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Biomedical subjects

U Gleichmann

Publications and source records attributed to U Gleichmann.

At least 145 records · Page 8Linked to original sources
PubMed1977

[Non-invasive determination of cardiac pump function by respiratory gas exchange measurement during submaximal exercise -- comparison with hemodynamic (heart catheterisation) data (author's transl)].

The continuous measurement of respiratory gas exchange under linearly increasing work load allows a relatively exact and reproducible localization of the point of rise of the ventilatory equivalent for oxygen (ASV). On the basis of the values of oxygen consumption (V(O2)(ASV)), oxygen pulse (O2-pulse(asv)) and relative ventilatory equivalent (Vetn. Equivalent(asv)/V(O2(ASV)), measured at the point ASV, it is possible to divide patients with different severity of heart disease into 4 groups of cardiac response to exercise: group I = normal, group II = diminished, group III = definitely limited and group IV = severely limited cardiocirculatory capacity. Simultaneous cardiac output measurements (thermodilution method) as well as the comparison with hemodynamic and angiographic data acquired during separate heart catheterization reveal good correlations between V(O2(ASV) and O2-pulse(asv) on the one hand and exercise values of cardiac output and stroke volume on the other (r = 0.82). Consequently, definite relations exist between the absolute ASV values as well as the group classification (I--IV) based on these and further heart catheterization data such as left bentricular (LV) enddiastolic pressure, LV ejection fraction, contraction pattern of the left ventricle and coronary angiogram respectively. The described method of measuring respiratory gas exchange under submaximal unsteady state bicycle exercise represents a reliable and rapid non-invasive stress test of cardiac pump function without putting too much strain on the heart patient as is frequently the case with the more familiar steady state (maximal) tests.

Cardiac Catheterization↗
PubMed1976

In vivo evaluation of the Lillehei-Kaster heart valve prosthesis.

In vivo evaluation of the Lillehei-Kaster heart valve prosthesis was performed in 28 patients; 22 had undergone aortic valve replacement and 6 had had mitral valve replacement. Mean pressure gradients ranged from 6 to 53 mm Hg in aortic prostheses; valve area varied from 0.83 to 2.9 cm2. The maximum opening angle of 80 degrees was never reached in this group of patients; opening angles ranged from 57 to 74 degrees without evidence of disc malfunction. There was no correlation between the ratio of effective to geometric valve area and the degree of opening of the disc occluder. Similar results were found in the mitral valve group. Gradients ranged from 6.0 to 12.5 mm Hg and valve area from 1.6 to 2.2 cm2. The maximum opening angle was 59 to 63 degrees. It is concluded that incomplete opening of the disc occluder in pivoting-disc valves is not necessarily a sign of disc malfunction. Lillehei-Kaster valves smaller than 18 mm in internal diameter should be avoided in adults, and outflow aortoplasty for implantation of a larger prosthesis should be used in patients who have a narrow aortic root.

Adult↗
PubMed1976

[The Lillehei-Kaster valve prosthesis hemodynamic and mechanic features in vivo (author's transl)].

29 patients with Lillehei-Kaster vale prostheses, 22 in aortic position and 7 in mitral position, were examined. With small aortic valves (A 14 - A 16) mean gradients averaged 32 mm Hg, valve area varied between 1 and 1.2 cm2. Only size A 20 and larger showed satisfying gradient and valve areas of 1.9 cm2 and greater. The mitral gradients averaged between 10 and 5 mm Hg according to size and valve areas were about 1.6 cm2. The maximal measured opening angle of the pivoting disk averaged 64degrees in the aortic valves and 61degrees in the mitral valves; complete opening (80degrees) was not observed.

Aortic Valve↗
PubMed1976

[Pulmonary artery pressure and left ventricular late diastolic pressure in rest and during dynamic load. Comparative studies on pressure transmission in the pulmonary circulation during simultaneous determination].

Left ventricular enddiastolic pressure (LVEDP), mean pulmonary artery pressure (PAPM) and enddiastolic pulmonary artery pressure (PADP) were simultaneously recorded in 19 subjects with normal left ventricular (LV) function, and in 109 patients with LV-dysfunction, 83 of whom were also studied during exercise. Patients with valvular heart disease or atrial fibrillation were excluded from this study. LVEDP and mean pulmonary capillary wedge (PCW) pressure were simultaneously recorded in 81 patients at rest, andin 16 patients also during exercise; the LV diastolic pressure prior to atrial contraction (LVPpreA) could accurately be identified in 45 patients at rest and in 23 patients with exercise. In contrast to the widely accepted opinion of others, the PADP (mean 8.2 +/- 2.2 mm Hg at rest and 12.3 +/- 3.4 mm Hg with exercise) showed a close approximation of LVEDP (10.0 +/- mm Hg at rest and 16.2 +/- 3.5 mm Hg with exercise) only in normal subjects at rest (p less than 0.05 and p less than 0.01 respectively). In patients with LV dysfunction there was no significant difference between PADP (11.7 +/- 4.5 mm Hg and 23.0 +/- 8.9 mm Hg), PCW (11.6 +/- 5.1 mm Hg and 24.1 +/- 11.9 mm Hg) and LVPpreA (12.5 +/- 5.5 and 21.5 +/- 7.7 mm Hg) at rest and during exercise. LVEDP could be estimated with sufficient accuracy only from the PAPM (18.9 +/- 6.5 and 35.7 +/- 10.8 mm Hg). The increase in LVEDP (14.7 +/- 7.7 mm Hg) with exercise was not significantly different from the increase in PAPM (16.8 +/- 7.1 mm Hg). There were highly significant correlations (p less than 0.001) between LVEDP and PADP (r = 0.85) as well as PAPM (r = 0.86) at rest and during exercise with the regressionline being closest to the line of identity for LVEDP and PAPM. The pressure gradient between LVEDP and PADP (LVEDP - PADP = 6.3 mm Hg with exercise) equaled the pressure increase in LV by atrial contraction (LVEDP - LVPpreA = 6.3 and 13.3 mm Hg). The pressure difference between PADP or PAPM and LVEDP remained constant despite marked variation of other hemodynamic parameters, e.g. stroke volume index (SVI), heart rate (HR) and cardiac index(CI). These data suggest that an elevated LVEDP is caused mainly by an augmented atrial contraction in patients with LV dysfunction at rest and with exercise. This mechanism precludes an enddiastolic pressure equilibrium between pulmonary artery and left ventricel. PAPM allows the best estimation of LVEDP independent from other hemodynamic variables.

Adult↗
PubMed1976

[Graphic analysis of electrocardiograms with the exercise test].

The effort ECG is one of the most useful and most commonly employed methods for the early diagnosis of coronary disease in patients with a normal ECG at rest. Perfection of a computerised method for this purpose is reported. An effort test is run on the cyclergometer and the ECG is read for 2 min at rest, during the test, and for 3 min afterwards. The chest bipolar leads are used. The diagnostic possibilities are greatly improved by computerisation and interpretation of the effort ECG.

Coronary Disease↗
PubMed1975

[Diagnostic and prognostic value of endomyocardial biopsy in patients with congestive cardiomyopathy (author's transl)]rdiomyopathy(author.

Endomyocardial biopsies were obtained from the right ventricle in 25 patients with the clinical diagnosis of congestive cardiomyopathy. The biopsies were subjected to virological and histological studies (light and electronmicroscopy) and the findings correlated with clinical data. Abnormal morphological findings were present in all patients. The presumed clinical diagnosis was confirmed in 19, the morphological changes not being consistent with the clinical diagnosis of CCM in six patients. Electronmicroscopy revealed cardiac storage disease in one patient and pathological changes secondary to previous myocarditis in the other five. Clinical follow-up studies of the five patients apparently confirmed the morphological results, because in no case was there clinical deterioration, three patients in fact being in a fairly normal cardiac state at present. Using a morphological scoring system, the 19 patients with morphologically confirmed diagnosis of CCM were subdivided into two groupds, those with four points or less (group I, n equal to 9), and those with five pints or more (group II, n equal to 10). During a mean follow-up period of nearly 12 months the first group had a low mortality rate (n equal to 2), while the other had a high one (n equal to 6). The occurrence of signs of degeneration and mitochondrial alterations, in particular, was associated with a poor clinical prognosis. This differentiation into two groupds could not be achieved by clinical means alone. Type B3 Coxsackie virus was isolated from one biopsy, but no patient had significant serological evidence of virological infection.

Adult↗
PubMed1975

[1-Year-results of anuloplastisy (Carpentier-technic) in 7 patients (author's transl)].

Of 7 patients who had Carpentier anuloplasty, two had very good, two had good and two had unsatisfactory results in postoperative cardiac catheterization one year after operation. One patient died of acute hepatitis. Reasons for the poor results are false indications and inadequate operative technic. These results show that the Carpentier-technic can well be recommended for critical use in carefully selected patients with mitral insufficiency.

Adolescent↗