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Biomedical subjects

W Saggau

Publications and source records attributed to W Saggau.

At least 37 records · Page 2Linked to original sources
PubMed1997

[Tricuspid valve endocarditis. Demonstration of a rare disease exemplified with 3 case reports].

BACKGROUND: Endocarditis of the tricuspid valve is a rare form of valvular endocarditis and occurs mainly in patients with special risk factors. CASE REPORTS: The three case reports demonstrate 3 young patients (age 30 to 37 years, 2 female and 1 male) with a typical history of those risk factors. The two women were intravenous drug addicts and one of them had suffered already an episode of tricuspid valve endocarditis several years ago. The man developed his infection after implantation of a pacemaker. In all of the three patients the endocarditis was due to infection with staphylococci twice staphylococcus epidermidis and once staphylococcus aureus. In two of the three patients the endocarditis could not be cured by intravenous antibiotics alone and these patients had to undergo cardiac valvular surgery. All patients left the hospital after several weeks without signs of infection. CONCLUSION: In clinical praxis the introduction of a special endocarditis service, a small team which has to be consulted in every suspected case of endocarditis, seems to be beneficial as well as the use of the Duke criteria for diagnosis in those cases.

AIDS-Related Opportunistic Infections↗
PubMed1997

A predictive parameter in patients with brain related complications after cardiac surgery?

OBJECTIVE: The prognostic estimation of cerebral complications after cardiac surgery is a major problem in the early postoperative period. Neuron specific enolase (NSE) is an enzyme involved in glycolysis, which is localized in neurons and axonal processes. It escapes into the blood and cerebrospinal fluid at the time of neural injury. Therefore we focused the study on the question of how far serum levels of neuron specific enolase can predict the neurological and neuropsychological outcome after cardiac surgery. METHODS: We determined, with a prospective study design of NSE serum levels in 200 patients undergoing cardiac surgery preoperatively, right after the operation and 48 h later. The NSE was measured with a solid phase enzyme immuno assay which utilized a highly specific monoclonal antibody to NSE. We evaluated the neurological and neuropsychological status before and 72 h after surgical intervention. As a control group we recruited 50 patients undergoing general surgical treatment. RESULTS: The preoperative serum levels of NSE are constantly low in all patients with a mean value of 11.1 ng/ml (8.3-13.6) and a mean +/- S.D. of 3.12 in the main group and a mean value of 9.6 ng/ml (7.8-10.3) and a mean +/- S.D. of 1.84 in the control group. The early postoperative measurements indicated a significant increase to a mean value of 19.7 ng/ml (8.7-70.9) with a mean +/- S.D. of 2.89 in the main group. In contrast there is no increase of NSE serum levels after general surgery. The 48 h postoperative mean levels declined to 14.2 ng/ml (9.9-26.2), S.D. of 3.23. In 17 out of the 200 patients a neurological complication occurred. Elevated NSE levels were found in 16 of these 17 patients. The highest concentrations of NSE were measured in 7 patients with the most severe neurological complications being transient ischemic attack and stroke. CONCLUSIONS: The early serum levels of NSE after cardiopulmonary bypass, in those patients with severe neurological deficits, indicate that NSE is a suitable marker for the detection and quantification of cerebral injury after open heart surgery. Therefore, in addition NSE seems to be of predictive value for the clinical outcome and gives implications for the treatment and prognosis of patients with brain related complications in cardiac surgery.

Adult↗
PubMed1997

Myxoma complex associated with transient hyperthyroidism: are diseases of the thyroid part of the complex?

The myxoma complex is a very rare disease. We report on a 31-year-old woman who suffered a hyperthyreosis, which resolved spontaneously. A few months later she developed a Cushing's syndrome, caused by a primary adrenocortical nodular dysplasia. A bilateral adrenalectomy had to be performed. 15 months after this operation she developed a cerebral infarction caused by an embolus from a left atrial myxoma. Our patient is a further case of Carney's syndrome. The aspect of the hyperthyreosis is interesting: Perhaps disease of the thyroid represents a new element of Carney's syndrome.

Adult↗
PubMed1994

Evoked potential monitoring during repeatedly induced ventricular fibrillation for internal defibrillator implantation.

Repeated induction of ventricular fibrillation (VF) with circulatory compromise during implantable cardioverter defibrillator (ICD) testing may cause cerebral injury. To test this hypothesis, somatosensory evoked potentials (SEP), a more sensitive marker of injury, were recorded in patients (N = 10) undergoing ICD implantation. SEP were recorded before induction of anesthesia, after induction of anesthesia, before and at several times following induction of VF. Possible modifying factors of the SEP measurements such as anesthetic application, blood pressure, body temperature, and hematocrit remained constant throughout the operations. Central conduction time was unaffected by ICD defibrillation testing. Amplitude of SEP primary complexes was transiently reduced at 34.9% (P < 0.01) by defibrillation testing, but returned to control within 10 minutes after testing. It is concluded that while ICD defibrillation testing may produce transient changes in SEP, there is no evidence of residual cerebral injury.

Adult↗
PubMed1994

[Heart rhythm after conversion of ventricular tachyarrhythmia by internal shock delivery].

The purpose of this retrospective study is the analysis of dysrhythmias following internal cardioversion/defibrillation of ventricular tachycardia (VT) or fibrillation (VF) and to discuss their relevance to the therapy with automatic implantable devices. Therefore, 304 internal conversions of VT/VF during and/or after implantation of automatic defibrillators were evaluated in 51 patients. Significant post-shock arrhythmias (bradycardia, atrial fibrillation, non-sustained VT of > or = 10 cycles) were absent after 89% of internal shocks. Pauses of > 2 s were observed in 2/9 patients without VVI-back-up pacing. The heart rate was > or = 50 bpm in 10/51 patients. Atrial fibrillation occurred in 7 patients. Non-sustained, mostly polymorphic VT consisting of > or = 10 cycles followed 18/304 (6%) internal shocks in 13 patients. The VT rate was > or = 200/min in 17/18 episodes and triggered an inadequate shock once. The incidence of non-sustained VT post-shock was unrelated to shock energy, type, and duration of the converted arrhythmia. In conclusion, automatic implantable devices should provide back-up pacing. Tachycardic rhythms can mislead automatic interpretation of the effect of internal shocks.

Adult↗
PubMed1993

In-hospital experience with multiprogrammable implantable antitachycardia/antifibrillation devices.

Multiprogrammable, automatic internal defibrillators with (n = 45) and without (n = 15) antitachycardia pacing features were implanted in 60 consecutive patients with refractory, malignant ventricular tachycardia (VT) (n = 42) or fibrillation (VF) (n = 18). Left ventricular (LV) ejection fraction was reduced to 39% +/- 12% as a result of structural heart disease in 56 patients. The complexity of the systems caused no additional risks to the surgical procedure or postoperative management. VT/VF detection parameters were individually adjusted to the arrhythmia type (detection cycle length 323 +/- 40 ms in patients with VF vs 405 +/- 40 ms for VT patients, P < 0.05) and incidence (longer detection periods if frequent nonsustained VT was also present). Shock energy was reduced in patients with VT as compared to VF (11J vs 24J, P < 0.05). Antitachycardia pacing was activated in 19/28 (68%) patients with well tolerated VT. Signal, telemetry, as detected by the device, combined with programmability allowed the device to be checked for correct decisions (these were inappropriate in four patients in three of whom corrections were non-invasive) prior to discharge. In conclusion, in the automatic tachyarrhythmia control devices we studied, programmability and flexibility appeared to be clinically safe and useful. Prolonged observation periods are required, however, to evaluate the true clinical safety and persistent efficacy of device programmability and flexibility.

Algorithms↗
PubMed1992

Intraoperative transesophageal echocardiography for the evaluation of mitral, aortic and tricuspid valve repair. A tool to optimize surgical outcome.

The present study reviews the clinical applicability and usefulness of intraoperative transesophageal echocardiography (TEE) during valve repair. Intraoperative TEE was performed in 48 consecutive patients, who were divided into three groups: 1. mitral valve repair (MVR), 2. aortic valve repair (AVR), 3. tricuspid valve repair (TVR). Residual valve regurgitation was assessed by color Doppler echocardiography on a scale from 0 to 4. The ratios of the jet area (JA) to the left- and right-atrial areas (JA/LAA and JA/RAA) were analyzed before and after cardiopulmonary bypass (CPB). In group 1, 14 patients were scheduled for MVR, of which 4 patients underwent valve replacement and 10 MVR. Post-repair TEE studies showed a significant decrease of mitral regurgitation. In 2 of the 10 patients, TEE demonstrated severe residual regurgitation requiring valve replacement during the same thoracotomy. In group 2, 11 patients underwent aortic commissurotomy. Post-repair TEE showed an increase in the systolic opening diameter and opening area of the aortic valve. One patient underwent valve substitution because of severe aortic regurgitation. In group 3, 23 patients were scheduled for TVR. In 3 of them TEE showed no significant regurgitation thus rendering tricuspid valve surgery unnecessary. Twenty patients underwent TVR of whom two showed unacceptable post-repair regurgitation requiring further surgery. Eighteen patients showed a significant reduction of valve regurgitation after TVR, and a further reduction was achieved by adjusting the tricuspid annuloplasty under TEE guidance.

Adult↗
PubMed1992

Superiority of endocardial versus epicardial implantation of the implantable cardioverter defibrillator (ICD).

The implantable cardioverter-defibrillator (ICD) has proved to be an efficient device for the treatment of severe ventricular tachyarrhythmias (VT). From May 1985 to August 1991, the ICD was implanted in 107 patients of whom 72% suffered from coronary artery disease, 17% from cardiomyopathy, 5% from long QT-syndrome and 6% from other heart disease. All patients had a life threatening episode of VT or at least one episode of ventricular fibrillation. Of 107 implants, 12% were combined with other heart surgery, 55% were isolated epicardial implantations (epi I) and in 33%, the novel endocardial (endo I) approach was chosen. Between epi I and endo I we found no difference in operation time, but time for ICU and in-hospital stay was significantly shorter using the transvenous approach. In addition, sensing and pacing capability of the endocardial screw-in electrode was superior and the need for thoracotomy was avoided, a particular advantage in patients with previous heart surgery. Complications after epi I were: temporary low cardiac output, 1; perioperative death, 2; infection, 3, and after endo I: electrode dislocation, 2. Hence, endo I may become the method of choice for patients without concomitant surgery.

Adult↗
PubMed1992

[Aortopulmonary fistula formation after operation of aortic isthmus stenosis as a rare cause of recurrent hemoptysis].

An aneurysm of the aorta with aortobronchial fistula formation was seen in a 33 year old patient as a rare cause of recurring hemoptysis. 18 years previously he had undergone surgery of coarctation of the aorta. By means of different imaging methods the diagnosis was established in time and the aneurysm resected, so that the patient survived this mostly fatal incident.

Adult↗
PubMed1992

[Intraoperative evaluation of tricuspid valve annuloplasty with transesophageal echocardiography].

The present study shows a new application of transesophageal echocardiography (TEE) to optimize tricuspid valve annuloplasty. Eighteen patients with tricuspid regurgitation (TR) underwent De Vega tricuspid annuloplasty. After cardiopulmonary bypass the tension on the suture was adjusted until the surgeon could not feel any regurgitant jet by intraatrial palpation; subsequently, the tension was further adjusted on the basis of TEE. The post-pump residual tricuspid regurgitation was assessed by semiquantitative grading of tricuspid regurgitation (0 to 4+), area of regurgitant jet and percentage of right atrial area subtended by jet area. The data obtained by intraatrial palpation were compared with the data obtained by TEE. A significant reduction of residual tricuspid regurgitation was shown by TEE when compared to intraatrial palpation. After a follow-up period of 2 weeks, no significant changes in the grade of TR were observed. The results showed that the use of TEE was able to optimize the De Vega's tricuspid annuloplasty.

Adult↗
PubMed1991

Transcription, storage and release of atrial natriuretic factor in the failing human heart.

1. In this study the relationship between the synthesis of atrial natriuretic factor at the level of atrial natriuretic factor mRNA and the atrial storage and circulating plasma levels of atrial natriuretic factor were investigated in 15 patients with heart failure. The patients underwent right and left heart catheterization before cardiac surgery for valve replacement or coronary artery bypass grafting. 2. Plasma concentrations of atrial natriuretic factor were correlated to atrial levels of atrial natriuretic factor mRNA. Atrial levels of atrial natriuretic factor mRNA and plasma concentrations of atrial natriuretic factor exhibited a close correlation to both pulmonary artery pressure and left atrial pressure. No relationship, however, could be found between the right atrial content of atrial natriuretic factor and both the expression of atrial natriuretic factor mRNA in the atria and the plasma levels of atrial natriuretic factor. 3. From these data it may be concluded that increased plasma levels of atrial natriuretic factor in the pressure- and/or volume-overloaded heart are associated with an elevated level of atrial natriuretic factor mRNA. We suggest that not only plasma levels of atrial natriuretic factor but also the expression of atrial natriuretic factor in the atrial are related to left ventricular filling pressures in the failing human heart.

Atrial Natriuretic Factor↗
PubMed1991

Performance of dynamic cardiomyoplasty related to the functional state of the heart.

Cardiomyoplasty (CMP) was performed with the left Latissimus dorsi in five beagles (group 1) with intact hearts and seven foxhounds (group 2) in whom the left ventricle was enlarged by 31 +/- 11.9% of cross-sectional area. Ventricular function curves were constructed at filling pressures ranging from 15-40 mmHg (group 2). Myocardial contraction patterns were investigated by epicardial 2-D echocardiography. Skeletal muscle contraction caused a significant increase in aortic pressure, dP/dt, stroke volume, work and performance in all animals. Function curves were shifted upward in a parallel manner. Echocardiography showed an increase of the LV cross-sectional delta area of 14.8% +/- 5.8% (group 1) and of 39.5% +/- 15.1%, and approximation of the edges of the wall defects (group 2). In conclusion, dynamic CMP as applied in this acute model, increased the performance of normal canine hearts and hence, a model of cardiac failure may not be a prerequisite for the investigation of certain technical aspects of CMP. In the failing heart, a parallel upward shift of myocardial function curves suggested increased performance of the heart/skeletal muscle complex over a wide range of filling pressures. However, the descending limb of the function curve with increasing filling pressures was observed despite skeletal muscle contraction. Hence, similar to other assist systems, the residual function of the heart may be of considerable importance in the overall performance of dynamic CMP.

Acute Disease↗
PubMed1991

Non-invasive assessment of perioperative myocardial cell damage by circulating cardiac troponin T.

Troponin T is a unique cardiac antigen which is continuously released from infarcting myocardium. Its cardiospecificity as a marker protein might be particularly useful in assessing myocardial cell damage in patients undergoing cardiac surgery. Therefore, circulating troponin T was measured in serial blood samples from 56 patients undergoing cardiac surgery and in two control groups--22 patients undergoing minor orthopaedic surgery and 12 patients undergoing lung surgery by median sternotomy. In both control groups no troponin T could be detected, whereas activities of creatine kinase were raised in all 12 lung surgery controls and activities of the MB isoenzyme were raised in five of the 12 patients in the lung surgery group and in four of the 22 patients in the orthopaedic surgery group, respectively. All the patients undergoing coronary artery bypass grafting (n = 47) and cardiac surgery for other reasons (n = 9) had detectable concentrations of troponin T. Five patients had perioperative myocardial infarction detected as new Q waves and R wave reductions. In these five patients troponin T release persisted and serum concentrations (5.5-23 micrograms/l) reached a peak on the fourth postoperative day. In the 51 patients without perioperative myocardial infarction serum concentrations and the release kinetics of troponin T depended on the duration of cardiac arrest. In patients in whom aortic cross clamping was short troponin T increased slightly on the first postoperative days; in patients with longer periods of aortic cross clamping troponin T concentrations were higher and remained so beyond the fifth postoperative day. In patients with non-specific changes on the electrocardiogram troponin T concentrations were significantly higher on days 1 and 4 after operation than in patients with normal postoperative electrocardiograms(11.2 (5) and 4.5 (2.6) v 8.2 (3.4) and 2.9 (1.6) 1microg/l). Serum concentrations of troponin T showed some myocardial cell damage in every patient undergoing cardiac surgery. The persistent increases that were more common in patients with longer periods of cardiac arrest must have been caused by damage to the contractile apparatus. These results suggest that perioperative myocardial cell necrosis may be more common than indicated by changes of the QRS complex on the electrocardiogram.

Acute Disease↗
PubMed1991

[Combined anti-bradycardia/anti-tachycardia pacemaker-cardioverter-defibrillator systems in patients with recurrent ventricular tachyarrhythmias].

In 41 patients with recurrent sustained ventricular tachycardia and/or ventricular fibrillation an integrated pacemaker-defibrillator-system (PCD, Medtronic, model 7216 A or 7217 B) was implanted. In 21 out of 24 (88%) patients a new transvenous implantation technique in combination with a subcutaneous patch electrode was used. The implanted devices comprise antibradycardiac pacemaker functions, two different forms of antitachycardiac pacemaker functions (ramp and burst pacing), and internal cardioversion or defibrillation capabilities. During a mean follow-up of 8 months 147 episodes of ventricular tachycardia were detected, 131 of them were terminated successfully by antitachycardiac pacing; in 13 episodes internal cardioversion was applied to revert ventricular tachycardia. Twenty-seven episodes of ventricular fibrillation or rapid ventricular tachycardia (greater than 200/min) were detected and successfully terminated by internal defibrillation. In six patients with intermittent rapid atrial fibrillation, change of antiarrhythmic therapy was required to avoid activation of the device. The new integrated pacemaker-defibrillator systems improve therapy in patients with life-threatening tachyarrhythmias by reducing the number of internal cardioversions/defibrillations; the non-thoracotomy approach reduces the post operative risk.

Adult↗
PubMed1990

Atrial natriuretic peptide mRNA in patients with heart disease.

The regulation of atrial natriuretic peptide (ANP) synthesis within cardiac atrial myocytes was investigated in 8 patients undergoing cardiac surgery (valve replacement or coronary bypass graft). Hemodynamic data were obtained during cardiac catheterization and venous plasma samples for ANP were withdrawn prior to surgery. Probes for determination of tissue ANP levels and ANPmRNA concentrations were taken from the right atrium. Both plasma ANP (r = 0.75; P less than .05) and ANPmRNA (r = 0.86; P less than .01) were closely related to mean pulmonary artery pressure. ANPmRNA was also related to plasma ANP (r = 0.60; P less than .07). However, no significant relationships were obtained between either plasma ANP or ANPmRNA and right atrial ANP concentrations. These data suggest that right atrial ANP synthesis is regulated by cardiac filling pressures and possibly by plasma ANP levels, independent from corresponding ANP tissue concentrations.

Aged↗
PubMed1989

[Cor triatriatum in adulthood].

Cor triatriatum was diagnosed in a 32-year-old woman (Case 1) and a 36-year-old man (Case 2). The definitive diagnosis in Case 1 was made by transthoracic 2-D echocardiography, in Case 2 (after a chance finding) only after additional transoesophageal echocardiography. Colour Doppler echo in Case 1 provided information on the number and localization of membrane openings, while in Case 2 simultaneous measurement of maximal flow velocity and normal right-sided pressures indicated that the anomaly was haemodynamically insignificant owing to the size of the central opening in the membrane (maximal diameter 2.1 cm). In Case 1, abnormal haemodynamic findings on right-heart catheterization provided the indication for surgery and the membrane was successfully removed. Postoperatively the patient was much improved and cardiac catheterization demonstrated normal values.

Adult↗
PubMed1988

Noninvasive assessment of coronary artery bypass patency: determination of myocardial thallium-201 washout rates.

This prospective study was undertaken to investigate the response of thallium-201 washout rates to coronary artery bypass surgery. Thirty-four patients with coronary heart disease were studied before and after coronary artery bypass grafting, 27 patients with normal coronary arteries serving as controls. All patients underwent cardiac catheterization and thallium-201 serial imaging, including assessment of myocardial washout rates. Pre-operatively, thallium-201 washout rates yielded a considerably higher sensitivity in detection of coronary artery disease, without significant loss of specificity compared to qualitative evaluation of serial static thallium-201 scintigrams. Post-operatively, 50 of 57 segments supplied by a patent graft showed normal washout rates, while in 9 out of 11 segments an occlusion of the graft was indicated by decreased washout rates. Compared to pre- and post-operative qualitative interpretation of static thallium-201 images, the post-operative assessment of washout rates increased both sensitivity (82% vs. 64%) and specificity (88% vs. 77%) for the evaluation of bypass graft patency. Thus, quantitative assessment of thallium-201 washout rates improves the diagnostic reliability of noninvasive detection of myocardial ischaemia with regard to the evaluation of coronary artery bypass graft patency.

Coronary Artery Bypass↗