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Biomedical subjects

W Klinner

Publications and source records attributed to W Klinner.

At least 37 records · Page 2Linked to original sources
PubMed1982

[Report on a successful orthotopic cardiac transplantation in Germany].

The first successful heart-transplantation carried out in the Department for Cardiovascular Surgery of the University of Munich, Klinikum Grosshadern is reported. The recipient, 32 years old at the time of operation, had sustained a large antero-lateral-septal myocardial infarction in June 1980; thereafter the left ventricular ejection fraction was severely impaired (e.f. = 19%). Yet, the operation was definitely planned some year later, after the patient had survived an embolus to the right lung, an acute left heart failure and a small ulcer of the stomach. The operation was performed on 8-19-1981. The donor was a 23 year old young man, who had met a fatal motorcycle accident 10 days ago. The man was pronounced dead in the afternoon of the preoperative day according to the criterions of the German Society for Surgery by means of a carotid angiogram. Donor and recipient were well matched in regard to blood group, HLA-A2-System and finally cross-match-test. Transplantation was carried out according to the technique of Lower and Shumway. Immediately p.o., immunosuppressive therapy was started using azathioprine, cortisone and antihuman thymocyte globulin. Two acute rejections were noted, the first from p.o. day 6 to 15, the second from p.o. day 22 to 34. The second acute rejection was complicated by a pneumatosis cystoides intestinii, which caused a change of the immunosuppressive therapy to Cyclosporin A. No further complications were registered in the following p.o. course, the patient is discharged since Christmas 1981.

Adrenal Cortex Hormones↗
PubMed1982

Stenosis of the supraaortic branches combined with coronary artery disease: one-stage surgical treatment.

Combined one-stage surgery of the supraaortic branches and the coronary arteries was performed on 17 consecutive patients, 13 men and 4 women, having a mean age of 56.7 +/- 8 years. Angina pectoris was the primary symptom in all patients. Signs of cerebro-vascular insufficiency were present in 4 cases, 2 with syncopies, one with amaurosis fugax, and one with drop-out symptoms. All patients were invasively examined. Coronary angiogram verified triple vessel disease in 13 cases, double vessel disease in 3 and single vessel disease in one. Angiography of the carotid artery proved unilateral disease in 11 patients, in 5 both sides were either stenosed or occluded. One patient had a left-sided proximal 80% lesion of the subclavian artery. In all cases, the supraaortic branches were done first, followed by revascularization of the coronary artery system. All patients survived the early postoperative course; one died suddenly 33 months after operation. After 16.8 +/- 14 months, 11 out of 15 patients felt much better. Signs of cerebro-vascular insufficiency were not present. Our conclusion: one-stage surgery of the supraaortic branches and the coronary arteries would seem justified. A list of indications is presented.

Adult↗
PubMed1981

[Antibiotic prophylaxis with cephalosporins in heart surgery].

60 minutes after i.v. injection tissue levels of 7 different cephalosporins were obtained using biological assay. The following concentrations were measured: cephalothn 1.4 micrograms/g; cepharin 4.7 micrograms/g; cephacetrile 11.2 micrograms/g; cephradine 15.4 micrograms/g; cefazedone 26.9 micrograms/g; cefamandole 40.3 micrograms/g, and finally cefoxitin 43 micrograms/g. The high tissue levels of cefamandole and cefoxitin are especially remarkable as i.v. doses of both antibiotics had been 50 mg/kg body weight ( doses of all other cephalosporins 100 mg/kg body weight). Except cephalothin, all cephalosporins tested were suitable for antibiotic prophylaxis in cardiac surgery.

Cardiac Surgical Procedures↗
PubMed1981

Surgical treatment for congenital occlusion of the inferior vena cava in its diaphragmatic portion.

This is a case report on a congenital occlusion of the inferior vena cava in its diaphragmatic part. Additionally, the proximal 10 cm within the retrohepatic portion of the vessel were highly stenotic. With exception of the vena hepatica brevis all larger hepatic veins were occluded. Correction was achieved using a 14 mm Gore-Tex (Polytetrafluoroethylene) graft, which connected the abdominal part of the inferior vena cava to the right atrium.

Adult↗
PubMed1979

[Combined surgical treatment for coronary heart disease as well as heart valve diseases and carotid artery stenosis].

This is an account on combined procedures in 124 patients suffering from arteriosclerotic vessel disease. In order to judge the proceedings and the results the patients were divided up into two groups. in 15 patients (group I) a carotid endarterectomy combined with an aorto-coronary bypass operation was performed; once a subclavian artery stenosis was resected at the same time. One patient of that group died after 31 days (7%). In group II 108 heart valve operations were performed together with a coronary artery revascularisation. Early and late mortality divided up as follows: aortic stenosis 6/44 (14%) respectively 2/44 (5%); aortic insufficiency 1/14 (7%) resp. 0; combined aortic disease 1/8 )13%) resp. 0; mitral stenosis 1/11 (9%) resp. 0; mitral insufficiency 6/26 (23%) resp. 2/26 (8%); combined mitral valve disease 1/2 (50%) resp. 0; three times both valves (aorta, mitral) were replaced without mortality. In our opinion combined procedures, resection of supraaortic artery stenosis respectively cardiac valve operations and aorto-coronary bypass are indicated especially since the functional long-term results are excellent. Though one should consider the high operative risk in patients with mitral insufficiency and combined mitral valve disease.

Arterial Occlusive Diseases↗
PubMed1979

Congenital cardiac malformation in infants and children.

There were 51 deaths following cardiac operation in children under one year of age. Nearly all these children were operated upon without using a cardiopulmonary bypass. The commonest cause of death was intra- or postoperative cardiac arrest usually occurring in patients with complex cardiac anomalies. The second most commonest cause was repiratory deficiency. In children between the ages of 2 and 14 years (91 deaths in 1859 patients, i.e. a mortality of 4.64%), the commonest cause of death was cardio-vascular insufficiency usually caused by the operation. In patients with tetralogy of Fallot (147 deaths amongst 709 patients) one must distinguish between right sided and left sided cardiac insufficiency. Here the next commonest cause of death was bronchopneumonia with septicaemia usually as a result of long term artificial respiration. Other causes of death such as haemorrhages and embolic phenomena are much less important. In order to lower the mortality, better postoperative treatment in an intensive therapy unit especially for children undergoing cardiac operations is suggested.

Adolescent↗
PubMed1978

[Assisted circulation with the heart-lung machine after cardiosurgical interventions: one year's experience with intra-aortal counter-pulsation with the heart-lung machine after cardiosurgical operations is reported (author's transl)].

In the period from September 1976 to 1977, aortic or mitral valve replacement was performed in 84 and 34 patients respectively. Cardiogenic shock occurred during or immediately after the operation in 3 and 2 patients respectively (= 8.8% and 2.4%). In spite of the use of intra-aortal counter-pulsation, none of the patients survived the acute event. During the same period, 8 (= 5%) out of 113 patients who had undergone coronary surgery needed intra-aortal counter-pulsation. 4 of them survived the acute left heart failure and at the present time are clinically healthy (N.Y. Heart Association Class II).

Acute Disease↗
PubMed1978

[Early and late results after surgical treatment for pulmonic stenosis with intact ventricular septum (author's transl)].

From 1958 to 1975, 309 pts. were operated on for pulmonic stenosis (PSt) with intact ventricular septum. The lesion was of the isolated valvular type in 81,5%, of the infundibular type in 9,1%, and of the combined type in 9,4%. A closed transventricular valvulotomy (Brock) was performed in 33 cases, primarily in infants. 130 pts. underwent transarterial valvulotomy in inflow occlusion, and 146 pts. were operated with the aid of extracorporeal circulation. Hospital mortality was 3,9%. All three operating methods showed almost identical early results, whereas the long-term results indicated a superiority of the open techniques. The results were less satisfying in pts. more than 20 yrs. of age than in younger ones. In 10 cases (3,4%) follow-up revealed recurrent PSt requiring re-operation, mainly because of persisting infundibular hypertrophy and markedly thickened (dysplastic) valve cusps.--Indications for the different surgical techniques are discussed on the base of the results.

Adolescent↗
PubMed1978

[Hemodynamic long-term evaluation after total correction of tetralogy of fallot operated upon as adults (author's transl)].

22 Fallot patients who had surgery after 21 years of age were thoroughly checked on an average of 11 years postoperatively. The mean functional classification according to the New York Heart Association was 1.5. Hemodynamic studies revealed excellent results. The mean systolic gradient across the pulmonary valve (delta p) was 14 mm Hg at rest and 31 mm Hg during exercise. The data assessed during exercise show that one cannot truly speak of a "total correction". Right ventricular systolic and enddiastolic pressures were elevated as well as the enddiastolic and endsystolic volumes. Right ventricular ejection fraction was significantly diminished (45%). Our results show that there was no significant difference between the patients with or without an outflow tract patch. Pulmonary insufficiency apparently bears no negative influence on long-term prognosis up to 11 years postoperatively in patients operated for tetralogy of Fallot.

Adult↗
PubMed1977

[Diagnosis and surgical treatment of aneurysms of the sinus of Valsalva (author's transl)].

Among a total of 6000 patients of the Herzchirurgische Klinik of the University of Munich, 16 patients had an aneurysm of the sinus of Valsalva. Mostly, this was localized in the right sinus, less often in the non-coronary sinus, and only in one case in the left sinus. In 9 patients the aneurysm had ruptured into the right ventricle or into the right atrium. In 2/3 of the cases the aneurysm was associated with a VSD or an acquired malformation of the aortic valve. The diagnosis in part was based on the typical history with a sudden begin of cardiac symptoms secondary to rupture of the aneurysm; however, the most useful diagnostic procedure was the heart catheterization including an angiogram of the aortic root. Surgical treatment led to good early and late results; there was a low operative risk, and complications were rare; however, the prognosis may be less favorable in the presence of an acquired malformation of the aortic valve.

Adolescent↗