CABG. Between I/85 and VII/89 multivessel PTCA was performed in 231 patients (202 m, 29 w; age 57 +/- 9 years). 71% of the patients had 2-vessel disease (VD), 14% 3-VD. 15% had angioplasty of one major and at least one important side branch. Clinical follow-up was achieved by a questionnaire 19.8 +/- 10.1 months after PTCA. 473 of 508 (93.1%) treated stenoses were successfully (residual stenosis less than 50%). 198 patients (86%) had successful angioplasty of all treated lesions. 31 patients (13%) had failed PTCA of one stenosis, 1 patient of both treated lesions. 1 patient underwent emergency CABG. A complete revascularisation (group A) - no residual stenosis greater than 50% in any coronary artery - was achieved in 164 patients (71%). 65 patients (28%) had incomplete revascularisation [group B]. 206 patients (89.1%) had clinical follow-up by questionnaire, 144 patients in group A (87.8%) and 60 patients in group B (92.3%) [n.s.]. 3 patients had died by noncardiac reasons (two in group A and one in group B), 1 patient of group A by cardiac reason. 70% in group A and 68% in group B had continuous clinical improvement (n.s.). Total amount of cardiac events (PTCA, CABG, cardiac death, MI) showed no significance between both groups - 35 (24%) vs 23 (38%). Patients in group B had more CABG (12% vs 3%) and angioplasty of further lesions (7% vs 1%) [p less than 0.05] during follow-up. We conclude multivessel PTCA shows good primary results with low risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1990

[Risk factors in patients with recurrent coronary heart disease].

Progression of the coronary heart disease (CHD) and early occlusion of the coronary artery bypass grafts (CABG) represent significant problems for patients after myocardial revascularisation. Between November 1984 and August 1988 121 patients underwent surgery for a second and 3 patients for a third myocardial revascularisation. The mean age at the time of the second and third operation was 59 and 62 years, respectively. The mean interval between the first and second operation was 5.4 years, between the second and third 4.0 years. The indications for reoperation were graft stenosis or occlusion (graft dysfunction) in 43 patients (35%), progression of CHD in 25 patients (25%) and graft dysfunction as well as progression of CHD in 56 patients (45%). During the reoperation 109 patients received new venous CABG, whereas 15 patients were given an IMA-bypass graft, either solely or in addition to venous CABG. The IMA-grafts implanted during the first operation were patent in all 6 patients. They did, however, in some cases cause considerable preparatory difficulties during the reoperation. Perioperative complications were: low-output-syndrome in 9 patients (4 x lethal), myocardial infarction in 5 patients (1 x lethal), malignant ventricular cardiac dysrhythmia in 5 patients (2 x lethal), postoperative bleeding in 3 patients and cerebrovascular insufficiency in 2 patients. The perioperative lethality amounted to 5.7% (n = 5). The results of our retrospective study indicate that one third of the patients had to undergo a reoperation primarily as a result of graft dysfunction.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Early ambulation and rehabilitation following heart surgery from the viewpoint of the cardiologist for adults].

Traditional concepts about the early phase of postoperative remobilization after cardiac surgery favor physical inactivity--as did earlier concepts for rehabilitation after myocardial infarction like the armchair treatment philosophy. For an overwhelming majority of our patients, however, this concept does not hold, according to our experience during the last decade. In contrast, we propose a model of stepwise mobilization and rehabilitation starting the first postoperative days. At the end of the first week most patients are able to climb staircases. In the second week group physical therapy can be started. At the 14th postoperative day, discharge from the surgical ward is warranted. During this step of early mobilization some exceptions have to be made and some special aspects have to be considered. Early mobilization must be postponed in patients with overt heart insufficiency, a low ejection fraction, complex ventricular arrhythmias or pericardial effusions. Cautious mobilization is also required in patients with mitral valve replacement and persistent elevation of pulmonary pressure and resistance. This holds also for patients with valve replacement during acute endocarditis, patients with repair of a dissecting aneurysm of the aorta and patients with perioperative myocardial infarction. The stage of early postoperative mobilization usually ends after the second week and is followed by the next step, the rehabilitation phase during weeks 3 to 6. The goals of the rehabilitation program are; increasing the physical fitness of the patient, thereby increasing his self-assurance and self-esteem; establishing a health-education program, increasing the patients health competence and his coping capacities.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

[Transaortic myectomy for hypertrophic obstructive cardiomyopathy--efficacy of intraoperative pressure measurement].

The many aspects of postoperative course of hypertrophic obstructive cardiomyopathy (HOCM) have been apparent, while many studies concerning long-term follow up have been published in recent years. Many surgical approaches have been performed but recently transaortic subvalvular myectomy is most common. This study reviews 22 patients with HOCM operated on between 1984 and 1989. Transaortic approach was used for all adult patients. One patient had a complication with an iatrogenic VSD, which was closed by Dacron patch during the procedure. There was one hospital death; She is a 67 year-old woman who died due to an acute abdomen. All 14 patients followed up over 3 months had significant functional improvement. Our retrospective study suggests that myectomy in patient with HOCM seems to be not only palliative but curative operative method. Left atrial- and left ventricular dimension tended to normalize in the postoperative course. The intraoperative estimation of Brockenbrough phenomenon is effective to assess the release of left ventricular outflow obstruction.

Adult↗
PubMed1989

[Optimal long-term control of arterial hypertension. Experiences with ambulatory, sports-oriented groups of patients with hypertension].

Out-patient groups of hypertensives were organized in an effort to improve long-term treatment results with greater attention to general measures and to increase compliance. Under supervision of a doctor and a physiotherapist 45 patients (aged 54 +/- 10 years) with mild or moderately severe hypertension were enrolled in a sports training programme after thorough examination. At the same time they were given advice and instructions on self-measurement of blood pressure, diet, medication, general life style and relaxation techniques. In the first 20 patients (observation period of more than one year) a significant reduction in both resting (systolic of -9%) and exercise (systolic of -12%) blood pressures was noted. At the same time exercise tolerance was raised (+18%), while body-weight and total cholesterol concentrations were lowered. It was possible to reduce drug dosage in seven patients, in three more it was discontinued. Left-ventricular wall thickness fell slightly but not significantly. There were no complications. It is concluded that group therapy with sport as a vehicle and advice on general life style are satisfactory means for controlling hypertension and achieve better compliance.

Adult↗
PubMed1989

[Congenital arteriovenous fistula of the coronary arteries in adults: 12 personal cases, a review of the literature, discussion of treatment possibilities].

Between 1976 and 1988, we found in a series of 18,000 coronary angiographies, 12 cases with 15 arteriovenous fistulas of the coronary vessels (incidence of 0.7%). Clinical symptoms were atypical angina pectoris and dyspnea upon exertion. Three patients had a systolic-diastolic murmur. In six cases we found fistulas accidentally, in concurrence with another important cardiovascular disease; 10 fistulas were singular, two fistulas were bilateral. The course was in 10 cases to the pulmonary artery, in three cases to the right atrium, in one case to the right ventricle, and in one case to the superior vena cava. With the exception of one patient, shunt volume was minimal. There were two preoperative sudden deaths of patients with extended fistulas and supra-ventricular arrhythmias. Complications and delineations of management are discussed.

Adult↗
PubMed1988

[Bradycardia factitia].

Repeated intake of 240-400 mg non-retard verapamil by a 26-year-old male nurse brought about interference dissociation resulting from extreme sinus bradycardia, passive AV nodal rhythm and hypotension. Because of a history of myocarditis a recurrence was suspected and an organic cause of the arrhythmia assumed at first, until its self-inflicted origin was discovered. The case demonstrates the need to consider self-medication, even if at first denied, in the differential diagnosis of arrhythmias even in the absence initially of any clear-cut pointers towards it.

Adult↗
PubMed1988

Regional myocardial free fatty acid extraction in normal and ischemic myocardium.

The rate constant for free fatty acid influx (k1) was studied in normal and ischemic myocardium. In 15 normal subjects and 30 patients with coronary artery disease, 201Tl and 15-(p-123I-iodophenyl)-pentadecanoic acid (IPPA) were administered during exercise under fasting conditions and at rest. In 10 patients, the study was repeated after percutaneous transluminal coronary angioplasty; in three patients, the study was repeated after infarction. The initial accumulation of IPPA, related to that of 201Tl (both background and crossover corrected), was used for determinations of the regional rate constant of IPPA influx into myocardial tissue (k1*). In normal subjects, no significant differences in k1* between major myocardial segments were found; the average value of k1* was 0.57 +/- 0.13/min (mean +/- SD) at rest and 0.42 +/- 0.06/min at exercise (average workload, 123 +/- 47 W). With increasing free fatty acid plasma concentration and perfusion, free fatty acid influx increased in a saturable fashion. The Michaelis-Menten constant (KM*) and the maximal velocity (Vmax*) for IPPA influx into myocardial tissue were estimated to be 470 nmol/g and 430 nmol/g.min, respectively. In ischemic areas, k1* was reduced to 57 +/- 18% of k1* value in nonaffected segments. The areas were larger than those showing reduced 201Tl uptake. Preinfarction and postinfarction studies showed that the size of 201Tl defects in postinfarction images corresponded with the size of the area with reduced k1* observed in preinfarction scintigrams. Revascularization led to an increase of 201Tl uptake and to normalization of k1*.

Coronary Disease↗
PubMed1988

Double-nuclide study of the myocardium using 201Tl and 123I-labeled fatty acids in non-ischemic myocardial diseases.

Metabolic impairment and perfusion abnormalities are known to occur in hypertensive heart disease (HHD) and in cardiomyopathies. Free fatty acid (FFA) extraction is severely inhibited in a number of pathobiochemical reactions. This parameter was assessed using the radiolabeled FFA analogue 123I-(p-iodo-phenyl-)-pentadecanoic acid (IPPA) and 201Tl as perfusion marker, both of them injected at maximal physical workload. The regional extraction fraction of IPPA (IPPA-EF) was estimated by relating the regional IPPA and 201Tl uptake to each other. In HHD (normal coronary arteries) with posterior wall thickness less than or equal to 12 mm IPPA-EF was 77 +/- 18% (SD) in septum and 92 +/- 17% in the posterolateral wall (N = 13), with thickness of greater than 12 mm 60 +/- 23% in septum and 61 +/- 20% in the posterolateral wall (N = 8) when compared with IPPA-EF in normal subjects (= 100%, N = 9). In hypertrophic cardiomyopathy (HCM) IPPA-EF averaged 51 +/- 20% in septum and 87 +/- 10% in the posterolateral wall (N = 11). In these patient groups no systematic regional changes in 201TI uptake were observed. In dilated cardiomyopathy (DCM) both IPPA-EF and 201Tl uptake showed distinct regional variations and a great interindividual variability with a mean IPPA-EF reduction of 12% (N = 9). Thus, IPPA uptake in primarily non-ischemic myocardial disease may already be compromised when 201Tl uptake is unchanged. The double-nuclide method for IPPA-EF determination allows to eliminate the influence of flow in FFA imaging and enhances the potential of scintigraphy in the differential diagnosis of HHD versus coronary artery disease.

Cardiomyopathies↗
PubMed1987

[Color Doppler echocardiography in the diagnosis of aortic dissection and aortic wall abscesses].

In eleven patients with aortic dissection or perforated endocarditic aortic wall abscess cavity, the diagnostic usefulness of Color Doppler Echocardiography (CDE) for the identification of true and false lumen as well as the perforation jet was assessed by comparison with the findings of angiography, digital subtraction angiography, computed tomography and surgery. The information gained in addition to that of these procedures, as well as to that of the four conventional echocardiographic techniques was evaluated. Six patients had aortic dissections of DeBakey type I or III; in all of them the diagnosis had been established with conventional ultrasonic techniques. Similarly, in all patients with aortic dissection of DeBakey type I, a clear differentiation between true and false lumen in the aortic root and ascending aorta could already be made by grey-scaled echocardiography. In these patients, however, CDE made the additional demonstration of the perforation jet into the false lumen possible. In those three patients with aortic dissection of DeBakey type III as well as in the abdominal aortic region of DeBakey type I, color Doppler echocardiography was the only method to define true and false lumen and to clearly localize the perforation sites. Two further patients were found to have a small, local dissection, which could only be assumed by conventional echocardiography; the color Doppler M-mode image led to a clear diagnosis. In three patients an endocarditic abscess cavity of the aortic wall could be detected by conventional echocardiography. Two-dimensional color Doppler echocardiography additionally enabled us to visualize the presence and the course of perforation flows. In two patients color-coded Doppler echocardiography made it possible to detect perforations in regions which could not be localized either with conventional echocardiographic techniques or the above-mentioned control procedures.

Abscess↗