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Biomedical subjects

W Ruschewski

Publications and source records attributed to W Ruschewski.

At least 37 records · Page 2Linked to original sources
PubMed1992

[Supra-aortic extracranial revascularization in cerebrovascular disorders with special reference to stage classification].

The opinions concerning the value of a surgical approach in cerebrovascular insufficiency due to extracranial occlusive arterial disease are still controverse. We analysed a consecutive series of 216 patients after carotid endarterectomy performed in the period of 1980 to 1988. The preoperative symptoms permitted a classification into the clinical groups I to IV according to Vollmar. All operations were done under standard conditions. An intraluminal shunt was used in 194 patients (90%). In 24 patients (11%) a bilateral carotid revascularisation was carried out. The hospital mortality rate in our groups of patients was 5.1%. In order to evaluate the results, Doppler sonographic and clinical examinations with a mean follow-up of 8.1 months (range: 3 to 60 months) were performed. The neurologic examination revealed an unchanged condition in 63 patients (29%). Twelve patients (5.7%) suffered from a progression of the neurologic disorders.

Blood Vessel Prosthesis↗
PubMed1991

Successful surgical management of left ventricular free wall rupture in the course of myocardial infarction.

The case of a 49-year-old patient is described who presented with cardiogenic shock and electrocardiographic signs of an inferolateral Q-wave infarction, and who received systemic lysis with anisoylated plasminogen streptokinase activator complex (Eminase). After coronary angiography had revealed only peripheral occlusion of a posterolateral branch of the left circumflex coronary artery, a pericardial effusion surrounding both right and left ventricular cavity was identified by echocardiography and was successfully drained via an inferior pericardiotomy with an immediate rise of blood pressure. Upon thoracotomy myocardial rupture was detected in the infarct area and was closed with mattress sutures. A total of 39 cases of successful surgical repair of myocardial free wall rupture reported in the literature is discussed. The mean age of patients was 59.6 +/- 1.3 years. Posterior and anterolateral infarctions were the preferred locations of myocardial rupture. Rupture occurred with a mean delay of 5.0 +/- 1.0 days after the onset of clinical infarct signs. Among patients saved by surgical means were 33 males and 6 females.

Cardiac Catheterization↗
PubMed1989

Will emergency coronary bypass grafting after failed elective percutaneous transluminal coronary angioplasty prevent myocardial infarction?

An emergency aorto-coronary bypass grafting operation was performed within 12 hours after the development of acute myocardial ischemia due to partial or complete vascular occlusion in 34 of 950 (3.6%) patients who had received elective percutaneous transluminal coronary angioplasty (PTCA). Of the 34 patients, three (= 8.8%) died postoperatively in irreversible cardiogenic shock. Half of the surviving patients developed a Q-wave infarction after the operation, whereas the other half remained without transmural infarct. With comparable clinical data and times of operation up to placement of the aorto-coronary bypass vessel, an adequate residual perfusion must still have been present in the cases with non Q-wave infarction. Since in many cases a myocardial necrosis is unavoidable despite relatively early operative revascularization, the decisive role will be played by the remaining perfusion of the vessel concerned and any collaterals. It follows that treatment of an early PTCA complication, occurring in the catheter laboratory, ought to be the earliest possible aorto-coronary bypass operation unless available cardiological methods can reliably assure reperfusion. Treatment of a PTCA complication occurring later, however, e.g. after hours in the intensive-care unit, should be a repeat PTCA attempt: surgery at this stage will not prevent the transmural infarction but will increase risk of lethal complications.

Adult↗
PubMed1989

[Use of the autoperfusion catheter in acute coronary occlusion within the scope of percutaneous transluminal coronary angioplasty (PTCA)].

The procedure of an autoperfusion catheterization after acute coronary occlusion by dissection during percutaneous transluminal coronary angioplasty (PTCA) is described. Multiple side holes proximal and distal to the dissection allow passive myocardial perfusion only by systemic blood pressure. In the case presented, the catheter immediately reestablished coronary blood flow and thereby produced resolution of symptoms and myocardial ischemia. This easy procedure made it possible to perform the subsequent coronary bypass operation as a controlled revascularization and it prevented myocardial necrosis.

Angioplasty, Balloon↗
PubMed1985

[Experiences with telemetry-supported pacemaker controls in patients with VVI pacemakers].

Investigations on telemetry-supported pacemaker control were carried out in 55 patients with the VVI-pacemaker Quantum (Intermedics). The investigations were done at least once during the 6-24 month period after implantation. The telemetry function was utilised for pacemaker programming, for clarifying pacemaker defects and for characterising the type of pacemaker electrode used. It could be shown that the Osypka spiral electrode VY (Dr. Osypka) had a lower impedance, and greater pulse width and charge threshold in comparison with the two other electrodes used (Encor, Cordis; Polyflex, Intermedics). In 38 of the 55 patients (69%) a pulse amplitude of 2.7 V could be chosen, whereas an amplitude of 5.4 V was programmed in the rest. Pacemaker sensing threshold was set to values between 2.4 and 3.0 mV. Pacemaker problems appeared in three patients; in one patient due to programming too economically and in the other two due to pacemaker defects.

Adult↗
PubMed1981

Stabilization of flail chest by compression osteosynthesis--experimental and clinical results.

It has been demonstrated that the impaired ventilatory parameters can be normalized after early stabilization of flail chest. Most methods for operative fixation, however, have given disappointing results and only plate fixation procedures have been effective. The experimental results of osteosynthesis with dynamic compression plates are presented and demonstrate the superiority of compression osteosynthesis in rib fractures. Compression osteosynthesis resulted in a primary fracture healing with stable fragments after 14 days, whereas conventional plate fixation techniques required a much longer time and showed secondary fracture healing. The benefits of compression osteosynthesis could also be demonstrated in 10 patients with traumatic flail chest. Osteosynthesis resulted in marked pain relief, immediate stabilization of the chest wall, and a shorter time of intubation. Not all fractured ribs need stabilization, dorsal fractures are well fixed by the strong erector muscles, and in the lateral position only ribs III to VII need to be considered. Reasonable stabilization may be achieved with fixation of every second rib. In patients with bilateral rib serial fractures subcutaneous implantation of one or 2 rib struts is recommended--good results were obtained in 12 patients. The indication for operative stabilization of flail chest should be restricted to: 1. Patients with severe ventilatory restriction due to chest wall paradox alone. 2. Flail chest combined with intra-thoracic lesions which require thoracotomy. 3. Flail chest combined with lesions which require a prone position for surgical exploration. 4. Respiratory distress patients when the unstable chest wall interferes with mechanical ventilation or with underlying organs.

Adolescent↗
PubMed1981

Aortico-left ventricular tunnel.

Aortico-left ventricular tunnel (ALVT) is a very rare cardiac malformation with only 25 cases having been reported in the literature. This paper describes another 5 cases with surgical repair at the ages of 4, 5, 6, and 14 years, respectively. (A fifth case in an 11-year-old boy was operated upon just recently and is described separately in the addendum). The anatomical and clinical findings and diagnostic procedures including angiocardiography are reviewed. The surgical management is discussed, and the late results after follow-up periods of 5, 11, 13, and 16 years are presented. Three patients are doing well although showing clinical signs of mild aortic valve insufficiency, and one patient required aortic valve replacement 13 years after operation because of massive aortic regurgitation. Early surgical repair is recommended as soon as the diagnosis is established by angiocardiography in order to prevent secondary aortic valve lesion by dilatation of the aortic ring and aneurysmatic dilatation of the ventricular septum.

Adolescent↗
PubMed1981

Fontan procedure--indication and clinical results.

Twenty-six patients with tricuspid atresia (15), univentricular heart (7), and single ventricle (4) underwent 27 Fontan or modified Fontan procedures between 1975 and 1981. The age of the patients varied between 4 and 26 years. Twenty patients had had a total of 33 palliative operations prior to correction. The original Fontan procedure was performed in 10 patients from 1975 to 1977. According to the various anatomical findings modifications of the Fontan procedure, such as direct anastomosis or implantation of a valveless conduit, were introduced in 1977. Early mortality among all the patients was 22% (6 patients died). Three deaths occurred in the initial period 1975 to 1977. Among the last 20 patients (1978 to 1981) there were 3 early deaths. Three patients with single ventricle survived, one died due to pulmonary failure. There were 2 late deaths (sepsis, sudden cardiac death). Postoperative cardiac catheterization performed in 17 patients revealed excellent results in 13 patients; the remaining 4 displayed diminished arterial oxygen saturation, three of them had Glenn palliation prior to corrective surgery. Postoperative right atrial mean pressure varied from 10 to 23 mmHg. The left ventricular parameters were within the normal range.

Adolescent↗
PubMed1981

Early stenosis and calcification of glutaraldehyde-preserved porcine xenografts in children.

Thirty-four glutaraldehyde-preserved porcine aortic valves have been implanted in children at the Center of Thoracic and Cardiovascular Surgery in Göttingen since 1972. Severe stenosis of the right ventricular outflow tract (RVOT) due to massive calcification of the bioprosthetic valve was detected 15 to 76 months after surgery in 2 of 3 children with hospital-made, and in one of 25 children with commercially available valved conduits. The results with Hancock xenograft valves in mitral position were even more alarming. Five out of 6 children, aged 5 to 15 years (mean 9 years) presented similar massive calcification patterns of the bioprosthesis, necessitating reoperation from 23 to 63 months (mean 38.8 months) after implantation. Focal calcium deposits were found mostly in the central layers of the cusps; severe stenosis and regurgitation were due to immobilization of the leaf-lets which were fixed in a semi-open position. The causes for early valve dysfunction and calcification of glutaraldehyde-fixed porcine aortic bioprostheses in children remain to be further investigated. Degenerative changes have been shown to commence early after implantation, resulting in collagen disruption as early as 2 years later (3, 7, 19). There is evidence that these lesions could be predisposing factors for calcification, leading to accelerated calcification rats in children and patients with a high-calcium-turnover. The use of bioprostheses in children and adolescents must therefore be questioned since they appear to carry a high prospect to early valve deterioration.

Adolescent↗
PubMed1981

Early and long-term results after surgical treatment of abdominal aortic aneurysm.

From 1959 to July 1981, 121 patients underwent surgery for abdominal aortic aneurysm. One hundred-nine patients were male and 12 female. Ninety-one patients had an elective operation, 30 patients were operated on an emergency basis. Among the electively treated there were 32 asymptomatic patients. Early mortality of electively operated patients was 13.2% in period I (1959 to 1974), and 8.8% in period II (1975 to 1981). The early death rate of asymptomatic patients decreased from 9.4% to 4.8%. The prognosis of emergency patients remained unchanged: 50% died in both periods. Cardiac complications were the major cause of early death. The late complication rate related to the aneurysmectomy was 18.1%. Four patients died of rupture of the proximal anastomosis. Aneurysm-related reoperations were necessary in 19.1% of the patients. The mortality rate for patients under 65 years was 6.1% in period II, and 16.7% in patients over 70 years. Another severe risk factor is coronary artery disease (16.0% mortality in period II), especially in combination with advanced age (21.4% mortality in period II). The results indicate that the abdominal aortic aneurysm should be treated electively; however, poor risk patients should not undergo surgery if the aneurysm is asymptomatic. In younger patients with coronary artery disease, coronary artery bypass surgery should be considered prior to aneurysmectomy.

Adult↗
PubMed1981

Hemodynamics and energy balance of the left ventricle during low flow venoarterial bypass and venoarterial counterpulsation with an oxygenator in experimental animals.

The effects of partial venoarterial continuous flow and counterpulsating bypass with an oxygenator on the hemodynamics and energy balance of the left ventricle were studied in 8 anesthetized closed-chest dogs. A mean blood flow of 35%, and 48% of the animals's cardiac output was pumped via an extracorporeal circuit. 1. with continuous flow by means of a roller pump, and 2. with ECG-synchronized counterpulsation by means of a one-chambered electropneumatically driven ventricle pump. Central venous shunt blood was oxygenated with a double oxygenator and returned into the descending aorta. A bypass of 48% of cardiac output both with continuous and counter-pulsating flow resulted in a significant decrease of the maximal rise in left ventricular pressure (dp/dt max, 32% and 30% respectively) and of the calculated myocardial oxygen requirement (10% and 16% respectively). The improved myocardial energy balance during diastolic counterpulsation was due to a significant decrease in systolic aortic pressure (11%). During bypass of 35% of cardiac output with continuous flow the hemodynamics and energy balance of the left ventricle remained essentially unchanged. However, during bypass with counterpulsating flow a significant decrease in systolic pressure (7%) dp/dt max. (19%), and myocardial requirement oxidend (9%) was obtained. The results indicate that, if combined with counterpulsation, partial venoarterial bypass of only 35% of cardiac output can be an effective method of supporting the failing heart. Low flow venoarterial counterpulsation may therefore be of value for transitory use up to 72 hours in postoperative low-output syndrome or myocardial infarction whenever intraaortic balloon pumping alone is not sufficient or combined right and left heart failure is present.

Animals↗
PubMed1980

Fontan procedure and surgical modification in tricuspid atresia.

Nineteen patients with tricuspid atresia and reduced lung perfusion (valvular-and/or subvalvular pulmonary stenosis, transposition of the great arteries and/or single atrium) were operated in the period 1975--1979. The surgical procedures employed varied according to the additional cardiac defects. The age of the patients was between 2 and 18 years. Eleven children received a contuit with a Hancock valve, 8 children a valveless conduit. In 9 patients it was possible to connect the conduit to the right ventricle using the pumping action of the right ventricle with an anatomically intact pulmonary valve. Six patients died (4 early deaths, 2 late deaths, early mortality rate 21%). In this study, the postoperative courses, which were complicated in several cases, are related to the hemodynamical findings. Thirteen children were examined between 1 and 38 months following the operation. Cardiac catheterization was performed in 10 patients. Of the 13, 10 had fully saturated arterial blood. A remnant atrial defect was demonstrated in one child, and 2 displayed intrapulmonary shunts attendant to Glenn anastomoses which had been in place for 10 to 12 years. Among the patients the right atrial pressure ranged from 10 to 20 mmHg with a mean value of 14.5 +/- 0.9 mmHg. An increase in size of the right ventricle was demonstrated angiographically in the case of 2 patients who had valve-bearing conduits to the right ventricle.

Adolescent↗
PubMed1975

[Diangosis and treatment of pulmonary arteriovenous fistula in infancy (author's transl)].

Pulmonary arteriovenous fistulas are seldom diagnosed in infancy because of few signs and symptoms in early life. The clinical picture is due to the right-to-left shunt and includes dyspnea, cyanosis, polycythemia, clubbing, and murmur over the fistula. The diagnosis can be suspected by demonstration of a typical density on chest X-ray. It can be established by angiocardiography. Because of the life-threatening complications resectional treatment is recommended already in infancy. A case is reported, diagnosed on the second day of life by angiocardiography and treated 3 months later by lobectomy.

Adolescent↗
PubMed1975

[Coronary circulation and myocardial oxygen cosumption after cardioplegic arrest (author's transl)].

Coronary blood flow, myocardial oxygen consumption, and cardiac hemodynamics was measured before and after cardiopulmonary bypass in two group of patients (7 and 4) with minor congenital heart disease where cardiac arrest was induced by means of "cardioplegin" or "external surface cooling" (Shumway). Only myocardial oxygen consumption was reduced 20% after bypass in the "cardioplegin" group; all other measured parameters remained essentially constant.

Acid-Base Equilibrium↗