PubMed Health⌕ Search

Biomedical subjects

W D Bussmann

Publications and source records attributed to W D Bussmann.

At least 91 records · Page 5Linked to original sources
PubMed1985

Sectoranalysis of left ventricular function by fully automated equilibrium radionuclide ventriculography.

We describe a fully automated method for quantification of left ventricular performance by equilibrium radionuclide ventriculographic studies, based on subdivision of the left ventricular region into 9 equiangular sectors. The precise identification of the left ventricular contours is achieved by the use of morphological and functional criteria in a sequential edge detection algorithm with a success rate of 96%. In addition to left ventricular global and sectorial ejection fraction the first harmonic of the corresponding Fourier spectrum is approximated to each sectorial time-activity curve and to the global one. Sectorial phase is calculated as the difference between the phase of the sectorial and global first Fourier component. Computerized comparison between the sectorial parameters at rest and during peak exercise localizes and classifies the degree of global and regional impairment in response to exercise. The processing time of 60 sec makes this method suitable for routine use. The validity of our procedure has been tested in 34 patients before and after successful transluminal coronary angioplasty. In these patients, 73% of the stenosed vessels before dilatation were localized by sectorial ejection fraction, 77% by sectorial phases, and 88% by the combination of both.

Angioplasty, Balloon↗
PubMed1985

Hemodynamic effects of molsidomine in patients with acute myocardial infarction.

The hemodynamic effects of molsidomine were studied in 48 patients with acute myocardial infarction and compared with hemodynamic properties in a control group of 24 patients. The most pronounced decrease in pulmonary artery diastolic pressure occurs between 30 and 60 minutes after oral administration of 8 to 12 mg (n = 16). There is no major difference in action between the oral and intravenous application of 8 to 12 mg (n = 22). Its effect lasts about 3 to 4 hours and may exceed up to 8 hours in patients with left heart failure (n = 10). The mean arterial pressure is affected only with high doses (12 mg). Cardiac output decreases slightly only in patients without left heart failure. An additional intraindividual comparison of nitroglycerin (1.6 mg sublingually) and molsidomine (12 mg intravenously) (n = 11) revealed no significant difference in hemodynamic effectiveness. Molsidomine, like nitroglycerin, acts primarily to reduce cardiac preload. An additional moderate action on afterload with a slight decline in arterial pressure may be noticed at high doses.

Blood Pressure↗
PubMed1985

[Transluminal coronary angioplasty 1977-1985. Experience with 1000 interventions].

Transluminal coronary angioplasty (TCA) was introduced in 1977 for dilatation of coronary stenoses. From October 1977 to December 1984 1087 procedures have been performed in Frankfurt. The mean success rate was 77% with an increase from 58% to 84% since 1977. Recurrences were seen within the first year in 15% of the patients, which could be treated successfully in a high percentage with a second TCA. Emergency bypass operations were necessary in 5.2%. Four patients (fatality rate 0.37%) died as consequence of the intervention. Within few years TCA has become an established procedure for myocardial revascularisation, with a high success rate. Major progress has been possible in the last few years due to technical developments, which are still going on. They may lead to further improvement of the results and enlargement of the indication for TCA.

Adult↗
PubMed1985

[Percutaneous pulmonary valvuloplasty].

Five patients (aged between 11 and 59 years) with valvular pulmonary artery stenosis and pressure gradients between 60 and 143 mm Hg underwent percutaneous transluminal balloon valvuloplasty. Selection of the appropriate balloon size was based on the measurement of the dimension of the value anulus as a determinant from the angiogram. Balloon catheters were used with a diameter of 18 to 20 mm. After placement in the stenotic valve the balloon was filled with diluted contrast material for 10-20 s. The balloon indention by the stenotic valve disappeared suddenly during expansion with one to three atmospheres. The pressure gradient in individual patients decreased from 60 to 25, from 143 to 60, 100 to 55, 143 to 60, and 60 to 37 mm Hg, in the mean from 101 to 52 mm Hg. All patients were discharged two to four days after the procedure. During follow-up with recatheterization after three to nine months (four patients) the gradients decreased as compared to the value immediately after valvuloplasty. The exercise capacity increased in all patients. No complications were observed. Balloon valvuloplasty of pulmonary valvular stenosis seems to be an alternative to the operative procedure.

Adolescent↗
PubMed1985

[Anti-angina effect of the calcium antagonist bepridil in stable angina pectoris].

Twelve patients with angiographically proven coronary artery disease and stable, exercise-induced angina pectoris were treated in a randomized sequence with placebo (PL) and bepridil tablets in maintenance doses of 200 mg, 400 mg and 600 mg per day for one week each, according to a double blind-protocol with intra-individual cross-over. The four treatment phases were separated by 2-week wash-out periods (placebo). On day 7 of each treatment phase and at the end of each wash-out period heart rate and blood pressure were measured 2 and 5 hours after drug intake and exercise stress testing was performed. The mean plasma concentrations at the end of the 1-week treatment periods 2 hours after drug intake were: 375 +/- 202 ng/ml (200 mg/day), 844 +/- 273 ng/ml (400 ng/day) and 1378 +/- 538 ng/ml (600 mg/day). Systolic blood pressure was not influenced by either bepridil dose. Diastolic blood pressure was slightly reduced (-6%) after 600 mg bepridil/day (p less than 0.05). While heart rate at rest in the upright position tended to lower values with regard to bepridil dosages, it was significantly lowered at the end of stress testing (2 hours/5 hours):400 mg: -7% (p less than 0.05)/-15% (p less than 0.05); 600 mg: -11% (p less than 0.001)/-10% (p less than 0.05). Myocardial ischemia (sum of ST-segment depressions) was improved in a dose-dependent manner (2 hours/5 hours):200 mg: -21% (p less than 0.05)/-31% (n.s.); 400 mg: -27% (n.s.)/-31% (p less than 0.01); 600 mg: -56% (p les than 0.001)/-55% (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Lack of symptomatic and long-term hemodynamic effects of prazosin in chronic heart failure. Double-blind, randomized study over one year].

Long-term treatment of congestive heart failure with prazosin is disputed. Only few controlled trials have been reported so far. Our study is the first randomized double-blind placebo controlled trial over several months that also takes haemodynamic measurements into account. 25 patients with congestive heart failure classes III and IV (NYHA) received either prazosin 20 mg/d orally (n = 12) or placebo (n = 13) and were followed up closely. Before treatment, after 6 and after 12 months we performed echocardiography, heart volume (estimated by chest X-ray) and right heart catheterization at rest and during exercise. No significant differences could be noticed during follow-up concerning the following parameters: symptoms (NYHA), left ventricular end-diastolic diameter, shortening fraction, heart volume and systemic vascular resistance. While diuretics could be reduced in 3 patients with placebo an increasing dose was necessary in 6 out of 12 patients of the prazosin group. Long-term treatment of congestive heart failure with prazosin may be valuable only in exceptional cases.

Adult↗
PubMed1985

[In vitro study of transvenous commissurotomy in severe mitral valve stenoses using the balloon catheter].

To answer the question whether mitral commissurotomy with a balloon catheter is possible, the following in vitro study was performed. In 12 patients who were operated due to severe mitral stenosis the fibrotic (n = 8) or calcified (n = 4) valves were excised and mounted in a glass cylinder. In a first step a valvuloplasty was performed with a balloon catheter (size 20 mm). Mitral valve area increased by about 40%. With simultaneous inflation of a second balloon catheter (size 15 mm) valve area increased more than 100% and reached 1.63 cm2 in the mean. Valvuloplasty was successful (increase of at least 0.5 cm2) in 11/12 cases. In 9 valves the rupture occurred within the commissures, twice within the leaflets and once the opening area increased due to dilatation. Commissurotomy with a balloon catheter seems to be possible even in calcified mitral valves although in most cases a mild to moderate stenosis will remain.

Adult↗
PubMed1984

Reduction of creatine kinase and creatine kinase-MB indexes of infarct size by intravenous verapamil.

In a prospective, controlled study, 29 patients were randomly allocated to receive intravenous verapamil, 5 to 10 mg/hour, for 2 days starting at a mean of 8 hours after the onset of myocardial infarction. Twenty-five patients received no specific treatment and served as control subjects. Left ventricular (LV) filling pressure in all patients was initially less than 15 mm Hg. Age, infarct localization and hemodynamic values on admission (Swan-Ganz catheter) were comparable in both groups. Maximal creatine kinase (CK) and creatine kinase-MB (CK-MB) values were markedly lower in the verapamil group than in the control group (CK 547 vs 703 U/liter, p less than 0.05; CK-MB 51 vs 68 U/liter, p less than 0.025), as was infarct weight (48 vs 65 g-Eq, p less than 0.03; CK-MB 31 vs 49 g-Eq, p less than 0.005). Arterial blood pressure was 10% lower in the verapamil group than in the control group. Systemic vascular resistance and LV filling pressure remained unchanged. Verapamil reduced myocardial infarction size by about 30% in patients without LV failure and the arterial pressure was reduced.

Blood Pressure↗
PubMed1984

[Transfemoral occlusion of persistent ductus arteriosus].

In six patients aged between 17 and 53 years with persistent ductus arteriosus a non-operative occlusion of the ductus developed by Porstmann was used. The procedure comprises the percutaneous insertion of an Ivalon plug via the femoral artery in local anaesthesia and lodging in the patent ductus. Placement is enabled by pre-placing of an arterio-ductus-venous wire catheter. In all six consecutively treated patients the procedure was successful. Follow-up assessment after three months confirmed positioning of the plug in the ductus. In one female patient with cardiac insufficiency the complaints had completely disappeared and cardiac size had greatly diminished. Thus a comparatively trouble-free catheter technique for occlusion of the ductus is available which may replace surgery.

Adolescent↗
PubMed1984

[Anti-anginal efficacy of oral nitroglycerin. A clinical double-blind study with dose-effect relationships].

Nitroglycerin, bound to polymerized cellulose (Nitroglin) was administered orally in single doses of 2.6 mg, 6.5 mg, 10 mg and 20 mg (randomized sequence) on four different days to 12 patients with angina due to coronary heart disease. This was done within the framework of a placebo-controlled double-blind study with intra-individual cross-over to assess dose-related reduction of the ischaemia reaction in the exercise ECG. The ischaemia reaction (sum of ST segment depressions) 30 min after a placebo was 10.4 +/- 4.6 mm; after 2.6 mg nitroglycerin it was 8.0 +/- 4.3 mm (-23%, not significant); after 6.5 mg it was 6.4 +/- 3.4 mm (-38%, P less than 0.01), after 10 mg it was 4.7 +/- 2.9 mm (-55%, P less than 0.001), and after 20 mg 2.7 +/- 1.9 mm (-74%, P less than 0.0001). The dose-related effect of nitroglycerin was still demonstrable to the same extent three hours after intake. After 20 mg a reduction in ischaemia reaction by 55% compared with the placebo effect was still present 6 hours later (P less than 0.01). The arterial blood pressure on lying and standing as well as the heart rate on lying, standing and on exercise did not change significantly, regardless of dose. Taken by mouth nitroglycerin was well tolerated and had a dose-related anti-anginal effect. After single doses of 10-20 mg the anti-ischaemic effect was shown to persist for several hours.

Administration, Oral↗
PubMed1984

[Percutaneous bursting of the pulmonary valve].

In a 25-year-old female patient with pulmonary valve stenosis valvuloplasty could be successfully performed using a balloon catheter inserted via the femoral vein. Balloon measurements were 2 cm width and 3 cm length, the required pressure was 5 atm. There was a decrease of the pressure gradient form 60 to 25 mm Hg, systolic right ventricular pressure decreased from 88 to 50 mm Hg. Besides transluminal angioplasty of coronary stenoses and non-surgical occlusion of patent ductus arteriosus thus a further catheter technique for treatment of organic heart disease has become available, being able to replace surgery.

Adult↗
PubMed1984

Dose-response relation of antianginal activity of isosorbide dinitrate.

Eleven men with angiographic evidence of coronary heart disease and stable, exercise-induced angina pectoris were given placebo (P) or isosorbide dinitrate (ISDN) in a daily dose of 30, 120, 240 or 480 mg, in a randomized single-blind trial. The daily doses were administered 6 times a day as single oral doses of 5, 20, 40 and 80 mg. Each dose or placebo was given for 7 days. Before therapy was begun, and on the seventh day of each treatment period, an exercise ECG with standardized level and duration of exercise was recorded. Subsequently, a 4-week treatment period with 480 mg/day was carried out at the end of which another stress test was performed. The was followed by a final 2-week placebo period. The frequency of anginal attacks per week tended to decrease with increasing nitrate doses, but decreased significantly only after the highest dose (480 mg/day) compared with placebo. Continuation of therapy with 480 mg/day maintained the reduced rate of anginal attacks. The ischemic response, expressed as the sum of ST-segment depressions in the exercise ECG, revealed a dose-dependent reduction of 26% (30 mg/day), 39% (120 mg/day) (p less than 0.01), 63% (240 mg/day) (p less than 0.01) and 72% (480 mg/day) (p less than 0.01), respectively. At the end of the 4-week treatment period with 480 mg/day, antianginal efficacy was found to be moderately reduced, showing a 56% reduction of ischemic response compared to the placebo trial. The time of onset of angina during exercise testing was also delayed in relation to the dosage given.(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

Effects of intravenous nitroglycerin on ventricular ectopic beats in acute myocardial infarction.

Ventricular premature beats (VPBs) in 21 consecutive patients with acute myocardial infarction (AMI) were continuously recorded on magnetic tape by means of an automatic arrhythmia monitor and counted manually. The patients were sequentially assigned to either a control (n = 11) or nitroglycerin group (n = 10). Both groups were comparable for age as well as for onset, localization, and extension of infarction. Recording in the control groups was begun at a mean of 9.3 hours following onset of infarction as obtained from patient history. This interval was 12.0 hours in the nitroglycerin group. At the start of therapy, the number of VPBs was identical in both groups. Ten patients received a mean of 2.1 mg of nitroglycerin per hour intravenously for 48 hours, whereas the control group received no specific therapy. The number of VPBs in the control group increased progressively until the sixth hour of registration and reached a maximum of 165% of the baseline value before subsequently declining. Nitroglycerin administration was associated with a significantly more rapid reduction in ventricular arrhythmias: 6 hours after onset of recording, the number of VPBs had declined to 39% of the baseline value (p less than 0.05 compared to control group). This study demonstrates that nitroglycerin reduces ventricular ectopic beats in the acute phase of myocardial infarction.

Arrhythmias, Cardiac↗
PubMed1984

Loss of effectiveness of dihydralazine in the long-term treatment of chronic heart failure.

The sustained effectiveness of the arteriolar vasodilator dihydralazine has not yet been established. Acute and long-term supplementary therapy with dihydralazine was therefore compared with placebo in 14 patients with severe congestive heart failure (classes III and IV) due to congestive cardiomyopathy. The heart failure had in most cases been refractory to treatment with digitalis and diuretics. Right and left ventricular filling pressures, cardiac output and systemic vascular resistance at rest and during exercise were measured by means of repeated right-heart catheterization. Left ventricular dimensions and contractility were measured with echocardiography, and heart volume determined by chest X-ray. Following the acute administration of 25 mg i.v. (n = 10) or 100 mg oral dihydralazine (n = 8), cardiac output increased significantly from 4.0 to 6.7 l min-1 and from 4.7 to 7.7 l min-1 respectively (2P less than 0.001). Systemic vascular resistance (SVR) decreased by about 50% (2P less than 0.02). The pulmonary artery diastolic pressure remained unchanged. At the same time, heart rate rose moderately, but significantly, and the arterial blood pressure fell slightly (approx. 7 mmHg). Shortening fraction increased from 12.5% to 17.0% (i.v.; 2P less than 0.01). During exercise, cardiac output reached about 11.7 l min-1 (i.v. and orally) as compared with 7.7 l min-1 before the administration of the vasodilator (2P less than 0.05). After a 12-week treatment period with 20 mg day-1 oral dihydralazine (n = 9), the haemodynamic effects were clearly diminished. In comparison with a placebo-period (4 weeks) following the study, only a moderate increase in cardiac output accompanied by a moderate decrease in SVR was found. In only 3 cases did the patients condition improve by one class (NYHA). All 3 had shown an initially extremely high SVR which could be effectively and persistently reduced under long-term therapy. Six patients remained unchanged, and 2 patients (class IV) worsened clinically, so that the medication had to be discontinued. Heart volume (chest X-ray) increased slightly during the 3 months of long-term therapy and notably during the one-month placebo period. According to these results, although patients with severe heart failure may show impressive haemodynamic improvement upon acute administration of dihydralazine, in most cases this improvement cannot be maintained under long-term therapy.

Adult↗
PubMed1984

[Reversibility of akinetic segments in coronary heart disease].

Akinetic wall segments not exhibiting contractions following nitroglycerin administration or in a post-extrasystolic beat are usually considered to consist of scar tissue; i.e. even by re-established or improved blood supply following aorto-coronary bypass surgery no functional improvement is expected. In the present study, the pre- and postoperative ventriculograms (RAO projection) of 24 patients undergoing bypass surgery were analyzed. Ventriculography was routinely performed following sublingual nitroglycerin and a post-extrasystolic contraction. In each patient the akinetic segment had received a bypass graft which was found to be patent on reangiography. In 7 of 24 patients (29%) the formerly akinetic segment exhibited improved contraction postoperatively; in 17 patients the segment remained akinetic. Global ejection fraction rose in the group of patients with improved akinesia from 47 +/- 10 to 65 +/- 10% (p less than 0.05). In the patients with unchanged contraction pattern, ejection fraction was found to be 56 +/- 12% prior to surgery and 54 +/- 16% after surgery (n.s.). The increase in ejection fraction was more pronounced in those patients showing improvement of anterior wall akinesia (from 39 to 72%) than it was in patients exhibiting improved inferior wall akinesis (from 54 to 59%). According to these findings, the regional ejection fraction was found to be higher postoperatively in patients with former anterior wall akinesis (78%) than in those showing inferior wall contraction abnormalities (49%). End-diastolic and end-systolic left ventricular volume changes postoperatively did not reach statistical significance, although end-systolic volume showed a clear trend to decrease (preoperative: 114 +/- 54 ml/1.73 m2; postoperative: 79 +/- 29 ml/1.73 m2; n.s.).(ABSTRACT TRUNCATED AT 250 WORDS)

Angina Pectoris↗
PubMed1984

Differences in the production of methemoglobin during high-dose treatment with isosorbide dinitrate or isosorbide 5-mononitrate.

12 patients with coronary heart disease were studied to see whether high doses of isosorbide dinitrate (ISDN, Corovliss) or isosorbide 5-mononitrate (IS-5-MN, Ismo) increase the erythrocyte methemoglobin production in an acute experiment and after 4 days of medication. The patients were divided into two groups. Group 1 (6 patients) was given a single dose of 80 mg ISDN on the morning of day 1 and Group 2 (6 patients) was given 80 mg IS-5-MN as a single oral dose. Under the influence of the IS-5-MN no change was observed from the initial methemoglobin (met-Hb) value (0.81% of the total Hb) at measurements performed 1 and 2 h after the administration of the drug. In Group 1 (ISDN) the initial met-Hb value was 0.58% of the total Hb, a slight increase to 0.70% being observed after 1 h and to 0.77% after 2 h (p less than 0.05). The patients were then treated as follows for a further 4 days: Group 1 480 mg ISDN/d, Group 2 480 mg IS-5-MN/d. On day 5 the initial met-Hb values in both groups were unchanged compared to day 1. The patients were then given first 80 mg ISDN (Group 1) or 80 mg IS-5-MN (Group 2) and 4 h later a single dose of 160 mg of the appropriate substance. In Group 2 (IS-5-MN) the met-Hb content remained unaffected. In Group 1 a slight increase of the met-Hb to 0.79% occurred 1 h after 80 mg ISDN and to 0.9% after 2 h (p less than 0.05). The dose of 160 mg ISDN gave rise to a further slight increase to 1.00% (after 1 h) and 1.13% (after 2 h) (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

[Direct recanalization with transluminal angioplasty in acute myocardial infarct].

Treatment of acute cardiac infarction by invasive recanalization permits simultaneous removal of stenosis and occlusion: this is achieved by direct transluminal angioplasty, passage of the occlusion with the folded balloon catheter and dilatation of the stenosis. In a 42-year-old patient with anterior wall infarction and cardiogenic shock a high subtotal occlusion of the interventricular anterior branch with a thrombus beyond the 99% occlusion was seen. Due to the life-threatening state of the patient the narrowing was directly passed and relieved by dilatation. The patient survived the severe cardiogenic shock. In a second patient with posterior wall infarction complete occlusion of the right coronary artery occurred. A balloon catheter was passed without prior manipulation of the guide wire, and the occlusion was passed without difficulty. After dilatation, only moderate narrowing could be observed. Both cases demonstrate that recanalization and simultaneous removal of stenosis is possible when transluminal angioplasty is used from the beginning.

Adult↗