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Biomedical subjects

W Kienast

Publications and source records attributed to W Kienast.

At least 19 recordsLinked to original sources
PubMed2004

Predicting the risk of early atherosclerotic disease development in children after repair of aortic coarctation.

AIMS: Increased cardiovascular morbidity is manifested a long time after the repair of aortic coarctation (CoA). By way of impaired flow-mediated vasodilation (FMD) and increased intima media thickness (IMT), surrogate parameters of atherosclerosis, cardiovascular risk factors (RFs) can be correlated with early vascular wall changes in children. This study investigated whether changes in arterial wall function and morphology are detectable in children after coarctation repair. METHODS AND RESULTS: We examined 28 children after successful repair of CoA vs. 30 control subjects. All children underwent identical screening, with a broad RF profile and FMD/IMT measurements. CoA-children presented significantly (P < 0.001) impaired FMD (4.87 +/- 2.6 vs. 10.2 +/- 3.1%) and higher IMT values (P < 0.001) than the controls (0.48 +/- 0.08 vs. 0.38 +/- 0.05 mm). The blood pressure during rest and exercise and the left ventricular mass were significantly elevated, but no additional RF could be identified in CoA-children. Only a remaining pressure gradient related significantly to FMD. CONCLUSION: This study documents early vascular wall changes in children after successful coarctation repair. Arterial hypertension and a resting pressure gradient are the major contributing factors to early atherosclerotic development and should be primary targets for therapy. Vascular status should be monitored regularly by FMD and IMT.

Adolescent↗
PubMed2000

Safety and efficacy of interventional occlusion of patent ductus arteriosus with detachable coils: a multicentre experience.

UNLABELLED: In order to define the safety and efficacy of Cook detachable coils for interventional closure of patent ductus arteriosus, we performed a retrospective analysis of all patients who underwent cardiac catheterization in seven centres for intended interventional occlusion of patent arterial duct. From January 1995 until March 1998, cardiac catheterization for intended interventional occlusion of patent arterial duct was performed in 317 consecutive children. Successful placement of at least one coil was achieved in 282 children (89%). The mean diameter of the ductus in children treated with Cook detachable coils was 1.65 mm, mean fluoroscopy time was 10.7 min. Occlusion rates were 62% 10 min after the procedure, 82% at the time of discharge, 91% at 4 months and 95% at late follow-up (2 years). In children with a ductus diameter of < or = 2.5 mm the rate of successful coil deployment was 94% with a 98% occlusion rate at late follow-up. Complications occurred in 11 procedures (3.5%) including haemolysis (3 patients), embolization of a coil to the pulmonary artery (7 patients, 2.3%) and inability to release a coil (1 patient). CONCLUSION: In our opinion, Cook detachable coils are safe and effective especially in the treatment of persistent ductus arteriosus with a diameter < or = 2.5 mm. Due to the low costs these coils appear to be superior to other devices in this subgroup of patients.

Adolescent↗
PubMed1998

Permanent junctional re-entry tachycardia. A multicentre long-term follow-up study in infants, children and young adults.

AIMS: Permanent junctional re-entry tachycardia is a relatively uncommon form of re-entry tachycardia with antegrade conduction occurring through the atrioventricular node and retrograde conduction over an accessory pathway usually located in the postero-septal region. It was the aim of the study to investigate the course of permanent junctional re-entry tachycardia with particular regard to the effectiveness of pharmacological treatment and ablation procedures; evaluation was performed with respect to the patient's symptoms, tachycardia rate, frequency of the tachycardia and left ventricular function. METHODS AND RESULTS: The long-term follow-up of 32 patients with permanent junctional re-entry tachycardia was evaluated. The first presentation with supraventricular tachycardia occurred between the 27th week of gestation and 27 years. The tachycardia rate ranged from 100 to 250 beats.min-1. During Holter-ECG, permanent junctional re-entry tachycardia was documented as present for over 50% of the time in 24 h in 22 patients (69%). Left ventricular performance was impaired in nine patients (28%) due to a tachycardia-related cardiomyopathy. Symptoms or signs of heart failure were mild to moderate in eight and severe in four patients; 20 patients showed no clinical impairment. Follow-up time was 1 to 31 (mean 10) years; current age of the patients ranged from 1.5 months to 35 (mean = 15 x 3) years. Four patients needed no therapy because of the infrequency of permanent junctional re-entry tachycardia episodes. Twenty-five patients initially received antiarrhythmic drugs, which were effective or partially effective in 14 (56%). Eight of them are still on medical therapy; in five treatment was discontinued because of absence of symptoms. Eleven patients had ablation of the accessory pathway during follow-up, three underwent ablation as a primary procedure. CONCLUSION: Permanent junctional re-entry tachycardia in our experience is an arrhythmia with a large variety of clinical symptoms. Patients with a slow tachycardia rate and infrequent episodes of tachycardia may never develop symptoms and therefore do not need any therapy. Patients with frequent permanent junctional re-entry tachycardia, a fast tachycardia rate and impaired left ventricular function need effective therapy. In infancy and early childhood medical therapy is recommended as a first option, whereas in older and symptomatic patients catheter ablation is an effective and safe procedure.

Adolescent↗
PubMed1994

Arrhythmias in infants and children with primary cardiac tumours.

Twenty-one patients, aged from 1 day to 16 years (median 8 months), with primary cardiac tumours, were studied with regard to the occurrence of arrhythmias. Standard electrocardiogram (ECG) was available in 20 cases and 24 h ambulatory ECG in 19; nine patients had prospective follow-up investigations (mean follow-up time 3.0 years). Standard ECG revealed preexcitation in two and arrhythmias in six patients. Ambulatory ECG disclosed seven patients with significant rhythm disturbances and in four of these, the arrhythmia was the symptom leading to the diagnosis of a cardiac tumour. Three patients were symptomatic from arrhythmia and two of them were successfully treated with antiarrhythmic agents. The remaining patient with recurrent life-threatening ventricular tachycardia underwent partial resection of a large left ventricular fibroma; no further episodes of ventricular tachycardia were observed postoperatively. Only one of the 15 patients with cardiac rhabdomyomas required antiarrhythmic therapy. None of the nine patients prospectively followed developed arrhythmias requiring therapy. The present data underline the fact that infants and children with cardiac tumours rarely need surgery because of arrhythmia resistant to medical treatment. As far as possible, conservative management is indicated in infants with suspected rhabdomyomas.

Adolescent↗
PubMed1993

[Coronary artery fistula--surgical or percutaneous embolization treatment?].

Three children aged 4 months, 2.7 and 7 years with the unusual fistula of the left coronary artery to the right atrium were observed over a 2-year period. The two younger children underwent emergency surgery although they showed no clinical symptoms. The reasons for surgical intervention were an aneurysm in the right atrium with obstruction of the vena cava superior and a considerably enlarged fistula, respectively. In the older child, we percutaneously embolized a terminate fistula of the ramus circumflexus with two platinum microcoils without complications. Two-dimensional-echocardiography and color flow mapping were used to confirm the diagnosis. After such diagnosis we recommend a coronary angiography in every case. The transcatheter-coil-embolization is an alternative method to surgical closure in selected cases. We recommend an early onset intervention in case of congenital coronary artery fistula.

Aortography↗
PubMed1992

Atrial automatic tachycardia in infancy and childhood.

Twenty-one cases (13 male, eight female) of atrial automatic tachycardia (AAT) assessed by standard and Holter-ECG in otherwise healthy infants and children have been documented. AAT was incessant in 12 patients, repetitive in seven, and of undetermined type in the remaining two. The frontal P wave axis suggested an ectopic focus in the high right atrium or right atrial appendage in 13 patients, in the low right atrium in one patient, and in the left atrium in seven patients. Thirteen out of 14 patients with the incessant or undetermined type of AAT were symptomatic, in contrast to only two of seven patients with the repetitive type. All patients were treated with between one and eight (median three) antiarrhythmic drugs. The most effective drug was amiodarone, followed by the class I C antiarrhythmic drugs, propafenone and flecainide. At present, all patients are alive 4 months to 21 years (median 2.5 years) after diagnosis of AAT. Twelve patients are in sinus rhythm, five of them without any medication. Nine patients still have AAT, which, however, is repetitive or intermittent in all but one. In conclusion, AAT is an unusual, and in its incessant form often severely symptomatic arrhythmia, which is resistant to conventional antiarrhythmic medication. However, amiodarone and class I C antiarrhythmic drugs are frequently effective. Since medical treatment with these drugs is often successful, and AAT may resolve completely, a conservative approach is indicated in many cases.

Adolescent↗
PubMed1991

[Current treatment protocol in cardiovascular diseases in childhood. 1: Heart failure, diseases in the neonatal period, congenital heart defects. 2: Arrhythmias, carditis, cardiomyopathies, shock, hypertension].

It is given an overview about actual strategies of the treatment of children suffering from heart diseases. Partly proven drugs are given in an optimized doses e.g. digoxin and digitoxin where as other new drugs and therapeutic principles are introduced e. g. catecholamines and vasodilator agents, antiarrhythmic drugs or electrotherapy and antiarrhythmic surgery. Various functional disturbances of the cardiovascular system can occur in the newborn period. New diagnostic principles especially echocardiography with doppler sonography, holter monitoring and exercise testing have lead to better therapeutic regimens. Heart catheterizations have new therapeutic tools like the balloon valvuloplasty of a stenotic pulmonic valve. At least the advances of cardiac surgery have lead to a shift of the time of correction to early childhood. Two step interventions are more and more removed and the related children and their families will have a better outcome and a better life quality.

Arrhythmias, Cardiac↗
PubMed1990

[Children after an electric injury. A retrospective 10 year study].

We analysed the clinical and laboratory findings of 31 patients who had undergone electrical injuries and who were treated in our hospital from 1979 to 1988. Only in two out of 30 injuries in the low voltage range we found arrhythmias of the heart caused by the accident. The paraclinical findings did not show any unambiguous pathological values. In accordance with the bibliography we are of opinion that children who underwent low voltage electrical shock may be considered as not endangered, of the case history is known and if clinical status and electrocardiogram are normal, so that they should not stay in hospital. Seldom complications and exeptions are mentioned. Because of the higher incidence in the early childhood and the special risk by nonprotected sockets measures should be propagated to increase the safety in the domestic environment of the children.

Adolescent↗
PubMed1984

[Clinical relevance of the so-called arteria lusoria in childhood].

Although arteria lusoria is relatively frequent, symptomatic cases are rare in childhood. Symptoms are not caused by the retroesophageal course of the vessel itself, but by additional anomalies of the other branches of the aortic arch, above all by the pretracheal course of the equilateral arteria carotis communis. In very rare cases, the anomalous right arteria subclavia passes between esophagus and trachea and may cause threatened impending respiratory disturbances together with an aberrant course of the arteria carotis. The diagnostic and therapeutic procedure is discussed; the development of pulmonary hypertension in vascular respiratory disturbances is pointed out.

Aorta, Thoracic↗
PubMed1977

[The prompt squatting in the ambulance of pediatric cardiology (author's transl)].

The result of prompt squatting is an increase of the venous return and of the arterial resistance. Consequences are increasing of the end-diastolic and systolic chamber pressure, stroke volume, average arterial blood pressure as well as decreasing of the frequency of the pulse controlled by baro-receptors. The regulatory mechanism both change the intensity of heart murmurs of various cardiopathies and of functional heart murmurs in children. Only the systolic murmur of muscular subvalvular aortic stenosis softens. The experiment is most valuable for the recognition of mild insufficiency of semilunar valves.

Adolescent↗