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Biomedical subjects

W D Bussmann

Publications and source records attributed to W D Bussmann.

At least 73 records · Page 4Linked to original sources
PubMed1987

[Transluminal angioplasty of aortic isthmus stenosis in juveniles and adults].

Percutaneous transluminal balloon angioplasty of coarctation of the aorta was performed on eleven patients, aged 5-35 years (mean 25 years). Three patients had had surgical resection of the coarctation previously. There were no complications. The balloons used had a diameter up to 20 mm and were inflated with pressures of 3-5 bar for 10-60 sec. In two of the preoperated patients dilatation did not succeed. It was successful in the remaining nine. In these patients the gradient was reduced from a mean of 58 +/- 17 to 18 +/- 11 mm Hg, the stenosis diameter being increased from 4.5 +/- 2.4 to 11.9 +/- 5.1 mm. In five of six patients, angiography three or twelve months postoperatively demonstrated persisting dilatation. It is concluded that this procedure can be successfully used in both juveniles and adults, not only in children.

Adolescent↗
PubMed1987

The Frankfurt experience in restenosis after coronary angioplasty.

Three hundred and thirty-three of 356 patients underwent angiographic follow-up from 1 to 18 months (mean 5.6 months) after percutaneous transluminal coronary angioplasty (PTCA). This is a reangiography rate of 94%. Recurrence rate after the first PTCA was 15% (n = 289). Restenosis rate was defined as an increase from immediate post-PTCA stenosis of more than 30%, or the loss of at least half of the initial gain in luminal diameter. Patients who needed a second angioplasty due to restenosis (n = 30) had a restenosis rate of 33%. Patients with angioplasty in the aortocoronary bypass (n = 14) had a restenosis rate of 45%. All patients were treated before, during and at least 4 to 6 months after the procedure with 60 to 100 mg of isosorbide dinitrate daily plus 160 to 360 mg of verapamil or 100 to 150 mg of gallopamil and 1.5 g of acetylsalicylic acid. In a second retrospective study 111 of 399 patients had the acetylsalicylic acid therapy discontinued or decreased. Forty-two of them developed restenosis (38%), whereas only 49 of 288 patients who continued to receive 1.5 g aspirin developed restenosis (17%). The restenosis rate was 32% in those who received the reduced dose of aspirin. Thus, a large dose of acetylsalicylic acid given before, during and 4 to 6 months after the procedure seems to be necessary to achieve a low rate of restenosis after PTCA.

Angioplasty, Balloon↗
PubMed1987

[Transfemoral valvuloplasty using the balloon catheter in mitral stenosis].

In two female patients (59 and 30 years old) with mitral stenosis, a successful valvuloplasty was carried out with a balloon catheter. After transseptal puncture with determination of the pressure gradient between the left auricle and the left ventricle, the atrial septum was initially dilated with a small balloon and a MediTech balloon catheter with a diameter of 25 mm was pushed forward into the region of the mitral valve via a guide wire. On filling of the balloon, the marked indentation at 3-4 atü hyperbaric pressure initially present could be eliminated. The pressure gradient fell from 8 mm Hg to 2 mm Hg in the first patient and from 12 mm Hg to 3 mm Hg in the second patient. The interventions were without complications. There was a marked clinical improvement with increase of physical exercise tolerance and decrease of dyspnoea in both patients. A mitral valve insufficiency did not occur. The new technique may possibly constitute an alternative to surgical commissurotomy.

Adult↗
PubMed1987

[Transfemoral valvuloplasty in calcified aortic valve stenosis].

In a 55 year old male patient and a 67 year old woman with calcified aortic valve stenosis, a valvuloplasty was performed via the femoral approach using a large-lumen balloon catheter. The 55 year old patient, who had undergone an aortocoronary bypass operation some years ago, displayed the symptoms of a cardiogenic shock. A surgical intervention would have entailed an additional risk. In the second case, there was a raised risk for the operation in view of a coronary two-vessel disease and with regard to the patient's age. By filling the balloon catheter placed in the aortic valve, the pressure gradient could be reduced from 100 mm Hg to 40 mm Hg, and in the second case from 95 mm Hg to 45 mm Hg. The slight aortic insufficiency which had been previously present in the two cases did not increase appreciably. The symptoms of cardiogenic shock disappeared, and there was a distinct clinical improvement. Valvuloplasty is evidently a possible method of treatment (even if it is palliative) in calcified aortic valve stenosis.

Aged↗
PubMed1987

Long-term treatment of severe chronic heart failure with captopril: a double-blind, randomized, placebo-controlled, long-term study.

Twenty-three patients with severe heart failure (NYHA classes III and IV) on treatment with digitalis and diuretics were additionally treated in a randomized double-blind study over a 6-month period with captopril (n = 12; mean daily dose 84 mg) or a placebo (n = 11) and were then reexamined. In the captopril group, the left-ventricular filling pressure decreased by 9 mm Hg (from 23 to 14) at rest and 6 mm Hg (from 35 to 29) during exercise. In the placebo group, there was an increase of 4 mm Hg (from 25 to 29) at rest and 7 mm Hg (from 33 to 40) during exercise; p less than 0.01 (p less than 0.01). In the captopril group, the cardiac index at rest increased 0.7 1/min/m2 (from 2.1 to 2.8) and during exercise 1.2 1/min/m2 (from 2.8 to 4.0). In the placebo group, the increase in cardiac index was considerably less pronounced at rest (= 0.2 1/min/m2; from 1.9 to 2.1) and during exercise (= 0.1 1/min/m2; from 2.7 to 2.8); p less than 0.02 (p less than 0.01). The improved cardiac output had a beneficial effect on the renal blood flow. Hippuran clearance increased by 46 ml/min (from 271 to 318), whereas in the control group it decreased 25 ml/min (from 259 to 234) (p less than 1.02). Both the heart rate and the arterial blood pressure remained constant, whereas the decrease in peripheral vascular resistance was definitely more pronounced in the captopril group (= 562 dyne X s X cm-5, from 1,841 to 1,279) than in the placebo group (= 123 dyne X s X cm-5, from 1,834 to 1,710; p less than 0.02). The heart volume, assessed radiographically, increased slightly in the placebo group, and the left-ventricular end-diastolic diameter remained constant in both groups. In the course of the study, two patients died in the captopril group and three in the placebo group. After six months, eight patients in the captopril group and three in the placebo group had improved by at least one NYHA category. The beneficial effects of captopril are due to its inhibitory effect on the renin-angiotensin system as well as to the inhibition of sympathetic stimulation. Consequently, in the captopril group the quantity of plasma norepinephrine decreased by 188 ng/ml (from 430 to 618); p less than 0.03. The indirect vasodilation caused by this mechanism leads to persistent unloading of the myocardium and an improvement in heart failure without loss of action by counterregulatory mechanisms.

Captopril↗
PubMed1987

[Coronary-dilating effect of minimal doses of nitroglycerin].

A previous study verified the antianginal efficacy of 0.025 mg nitroglycerin without it having any effect on heart rate and blood pressure. In a randomized double-blind study, 40 patients with coronary heart disease received intravenously either 0.025 mg nitroglycerin or placebo. Before and 1-2 min after injection, the aortic and left ventricular (n = 20) pressures were recorded and coronary angiography performed. Mean heart rate, systolic and diastolic aortic pressure, left ventricular filling pressure and the pre- and poststenotic diameter of the coronary arteries, as well as the diameter of a distal coronary artery segment, showed no significant changes (p greater than 0.05). The stenotic segment diameter of the coronary artery remained unchanged after placebo administration (1.01 +/- 0.5 to 1.13 +/- 0.49 mm; p greater than 0.05) but increased significantly after the injection of nitroglycerin (from 1.15 +/- 0.68 to 1.32 +/- 0.73 mm; p less than 0.01). These results support the hypothesis that dilatation of coronary stenoses is an important aspect of the antianginal action of nitroglycerin. This may have practical consequences in the treatment of patients with angina and low blood pressure or severe headaches after the administration of conventional doses of nitroglycerin.

Angina Pectoris↗
PubMed1987

Transfemoral plug closure of patent ductus arteriosus.

A patent ductus arteriosus should be closed because of its hemodynamic significance and/or the risk of infective endocarditis. Mortality of surgery is low. In adults, however, technical problems can arise due to calcification of the ductus walls. Using the transfemoral plug technique, developed by Porstmann, we attempted a ductus closure without surgery on 35 patients. The youngest was an 11-year-old girl, the oldest a 63-year-old woman (mean age of all patients: 37 years). The pressure in the pulmonary artery ranged from 15/5 to 70/27 mmHg, the diameter of the ductus from 2 to 9 mm (mean: 4.4 mm). According to the size and shape of the ductus, a plug of polyvinyl alcohol (Ivalon) with an inner steel wire frame was prepared. Threaded over a long arterio-transductal venous track wire, the plug was introduced into the femoral artery and advanced into the ductus by a pushing catheter. After removal of the track wire the plug remained wedged in the ductus. In all 35 patients, transfemoral ductus closure was possible. Patients with complaints improved remarkably within some days. Heart size and pulmonary congestion decreased considerably. All patients were followed for a period of 1-46 months. In two of them, the ivalon plug embolized into a side branch of the left pulmonary artery 7 and 2 weeks after the procedure, but without serious consequences.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1987

[Nuclear medicine in determining the shunt in ductus arteriosus Botalli].

In 9 patients with patent ductus arteriosus, quantification of left-to-right shunt was performed with dye dilution curves after peripheral injection and with radionuclide ventriculography. The study was repeated within 7 days after successful transluminal occlusion of the ductus with an Ivalon-plug. Reproducubility of the method could be studied in one patient in whom reopening of the ductus occurred. Dye dilution curves were analyzed using the method of Carter et al. Radionuclide ventriculography was performed as a combined first-pass and equilibrium study: effective stroke volume was derived from the first pass of the tracer through the heart; during the equilibrium phase left ventricular ejection fraction (EF) and left ventricular enddiastolic volume (EDV) were evaluated. The difference between total left ventricular stroke volume (product of EF and EDV) and effective stroke volume was taken as shunt volume. This volume as a fraction of total left ventricular stroke volume resulted in percent left-to-right shunt. The sensitivity of the dye technique was 78%; a quantification of the shunt lesion was possible in 55% of all cases (shunt greater than 35%). The sensitivity of the radionuclide technique was 90%. The severity of the lesion could not be determined in one patient with a minimal shunt. After successful occlusion of the ductus, dye dilution curves normalized in all cases. Radionuclide ventriculography showed normalization in all but one patient. This patient with concomitant mitral regurgitation still showed moderate left ventricular volume overload.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

[Transluminal dilatation and other nonsurgical catheter technics in the treatment of renovascular hypertension].

The development of percutaneous transluminal techniques has brought up new possibilities for causative treatment of renovascular hypertension. In renal artery stenosis transluminal angioplasty is meanwhile routinely applied; experience with angioplasty to date exceeds by far the number of 1000 published cases. Technical success is obtained in more than 90%. The clinical success in the therapy of reno-vascular hypertension is approximately 76% over all with nearly equal cure and improvement rates. In fibromuscular stenosis clinical success has been obtained in 95% with a cure rate of 56% and improval in 39%. The cure rate is particularly low in patients with atherosclerotic stenosis with 19%, however in 60% improvement has been obtained, resulting in clinical benefit in 79%. Results obtained by surgery seem to be superior to those of dilatation, especially with regard to cure rates. However, the differences are minor and are compensated by the evident advantages of transluminal dilatation, especially its easy application and lower risk. Thus, 8 years after its introduction in nephrology, transluminal dilatation is the therapy of choice in renal artery stenosis. Other nonoperative interventional techniques, including transcatheter aspiration and embolectomy, intraarterial thrombolysis, embolisation and modified angioplasty provided valuable alternatives to usual surgical therapy. However, experience with some of these procedures is still limited. The complication rate of transluminal angioplasty of 10-20%, necessitating surgery in nearly 5%, prohibits its uncritical use.

Angioplasty, Balloon↗
PubMed1986

[Percutaneous valvuloplasty of the aortic valve in adults].

In a 23-year-old patient with congenital stenosis of the aortic valve the pressure gradient could be reduced from 80 to 35 mm Hg using percutaneous balloon aortic valvuloplasty. The systolic pressure in the left ventricle fell from 200 to 165 mm Hg. A pre-existing mild aortic insufficiency did not worsen. In a 44-year-old female patient retrograde passage of a balloon catheter across the aortic valve failed due to technical reasons. At the present time percutaneous balloon aortic valvuloplasty in adults is more difficult than pulmonary valvuloplasty. It can, however, be considered, prior to surgery, in suitable patients with noncalcified valves.

Adult↗
PubMed1986

[Regional ventricular function before and after sublingual administration of nitroglycerin in patients with recent myocardial infarction in the subacute and chronic stage].

Seven patients with a recent myocardial infarction and mostly normal left ventricular end-diastolic pressure were investigated by radionuclide ventriculography after 3-4 days and three weeks before and after 1.6 mg nitroglycerin. Between day 3-4 and the third week global ejection fraction (EF) rose insignificantly (p greater than 0.05) from 31 +/- 4 to 37 +/- 6 percent. The regional EF in the non infarcted area remained nearly stable (74 +/- 5 to 85 +/- 13 relative percent, p greater than 0.05). However, the EF in the infarcted area rose from 22 +/- 9 to 38 +/- 11 relative percent (p less than 0.05 percent). On day 3-4 nitroglycerin induced a clear increase of the EF in the infarcted area from 22 +/- 9 to 35 +/- 11 relative percent (p less than 0.05). The global EF and the EF in the non infarcted area remained nearly constant (global EF from 31 +/- 4 to 34 +/- 5 percent, EF in the non infarcted area from 74 +/- 5 to 77 +/- 7 relative percent; p greater than 0.05). Three weeks after myocardial infarction 1.6 mg nitroglycerin did not produce a significant alteration of the ejection fraction (slight increase of the global EF from 37 +/- 6 to 40 +/- 6, the regional EF in the infarcted area from 38 +/- 11 to 48 +/- 11 relative percent and from 85 +/- 13 to 90 +/- 11 relative percent in the non infarcted area; p greater than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Cardiac Output↗
PubMed1986

[PLacebo-controlled double blind study of the anti-ischemic efficacy of transdermal depot nitrate].

Twelve patients with stable angina pectoris were studied in a randomized double blind cross-over placebo-controlled manner utilizing exercise testing and measurement of ST-segment depression before, 2, 6 and 24 hours after application of a transdermal system delivering 5 mg or 10 mg nitroglycerin per day. All testings were performed at a constant work load and exercise time. Significant improvement of ST-segment depression was only seen at 2 hours (5 mg: -45%, 10 mg: -55%) and 6 hours (5 mg: -16%, 10 mg: -31%) but not at 24 hours. The lack of efficacy at 24 hours appears to be due to tolerance.

Administration, Cutaneous↗
PubMed1985

[Transfemoral angioplasty in stenosis of the isthmus of aorta].

A 14-year-old patient with severe aortic coarctation was treated by advancing a balloon catheter across the stenosis via the right femoral artery. The 4 cm long balloon, transversal diameter 15 mm, was filled with saline containing contrast media for 10 seconds. The excess pressure in the balloon was 3.5 at. Subsequently the stenosis diameter increased from 3 to 7.3 mm. The systolic pressure gradient decreased from 75 to 35 mm Hg. After the operation the foot-pulse was palpable for the first time. The highly elevated arterial pressure in the upper extremities decreased markedly. Three months after the operation the vessel diameter was 10.2 mm and the pressure gradient only 10 mm Hg.

Adolescent↗
PubMed1985

[Pericardial effusions after heart surgery. Incidence and clinical sequelae].

The frequency and clinical outcome of pericardial effusions was investigated in 104 patients following open-heart surgery. A pre- and post-operative echocardiogram was made in all cases. Pericardial effusions were present in 26%, significantly more occurring after bypass surgery (37%) than after valve replacement (15%). In 4 out of 5 cases the effusion had no haemodynamic effect and in no instance was a repeat thoracotomy necessary. A significantly higher incidence of reduced exercise tolerance, increased heart rate, atrial fibrillation and a radiologically demonstrable increase in heart size of more than 10 mm, were indicative of the presence of pericardial effusions. In contrast, central venous pressure and blood pressure were no higher than in patients without pericardial effusion. Complication-free pericardial effusions thus occur frequently after cardiac surgery. A reliable diagnosis is only possible by means of echocardiography. It remains to be shown whether the long-term clinical progress is affected.

Adult↗
PubMed1985

[Anti-angina effectiveness of isosorbide dinitrate in an acute trial and following continuous 4-week therapy with 40 mg 6 times a day].

Ten patients with angiographically proven coronary heart disease, stable exercise-induced angina pectoris, and reproducible ST-segment depression were treated with isosorbide dinitrate (ISDN) tablets in daily doses of 240 mg (6 X 40 mg) and placebo (PL) for 28 days each on the basis of a randomized double-blind protocol with intraindividual cross-over. ISDN treatment resulted in a sustained reduction of anginal attacks with a weekly mean rate ranging from 1.4 (3rd week) to 3.9 (4th week) as compared to 10.2 (2nd week) to 11.7 (4th week) during placebo treatment (P less than 0.001). Ischemic response during stress testing (sum of ST-segment depressions) was significantly improved during ISDN treatment as compared to placebo. Day 1: 56% (P less than 0.01); day 7: 30% (P less than 0.01); day 28: 49% (P less than 0.001). Heart rate and arterial blood pressure in the upright position were different between ISDN and placebo on day 1 and day 7 of the treatment phases (P less than 0.02), but not on day 28. Nitrate responsiveness with regard to blood pressure and heart rate was restored after a drug-free interval of 2 days. The plasma concentrations for ISDN and the mononitrate metabolites exhibited a constant ratio during the treatment period. Thus, therapy with 6 X 40 mg ISDN per day resulted in a sustained reduction of anginal attacks and preserved improvement of ischemic ST-segment depression during exercise in upright position.

Adult↗
PubMed1985

[Anti-anginal effect of transdermally applied nitroglycerin as dependent on the size of the plaster].

Nitroglycerin plaster (in 5 cm2, 10 cm2 or 20 cm2 sizes) was applied to 12 patients with coronary heart disease, angina and exercise-induced ischemic reactions in the course of a simple-blind trial with intra-individual crossover in a randomized sequence over one week each. A 15 cm2 plaster served as a placebo. In the placebo phase the mean number of angina attacks was 9.3 per week. It decreased to 6.2 with the 10 cm2 plaster (P less than 0.05), to 2.6 per week with the 20 cm2 plaster (P less than 0.001). The ischemia reaction in the exercise ECG (sum of ST segment depressions), recorded on day 7 of the treatment phase, was improved three hours after plaster application, dependent on the size of the plaster: placebo 6.0 +/- 1.2 mm; 5 cm2 plaster 5.1 +/- 1.0 mm; 10 cm2 4.6 +/- 1.0 mm (P less than 0.05); 20 cm2 3.4 +/- 0.9 mm (P less than 0.001). The angina-free period during ergometry showed dose-dependent improvement 3 and 24 hours after application. Arterial blood pressure was decreased only after 20 cm2 plaster by 8% after three hours, as compared with the placebo (P less than 0.05). There was no effect on heart rate, at rest or on exercise, after any plaster. The results indicate that significant decrease in ischemia reaction occurred with a plaster of 10 cm2 or larger. A 24-hour effect was demonstrable only with respect to the duration of symptom-free exercise.

Administration, Topical↗
PubMed1985

Aldosterone and prolactin responsiveness after prolonged treatment of congestive heart failure with captopril.

After long-term captopril treatment, an inappropriate increase in aldosterone levels has been observed in hypertensive patients. It is not known, whether a similar change would occur in patients with severe congestive heart failure, and whether it is due to a decrease in endogenous dopaminergic inhibition of aldosterone secretion or to aldosterone stimulation by ACTH or an ACTH-related peptide. Therefore, the aldosterone and prolactin responses to metoclopramide have been studied in 10 patients with severe congestive heart failure (NYHA Class III or IV) after 6 months of captopril treatment, before and 11 h after pretreatment with dexamethasone. 7 placebo-treated patients served as double-blind controls. In captopril-treated patients, the supine aldosterone levels exceeded the normal range and were as high as in placebo-treated patients. The responsiveness of aldosterone and prolactin to metoclopramide was not influenced by captopril. Only in the placebo group were the aldosterone levels decreased by dexamethasone. Captopril increased plasma renin activity and serum potassium, and decreased supine epinephrine and norepinephrine and serum sodium. Thus, previous reports of inappropriately high aldosterone levels after long-term captopril treatment were confirmed in patients with severe congestive heart failure. It is concluded that increased aldosterone is due neither to a decrease in endogenous dopaminergic inhibition nor to dexamethasone-suppressible stimulation of aldosterone secretion.

Adult↗