PubMed Health⌕ Search

Biomedical subjects

W Bircks

Publications and source records attributed to W Bircks.

At least 19 recordsLinked to original sources
PubMed1992

[Hypertrophic obstructive cardiomyopathy: surgical therapy].

Surgical treatment of hypertrophic obstructive cardiomyopathy (HOCM), which may present in a typical (subaortic) or atypical (mid-ventricular) form, is indicated only after prior long-term drug treatment. The results obtained in 353 patients presenting with a symptomatic form of HOCM operated on between 1963 and 30 June 1991 are reported. The operative procedure took the form of transaortic subvalvular myectomy (TSM) as described by Morrow, modified by extending the myectomy. The patients comprised 210 males and 143 females aged between 6 and 76 years (average age 41.7 years). With few exceptions, all patients were in clinical stage III or IV (NYHA). The overall hospital mortality rate was 4.8% (n = 17); for TSM alone 3.1% (n = 8 out of 261 patients), for combination surgery with additional surgical measures 9.8% (n = 9 out of 92 patients). Among the last 194 patients (since 1984), the mortality rate was 2.06% (n = 4). To date, follow-up show an improvement in the symptoms and physical performance, and an annual mortality rate of about 1.8-4% among patients treated with drugs, and a post-operative mortality of about 1.1%, so that in HOCM patients with symptoms despite prior drug treatment, surgery can be recommended.

Adolescent↗
PubMed1992

Prediction of the site and severity of obstruction in hypertrophic cardiomyopathy by color flow mapping and continuous wave Doppler echocardiography.

OBJECTIVE: We investigated whether the site and severity of an obstruction in hypertrophic cardiomyopathy can be accurately predicted by the combined use of color-coded and continuous wave Doppler echocardiography. BACKGROUND: Predicting the site of obstruction by end-systolic cavity shape is not reliable. Therefore, hemodynamic localization of the obstruction is required before surgery is performed. Such localization should be possible with color flow imaging, which provides two-dimensional velocity mapping reflecting the distribution of pressures within the left ventricle. Discrepancies in assessment of the pressure gradient by Doppler echocardiography and cardiac catheterization (which are usually not performed simultaneously) may be due to spontaneous variation of the dynamic obstruction in addition to technical factors related to both methods. METHODS: Twenty consecutive patients with hypertrophic cardiomyopathy were examined 1 day before transseptal left heart catheterization. The obstruction site was defined by color flow mapping. The pressure gradient was determined by continuous wave Doppler echocardiography. Measurements were also performed simultaneously in 10 patients during cardiac catheterization. RESULTS: Midventricular obstruction was correctly identified in 4 patients and subvalvular obstruction in 15 patients. One patient had no obstruction at rest. Invasively and noninvasively determined pressure gradients correlated well (r = 0.89, SEE = 16.3 mm Hg). Multiple single-beat analysis in 10 patients, also simultaneously examined with Doppler echocardiography and catheterization, yielded an excellent correlation (r = 0.97, SEE = 13.1 mm Hg). Comparing the simultaneous (r = 0.96, SEE = 12.5 mm Hg) and nonsimultaneous (r = 0.81, SEE = 23.8 mm Hg) recordings in these patients, we found that the spontaneous variation of the dynamic obstruction mainly accounted for discrepancies (p less than 0.05). CONCLUSION: The combined use of color-coded and continuous wave Doppler echocardiography provides the relevant hemodynamic information required for decision-making in patients with hypertrophic cardiomyopathy who are considered for transaortic myectomy.

Adult↗
PubMed1992

Results of randomized mitral valve replacement with mechanical prostheses after 15 years.

Between 1974 and 1976 150 consecutive patients (pts) were operated on for isolated mitral valve replacement (MVR). Björk-Shiley (BS), Lillehei-Kaste (LK), and Starr-Edwards (SE) (type 6210) prostheses were implanted at random. All survivors were prospectively followed by regular clinical examinations every 6 to 12 months for 15 years. The mean follow-up time was 14.8 years. A constant subjective improvement after 15 years was reported in 62% of pts with BS, 30% with LK, and 49% with SE. The cumulative 14-year survival rate was 0.62 +/- 0.13 (BS), 0.56 +/- 0.16 (SE), and 0.54 +/- 0.15 (LK), respectively. Late mortality was due to thromboembolic events (n = 3), bleeding complications (n = 3), congestive heart failure (n = 7), documented arrhythmias or sudden death (n = 6). Thrombotic valve thrombosis (1 BS, 1 LK, 2 SE) required reoperations. Linearized cumulative rates after 14 years for thromboembolic complications were 14.2 +/- 3.1 (BS), 15.8 +/- 3.7 (SE), 24.3 +/- 4.2 (LK). The cumulative risk of severe bleeding complications was not different: BS: 35.8, LK: 35.2, SE: 34.3. During the first years of observation no significant differences between these mechanical prostheses could be observed, however, after 14 years of long-term follow-up the cumulative event-free rates were more favorable for the BS prosthesis.

Adult↗
PubMed1992

[Preservation of the posterior mitral valve leaflet and effect on follow-up results after additional mitral valve implantation].

As early as 1964, Lillehei et al. published the technique of preservation of the posterior mitral leaflet (PML) and chordae tendineae in combination with mitral prosthesis implantation (MPI). In a limited randomized number of 95 patients with MPI the influence of preservation of PML on hemodynamics and physical capacity at least 46 months after surgery without (group A) and with preservation of PML (group B) was investigated. Statistically significant differences in favor of group B were found for cardiac index, pulmonary artery pressure after stress, end-diastolic volume index (EDVI), physical capacity and survival rate after a complication-free course. Basing on these results at rest and after exertion (30 W), patients with preservation of PML and MPI are long-term in a better clinical condition.

Adult↗
PubMed1991

Beta-adrenoceptor density on mononuclear leukocytes and right atrial myocardium in infants and children with congenital heart disease.

Sympathetic regulation of myocardial performance has been shown to be altered in congestive heart failure. Right atrial tissue of children with severe acyanotic and cyanotic congenital heart disease (CHD) showed a significantly lower beta-receptor density than that of children with less severe defects. Since mononuclear leukocytes (MNL) contain a homogeneous population of beta 2-adrenoceptors which have similar properties to those of cardiac beta 2-adrenoceptors, they are frequently used for studying the beta-adrenergic system. In a group of 37 children with CHD of different types and severity who underwent cardiac surgery, we compared the MNL beta-adrenoceptor density to the type and severity of CHD and looked for a possible relationship to plasma catecholamine levels and to the right atrial beta-adrenoceptor density. Membranes of MNL and myocardial cells were radiolabeled with (-)3-[125I]Iodocyanopindolol [( 125I]ICYP). A significantly higher beta-adrenoceptor density on MNL was found in patients with moderate acyanotic CHD (group I) than in those with severe acyanotic (group II) and cyanotic CHD (group III). Patients of group I showed approximately 50% higher myocardial beta-receptor density than those of groups II and III. ICI 118.551-[125I]ICYP competition studies revealed that in groups II and III significantly lower proportions and densities of beta 1-receptors were found compared to group I. Noradrenaline (NA) plasma levels in group II and group III were significantly higher than those in group I. The adrenaline plasma levels were found to be very high in all children with CHD.(ABSTRACT TRUNCATED AT 250 WORDS)

Binding, Competitive↗
PubMed1991

Cardiac rhythm after Mustard repair and after arterial switch operation for complete transposition.

We compared the prevalence of arrhythmias among the first consecutive 45 patients with complete transposition (concordant atrioventricular and discordant ventriculo-arterial connexions) after arterial switch operation and the last 47 patients after Mustard repair in infancy. Both groups had 24-hour Holter electrocardiographic studies at similar periods of follow up (24 +/- 14 and 25 +/- 18 months). A second group of patients undergoing the Mustard procedure had been repaired at an older age before 1981. They were studied to determine the frequency of disturbances of rhythm during later postoperative follow-up (85 +/- 24 months). Symptomatic brady-/tachyarrhythmia syndrome never occurred after the arterial switch and only once in the group of patients repaired by the Mustard procedure in infancy, but developed at a late stage (69 +/- 28 months); five times in the group of patients having Mustard's repair at an older age. In addition, Holter monitoring did not detect bradyarrhythmias indicating sinus node dysfunction in a single patient after the arterial switch, but did so to a similar extent in both groups having the Mustard procedure (recent: n = 14; older: n = 18). Three cases of the group of older patients undergoing a Mustard operation developed complete atrioventricular block during follow-up. Normal findings were present in 93% of the cases after arterial switch, but in only 51% of the cases with a similar follow-up repaired by the Mustard procedure, and in 29% of the group having the Mustard repair at an older age.(ABSTRACT TRUNCATED AT 250 WORDS)

Age Factors↗
PubMed1991

The arterial switch-operation: early and midterm (6 years) results with particular reference to technical problems.

Since February 1985 the arterial switch operation (ASO) has become the surgical treatment of choice for newborns with simple TGA, appropriate forms of complex TGA and double outlet right ventricle (DORV) as well at our institution. Between 1985 and 1990 a total of 87 patients underwent surgery. In 60 patients with simple TGA and 8 patients with complex TGA or DORV, respectively, an arterial switch-operation was performed. Because of coronary artery anomalies (n = 13), dysplastic pulmonary valves (n = 3) or pressure drop in the left ventricle (n = 1), the initially planned arterial switch operation was discarded and a Mustard type procedure was in 17 patient. Finally there were two primarily performed Mustard operations. The hospital mortality after arterial switch for simple TGA was 15% (9/60), 0/8 in patients with complex TGA. Late mortality was calculated to be 12% (1/8) in patients with complex TGA and 3/60 in patients with simple TGA. Within the Mustard group there were 2/19 hospital deaths and one late death. Causes of early death after arterial switch were: intraoperative myocardial infarct (n = 3) low cardiac output syndrome (n = 2), intractable bleeding (n = 2), metabolic acidosis (n = 1), and septicemia (n = 1). Late after surgery there was one death due to chylothorax after thrombotic obstruction of the SVC, and 3 more deaths secondary to intraoperative infarct, progressive LV dysfunction and meningitis, respectively. Among the long-term survivors 2 patients developed a severe supravalvulary pulmonary stenosis. There were no significant arrhythmias, supravalvulary pulmonary aortic stenoses, aortic insufficiency or myocardial perfusion disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1990

Arteriovenous fistulas after median sternotomy--report of 2 cases and review of the literature.

We report 2 cases of arteriovenous fistulas as a very rare complication following median sternotomy. In the first case a fistula was observed between the right internal mammary artery and vein caused by a sternal wire. The second patient developed a fistula between the innominate artery and left innominate vein after suture repair of a slight hemorrhage from the innominate vein. The latter localization has not been previously described. In both cases the fistulas were discovered by a continuous murmur appearing 12 and 11 days postoperatively. The therapy consisted of resternotomy and resection of the fistulas. The literature is reviewed and etiology, diagnosis and therapy are discussed.

Adult↗
PubMed1990

Acute pseudo-obstruction of the colon (Ogilvie's syndrome) following open heart surgery.

The acute pseudo-obstruction of the colon or Ogilvie's syndrome is a rare surgical complication with an unknown pathogenesis. It is characterized by a distention of the large bowel without distal mechanical obstruction and a normal motility of the small bowel. The cause may be a postoperative imbalance between the sympathic and parasympathic innervation of the distal colon. In about one third of the cases a spontaneous perforation of the cecum develops, with a mortality of up to 50 per cent. We report the 5th case after cardiovascular surgery in the literature overall and the first in which conservative therapy successfully prevented perforation and laparotomy. An overview of the etiology, diagnosis, and treatment of this complication is given.

Aged↗
PubMed1990

[Long-term results of surgical therapy of thoracic aortic aneurysm (dissection of the ascending aorta)].

Thoracic aneurysms are classified according to the nomenclature of De Bakey (1-3b) or Daily (Stanford A-B). Our early and late results refer to dissections of the ascending aorta with and without aneurysms as well as with and without aortic valve involvement. The distal extension of the dissections was different. Since 1979 45 patients (mean age 48 years, range 23-70 years) were operated, the acute dissections mostly as emergencies after secured diagnosis. The preferred technique was reconstruction of the ascending aorta. However, also other techniques as prosthetic replacement or implantation of an conduit were used. The hospital lethality was 12.5% (n = 6); the late letality 24% (n = 7). The cumulative survival rate after 8 years was 74%.

Adult↗
PubMed1990

[Anti-tachycardia surgery in ventricular arrhythmia].

UNLABELLED: Recurrent sustained ventricular tachycardia (VT) is associated predominantly with ischemic heart disease, mostly in the chronic phase after myocardial infarction. Potentially life-threatening and drug-refractory ventricular tachycardias are called malignant VT. In the Federal Republic of Germany, VT develops in about 3,000 to 5,000 patients per year from the 100,000 who survive a myocardial infarction. About 10% of these patients prove to be medically-refractory or additionally are considered candidates for aneurysmectomy or coronary revascularization. Overall, for the Federal Republic of Germany, there is a need for approximately 500 to 1000 antitachycardia operations each year. The morphologic substrate for malignant VT are ischemically-damaged inhomogeneously-structured arrhythmogenic areas. The morphology results in electrical inhomogeneity which predisposes to electrophysiologic reentry phenomena. NATURAL HISTORY: The survival rate of patients with malignant VT who are not surgically treated is 70% at one year and 20 to 40% at four years (Figure 1). In those in whom the tachycardia can be medically controlled, the prognosis is 10.5 times more favorable than in those with medically-refractory arrhythmias. In one study of 45 patients with recurrent, sustained VT, only 20% of those with medical refractoriness were free of renewed arrhythmic events after 30 weeks as compared to 90% whose treatment had been designated effective (p less than 0.0004) (Figure 2). According to a further study, for patients with drug-refractory VT, the probability for sudden death within four years was 55% as compared with 5% for those with medically-controlled VT (p less than 0.0002). SURGICAL TREATMENT: The concept of surgical treatment of malignant VT encompasses delineation of the arrhythmogenic area by means of endocardial mapping and surgical ablation. Arrhythmogenic areas are located mostly in the transition zone between the viable muscle and an aneurysm at the left ventricular endomyocardial septum. With mapping, by means of local measurements of activity times, impulse spread throughout the heart can be recorded in a cartographic system. The left ventricular endocardial activation should be determined during sinus rhythm and tachycardia and, with normothermic extracorporeal circulation the left ventricle is incised, mostly in the aneurysmatic antero-apical area, prior to sequential interrogation of the endocardial surface (Figure 3). As an alternative to point-for-point mapping, by means of multi-terminal electrodes, electrocardiograms can be obtained simultaneously from multiple positions. During tachycardia, the earliest activation can be found in the arrhythmogenic area (Figure 4); during sinus rhythm, in these areas, delayed, low-amplitude and fragmented signals are present (Figure 5). Macroscopically, endomyocardial fibrosis is a common finding. The arrhythmogenic morphologic substrate is either reduced or rendered a homogeneous scar without electrical activity. In this regard, techniques for endomyocardial resection have been described by Harken and Josephson. As an alternative procedure. Guiraudon introduced the encircling endomyocardial resection with which the pathologic reentry circuit can be blocked and the microvascular blood flow to arrhythmogenic areas eliminated. One modification, the partial encircling resection, appears to yield comparable effectiveness with less damage to left ventricular function (Figure 6).(ABSTRACT TRUNCATED AT 400 WORDS)

Electrocardiography↗
PubMed1989

Ten years electrophysiologically guided direct operations for malignant ischemic ventricular tachycardia--results.

UNLABELLED: During the recent 10 years period worldwide more than 1000 patients underwent an electrophysiologically guided direct operation for malignant ventricular tachycardia in the setting of chronic ischemic heart disease. The published results of these operations as regards relief of ventricular tachycardia and survival are highly variable. The data presented here are largely based on a multi-institutional registry series (n = 665) and the combined Düsseldorf-Birmingham/Alabama (DUS-UAB) ventricular tachycardia surgery experience (n = 216). DATA: Survival (hospital deaths included) was 75% one year after operation and 45% at 5 years (DUS-UAB). The respective data of the registry series were 78% and 55%. The most prevalent mode of death in both analyses was acute/subacute/chronic heart failure. More extensive encircling procedures (incisional/cryo) for ventricular tachycardia ablation and the combination of encircling cryoablation and endocardial resection increased the risk of progressive left ventricular dysfunction and death; however, by multivariate analysis the severity of the underlying ischemic heart disease (indicated by NYHA functional class, LVEDP, No. of previous infarcts, and extensiveness of coronary disease) and the absence of a discrete left ventricular aneurysm were more powerful predictors for early and late postoperative mortality than the use of alternative surgical techniques for ventricular tachycardia ablation. Survival was particularly poor after the return of spontaneous sustained ventricular tachycardia.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1989

[Current aspects of surgery of congenital heart defects].

A review is given concerning the development of surgery for the congenital heart in recent years, or decades, respectively. Longterm results of operative and conservative treatment should be critically considered to avoid unsuccessful operations. Data from West Germany show that this type of surgery should not be done in all places where cardiac surgery is performed.

Extracorporeal Circulation↗