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W Klinner

Publications and source records attributed to W Klinner.

At least 19 recordsLinked to original sources
PubMed1997

Long-term survival in patients with repair of tetralogy of Fallot: 36-year follow-up of 490 survivors of the first year after surgical repair.

OBJECTIVES: We sought to analyze risk factors for long-term survival (up to 36 years) after surgical repair of tetralogy of Fallot (TOF). BACKGROUND: Survival after repair is excellent, but data >20 years are rare. METHODS: From 1958 to 1977, 658 patients underwent correction of TOF at our institution and were analyzed for survival. Of this patient group (age 12.2 +/- 8.6 years [mean +/- SD], range 2 to 67), 39.7% had a previous palliation. Operative (n = 139) and 1-year (n = 29) deaths were excluded for long-term calculations, resulting in a study group of 490 patients. RESULTS: Actuarial 10-, 20-, 30- and 36-year survival rates were 97%, 94%, 89% and 85%, respectively. Mortality increased 25 years postoperatively from 0.24%/year to 0.94%/year (p = 0.003). The most common cause of death was sudden death (n = 13), followed by congestive heart failure (n = 6). Multivariate correlates of impaired long-term survival were date of operation (before 1970, p = 0.0104), preoperative polycythemia (p = 0.0487) and use of a right ventricular (RV) outflow patch (p = 0.0079). Postoperative systolic RV/left ventricular pressure ratio and age showed no influence. Patients without preoperative polycythemia and an RV outflow patch (n = 164) had a 36-year actuarial survival rate of 96% and normal life expectancy. CONCLUSIONS: Cyanosis, operative experience of the surgeon and an RV outflow tract patch influence long-term outcome after repair of TOF in older children. Early repair by experienced surgeons to avoid polycythemia and excessive RV hypertrophy is supported by this study. However, mortality risk increases 25 years postoperatively, and thus heart monitoring should be intensified.

Actuarial Analysis↗
PubMed1997

Thirty-year results of Starr-Edwards prostheses in the aortic and mitral position.

BACKGROUND: Between 1963 and 1977 a total of 415 patients admitted to the University Hospital Munich underwent an isolated valve replacement with a Starr-Edwards prosthesis in the aortic or mitral position. METHODS: A retrospective follow-up of 87.1% of the patients representing 4,254 patient-years was completed. Surviving patients were examined by means of echocardiography. RESULTS: Survival rates after 10, 20, and 30 years were 62.3%, 39.4%, and 19.9% after aortic valve replacement and 75%, 36.5%, and 22.6% after mitral valve replacement (operative mortality excluded). Freedom from all valve-related complications, reoperations, and valve-related death was 66.4%, 43.3%, and 23.8% after aortic valve replacement and 73.4%, 35.4%, and 14.3% after mitral valve replacement. Of the surviving patients, 82% and 76% who received aortic or mitral valves, respectively, are in New York Heart Association class I or II. The pressure gradients of the aortic valves were between 20 and 73 mm Hg; those of the mitral valves were between 9 and 30 mm Hg. Fifty-two percent of aortic and 68% of mitral valves show no echocardiographic peculiarities. The left ventricular function in both groups is normal in 64%. CONCLUSIONS: The long-term results together with the echocardiographic results show that after 30 years the Starr-Edwards valve represents a standard that still needs to be achieved by newer prostheses.

Adult↗
PubMed1997

Long-term results of total repair of tetralogy of Fallot in adulthood: 35 years follow-up in 104 patients corrected at the age of 18 or older.

Long-term survival after surgical repair of tetralogy of Fallot (TOF) is reported to be excellent if the patients are corrected in childhood. However, age at operation has been demonstrated as an important risk-factor. The aim of our study was to investigate whether adult patients also benefit from surgery. From December 1958 to May 1977, 739 patients underwent a correction of their TOF with pulmonary stenosis at our institution. Foreigners (n = 52) and those who moved to a foreign country (n = 13) were excluded from further analysis. Sixteen patients were lost during follow-up (98% complete). Of the remaining patient population (n = 658; mean age: 12.2 +/- 8.6 years; range 2-67 years), 104 patients were 18 years or older at the time of correction. Operative (n = 25) and one-year (n = 8) deaths were excluded for long-term calculations, resulting in a study group of 71 patients. Actuarial 10, 20, 30, and 35-year survival rates were 94%, 93%, 83%, and 72% respectively, and not different from normal life expectancy. The most common cause of death was congestive heart failure (n = 3), followed by myocardial infarction (n = 2) and sudden death (n = 2). Parameters influencing longterm survival could not be detected. At follow-up (mean 27.7 years), more than 80% (n = 48) of the 58 survivors reported themselves to be in NYHA functional class I or II and 95% (n = 55) were in a better condition than before the operation. Repair of tetralogy of Fallot in adulthood shows excellent results with normal life expectancy for the patients.

Adult↗
PubMed1992

[Successful treatment of atrial fibrillation by resection of a congenital aneurysm of the left heart atrium].

Atrial fibrillation occurred in a 27-year-old patient with a history of globular cardiac enlargement since childhood. Because of the probable causal relationship between the preexisting heart disease-which was supposed to be an enlargement of the left atrium-and the rhythm disturbance, we recommended a surgical intervention. Cardiac surgery revealed a congenital aneurysm of the left atrial appendage which could be resected without any complication. Postoperatively, atrial fibrillation had returned to regular sinus rhythm. The bad prognosis with a high risk of systemic embolism is the reason why early cardiac surgery should be performed after diagnosis of this rare anomaly (20 reported cases) of the left atrium.

Adult↗
PubMed1990

Brock transventricular pulmonary valvotomy in patients with pulmonary stenosis: long-term results.

As no long-term results of a blind opening up of the pulmonary valve either by balloon valvoplasty or closed Brock valvotomy have been published, we examined the outcome of 12 patients with valvar pulmonary stenosis 17 +/- 5 (11-22) years after surgery. The Brock valvotomy had been carried out at a mean age of 3 +/- 2.8 (0.2-8.5) years. The mean pressure gradient across the right ventricular outflow tract had been 116 +/- 45 (75-97) mmHg at the catheter study or 106 +/- 43 (40-160) mmHg as measured intraoperatively. The right ventricular pressure after the Brock procedure was measured in the operating room in five patients as 46 +/- 15 (30-60) mmHg. Seven patients had been recatheterized at a mean age of 9.5 +/- 2 (7-12.7) years; at that time the gradient across the pulmonary valve had been 20 +/- 14 (10-37) mmHg. At a mean age of 21.7 +/- 3 (15-26) years these and five further patients were reexamined by echo Doppler. This time the pressure gradient across the pulmonary valve was 13 +/- 6 (7-20) mmHg. Moderate pulmonary incompetence was present in four and mild incompetence in eight patients; two had mild tricuspid insufficiency. All except one patient, who had suffered a cerebrovascular accident before surgery, were in NYHA functional class 1 and pursuing a profession. From these data we conclude that the blind opening-up of the pulmonary valve achieves excellent long-term palliation.

Blood Pressure↗
PubMed1990

Non-invasive assessment of right and left ventricular volumes 11 to 24 years after corrective surgery on patients with tetralogy of Fallot.

Patients who had corrective surgery for tetralogy of Fallot using a transannular right ventricular outflow tract (TRVOT) patch showed a higher risk of post-operative mortality and reoperation in the long-term follow-up. A total of 642 patients were operated upon for tetralogy of Fallot between 1952 and 1982. Twenty-six patients who survived for more than 10 years were selected for this study. Fifteen randomly selected patients (group 1) without outflow tract patch were compared with 11 patients (group 2) where a transannular right ventricular outflow patch had been used. Right and left ventricular volumes were assessed using combined first-pass and equilibrium radionuclide ventriculography. After administration of 25 mCi of 99mTc-pertechnetate, data were acquired with a gamma camera with a large viewing field and the patient at rest and during exercise. The patients in group 1 were able to manage a workload of 65 +/- 24 W on the bicycle ergometer while the patients in group 2 could only reach a mean maximum of 34 +/- 12 W. Right ventricular end-diastolic volume (RV-EDV) at rest was 198 +/- 67 ml in group 1 and 224 +/- 69 ml in group 2. During exercise, RV-EDV was increased to 218 +/- 75 ml in group 1 (P less than 0.01) and to 246 +/- 79 ml in group 2. Right ventricular end-systolic volumes did not change significantly during exercise. In group 1, the left ventricular (LV) volumes were comparable to the normal; in group 2, LV-EDV was diminished at rest and during the stress test.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1989

[Atrial septum rupture following blunt thoracic injury within the scope of polytrauma].

Blunt thoracic trauma is a frequent diagnosis in polytraumatic patients, blunt cardiac trauma a rare finding. Severe cardiac injuries e.g. myocardial rupture normally result in immediate death of the patients. If patients survive a cardiac trauma, it often remains unrecognized. The interval between trauma and diagnosis of cardiac injury can make up several months up to years. This applies in particular for the traumatic atrial septal defect. A case report of a traumatic atrial septal defect with left to right shunting due to blunt thoracic trauma in a young man is presented. To our knowledge this is the second case of a successfully repaired traumatic atrial septal defect in literature. Problems regarding diagnosis of the less commonly observed blunt cardiac traumas are discussed.

Adolescent↗
PubMed1989

[Predictive and rehabilitative perspectives in heart transplantation].

27 patients who underwent heart transplantation one to five years ago, were evaluated concerning psychological and social adjustment after heart transplantation. Prior to cardiac transplantation, predictors for good rehabilitation status were absence of psychopathology, clear motivation, good social background, advanced physical debility (being bedridden as opposed to ambulatory), absence of a history of excessive alcohol consumption. Age was not found to be a predictor of outcome. Criteria for good rehabilitation status after cardiac transplantation were absence of psychopathology, good compliance, social reintegration, return to work, psychological well-being, satisfaction with the quality of life and good exercise capacity. The criteria for good rehabilitation correlate positively with the predictors specified and with each other. Psychopathology after cardiac transplantation was related to psychopathology prior to the intervention, motivation, social background, postoperative compliance, social reintegration, return to work, psychological well-being and satisfaction with the quality of life. Compliance was related with the predictors motivation, social background, history of excessive alcohol consumption, psychopathology after transplantation and return to work. Social reintegration was correlated with social background and post-transplantation psychopathology. Return to work was related to motivation, post-transplantation psychopathology and compliance. While physical well-being was not associated with the predictors except motivation, it was related to the rehabilitation factors of post-transplantation psychopathology, social reintegration, and return to work. Satisfaction with the quality of life correlated with only the rehabilitation factors of post-transplantation psychopathology and psychological well-being. Physical exercise capacity was related to psychological well-being after transplantation.

Adaptation, Psychological↗
PubMed1988

The benefit patients derive from aortocoronary reoperation.

There is an increasing incidence of aorto coronary reoperation necessitated by intractable angina which averages 2% of 4676 initial bypass procedures. Graft obliteration, graft stenosis or progression of disease led to recurrence of symptoms in 96 patients (84 male, 12 female) who underwent a second operation. Not all occluded or stenotic bypasses were feasible for reoperation. Hospital mortality (30 days) was higher than after initial CABG, but could be reduced from 12.1% to 4.8%. Subjective and objective follow-up investigations were obtained in 77 of 84 survivors and demonstrate that successful reoperation is about 10% lower in patients with a malignant form of atherosclerosis (60%) than in patients who only suffer from occluded grafts or new proximal significant stenoses in previously unbypassed vessels (70%).

Adult↗
PubMed1988

Initial experience with heart and lung transplantation.

Between February 1983 and July 1987, twelve patients underwent heart-lung transplantation at the University of Cape Town and the University of Munich. The patients included eight men and four women, whose ages ranged from 15 to 49 years (mean, 27 years). The underlying pathologic condition was idiopathic primary pulmonary hypertension in five cases, Eisenmenger's syndrome in four cases, idiopathic pulmonary fibrosis in one case, diffuse fibrosing alveolitis in one case, and chronic emphysema in one case. The immunosuppressive regimen consisted of cyclosporine A, azathioprine, and rabbit antithymocyte globulin (RATG) during the first 2 postoperative weeks; RATG was subsequently replaced by methylprednisolone. Pulmonary rejection frequently occurred in the absence of cardiac rejection; in one case, however, this situation was reversed. Two patients required retransplantation, which was undertaken for caseating pulmonary tuberculosis with obliterative bronchiolitis after 1 year in one case and for early pulmonary insufficiency after 2 days in the other case. There were no operative deaths, but three early deaths occurred, owing to respiratory insufficiency of unknown origin (10 days postoperatively), multiorgan failure (10 days postoperatively), and acute liver dystrophy (11 days postoperatively). Five weeks after operation, a fourth patient died of multi-organ failure. There were five late deaths, all of which resulted from infectious complications. Three patients, including one who underwent retransplantation, remain alive and well, 10 to 36 months postoperatively.

Journal Article↗
PubMed1986

Surgical treatment of aneurysms of the ascending aorta. Twelve years' experience in 66 patients.

This study presents the results in 66 patients undergoing surgery for concomitant supracoronary vascular interposition and valve replacement carried out at the Department of Cardiac Surgery of the University of Munich, West-Germany, over a period of 12 years (from July 1, 1973 to June 30, 1985) using a technique similar to that described by Wheat. Forty-seven percent of the cases were true aneurysms and 20% chronic dissections. Thirty-three percent of patients had acute dissections. Early mortality was 16% in the total patient population, 9% in the group having true aneurysm and 32% in the group having acute dissection. No early death was observed in association with chronic dissections. The actuarial one-year survival rate in patients with true aneurysm or chronic dissection was 83.6%, and 54.1% in patients with acute dissection. The corresponding 4-year survival rates were 76.4% and 54.1%, respectively. The average improvement according to the New York Heart Association classification was 1.5 grades. These results confirm that the operative approach to ascending aortic aneurysms is superior to medical treatment, with the operative method involving vascular graft without concomitant aortic valve replacement as well as the method described by Wheat having both proved successful.

Acute Disease↗
PubMed1985

[Heart surgery in the aged patient].

107 patients at the age of 80 years or more were operated for coronary or valvular heart disease between 1978 and 1984. The indication for surgery was instable angina in coronary patients and intractable heart failure in such with valvular lesions. 9 coronary and 5 valvular patients died postoperatively, 7 were early postoperative deaths, mainly due to myocardial failure. The majority of cases could be improved for 1 to 2 stages according to NYHA-classification. In this group pulmonary complications were predominant. According to this observation heart operations can also be indicated in the older age patient group without very much more risk than in younger ones.

Aged↗
PubMed1984

Late results after correction of tetralogy of Fallot necessitating outflow tract reconstruction. Comparison with results after correction without outflow tract patch.

From 1958 to 1980, at the Department of Cardiovascular Surgery in Munich, 642 patients with Tetralogy of Fallot were corrected and survived the 30th postoperative day. In 140 ( = 21.8%) a valveless outflow tract patch was used. This technique was not needed in 502 ( = 78.2%) patients. Our cases differ from corrections performed today in that the patients were already 10 years old on an average when they underwent primary or secondary corrective surgery. Besides that, they could not benefit from modern methods of myocardial protection at that time. Twenty-five patients ( = 17.9%) with an outflow tract patch died within 25 years postoperatively. The main cause of death (in 68% of all non-survivors) was cardiac in origin. We compared the long-term survival rates of our 140 patch recipients with the rates of our non-patch group (patients without a right ventricular outflow tract patch) using the actuarial method. The difference between the 2 groups, 25 years postoperatively, proved highly significant: 80% survival in the patch group and 93.4% survival in the non-patch group. We conclude that patients with a valveless right ventricular outflow patch should be observed very carefully in a follow-up program. Increasing cardiomegaly postoperatively should be clarified.

Adolescent↗