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Biomedical subjects

W Saggau

Publications and source records attributed to W Saggau.

At least 55 records · Page 3Linked to original sources
PubMed1988

[Painless aortic dissection: the problem of early diagnosis. A case report].

Painless aortic dissections occur very rarely, the absence of the important cardinal symptom "pain" may cause a delayed establishment of diagnosis. As early operation improves prognosis, this delay may have harmful consequences for the patient. The case reported presented initially only with neurological symptoms and later with blood pressure instabilities. Nevertheless, the diagnosis has been established within 48 h, but the patient did not survive operative emergency treatment.

Aged↗
PubMed1986

Cardiodilatin-immunoreactivity in specific atrial granules of human heart revealed by the immunogold stain.

The immunogold technique was applied to detect cardiodilatin-immunoreactivity (CDD-IR) in human heart. Using antibodies directed against C-terminal regions of CDD, we could identify colloidal gold label in specific atrial granules of human heart. The granules in all areas of the myoendocrine cells were homogeneously labelled and all right atrial biopsy specimen of patients with different heart diseases reacted positively and had the same distribution of label. The Golgi-apparatus and ergastoplasma exhibited and extremely weak CDD-IR. The results indicate a predominant storage of CDD in specific granules.

Atrial Natriuretic Factor↗
PubMed1986

[Indications for ligation of ductus arteriosus Botalli persistens in premature infants].

Ligation of patent ductus arteriosus can be safely performed even in the smallest prematures and may be life-saving. Medical treatment with prostaglandin-inhibitors may be substituted in selected cases. From 1976-1985 a total of 215 prematures was treated. 52 of those experienced spontaneous closure. In 68 infants closure occurred following indomethacin-treatment. 48 had operation after failure of medical therapy and 53 with contraindications to indomethacin were primarily operated. The overall mortality reached 20% and was highest among those with combined medical and surgical treatment.

Birth Weight↗
PubMed1986

Ruptured aneurysms of the sinus of Valsalva.

From 1964 to 1984, 10 male and 5 female patients with ruptured aneurysms of the sinus of Valsalva (ASVs) underwent surgical correction. These procedures constituted 0.23% of the 6,350 surgical procedures that used cardiopulmonary bypass during this period. Five patients had an inflammatory condition (bacterial endocarditis, 4; syphilis, 1), and 1 had an ASV relapse 5 years after her first operation. Coexistent lesions included aortic valve regurgitation in 5 patients, ventricular septal defect in 3 (1 of whom had mitral insufficiency), patent foramen ovale in 2, and atrial septal defect in 1. Ninety-three percent were symptomatic (sudden onset of symptoms, 5 patients; gradual onset, 9 patients), commonly with shortness of breath, fatigability, chest pain, and tachycardia. The following connections occurred: noncoronary sinus to right atrium (RA) (5 patients); right coronary sinus (RCS) to RA (5 patients); and RCS to right ventricle (5 patients). There were no early or late postoperative deaths. One patient underwent reoperation after an ASV relapse. The mean follow-up period (+/- standard deviation) was 7.9 years (range, 10 months to 20.1 years). Eighty percent of the patients were found to be in New York Heart Association class I, and 20% were in class II. Apart from ASV relapse, late complications are determined by prosthetic valve dysfunction or evidence of valve disease. Early surgical intervention is justified in patients with ruptured ASV.

Adolescent↗
PubMed1986

Pathomorphological study of the endocrine heart in various cardiovascular diseases.

Tissue of the endocrine heart was examined from patients undergoing open heart surgery for aorto-coronary bypass and correction of valve and septum diseases. The right auricular myoendocrine cells were studied with immunohistochemistry and electron microscopy for cardiac hormones (cardiodilatin = CDD-99-126, which is identical to alpha-human atrial natriuretic polypeptide = alpha-hANP). Furthermore, the pre- and postoperative blood samples were analysed by radioimmunoassay (RIA) combined with high pressure liquid chromatography (HPLC) to determine the plasma concentration and the molecular forms of circulating CDD-99-126/alpha-hANP. The results show that, depending on the status of the patient, differing quantities of CDD-IR (cardiodilatin immunoreactivity) are detected in the myoendocrine cells. This is also confirmed by the granularity of myoendocrine cells, as seen in the electron microscope. The ACB (aorto-coronary bypass) patients with normotonia exhibit, as a rule, the status of a normal endocrine heart. In mitral valve diseases, particularly in the combined vitia, prominent autophagolytic changes in myoendocrine cells are frequently seen. Pre- and postoperative blood shows only one circulating form of cardiodilatin which exhibits the characteristics of the 28 amino acid residues containing molecule CDD-99-126/alpha-hANP. The postoperative CDD content of blood plasma tends to decrease mainly in patients with successful treatment.

Atrial Natriuretic Factor↗
PubMed1986

[Surgical indications in mitral valve stenosis, combined mitral valve defect or mitral valve insufficiency. Long-term prognosis of operated or drug-treated patients].

Data obtained from 683 patients with mitral valve disease, NYHA-class III or IV, were retrospectively studied by means of a multivariate Cox regression analysis. Based on symptoms and hemodynamic findings, surgical intervention had been recommended for all patients: closed mitral commissurotomy (n = 361), prosthetic mitral valve replacement (n = 241) and prosthetic mitral valve replacement together with a corrective procedure for the tricuspid valve (n = 81). While the majority of patients underwent surgery during the observation period (n = 528), a substantial number of patients continued on medical treatment (n = 155). The mean observation periods were 52, 49 and 31 months, respectively, in the three collectives. Surgically treated patients in whom closed mitral commissurotomy had been recommended had a better prognosis (p less than 0.0003) than those treated medically (five-year survival rate 89% vs. 63%). Age, clinical severity, previous mitral commissurotomy, pulmonary vascular resistance and right atrial mean pressure had no significant influence on prognosis. In patients in whom prosthetic mitral valve replacement had been recommended, surgical treatment led only to tendencial improvement in prognosis as compared with those treated medically (five-year survival rate 78% vs. 61%). Factors with an unfavorable influence on prognosis were age more than 49 years (p less than 0.05), pure mitral regurgitation (p less than 0.001), NYHA-class IV (p less than 0.02) and right atrial mean pressure in excess of 4 mm Hg (p less than 0.01). In patients in whom prosthetic mitral valve replacement together with a corrective procedure for the tricuspid valve had been considered necessary, surgical treatment had no significant influence on prognosis as compared with those treated medically (five-year survival rate 57% vs. 53%). Patients in whom previous mitral commissurotomy had been performed had an extremely poor prognosis (p less than 0.001). Pulmonary vascular resistance was significantly reduced both after mitral commissurotomy as well as after prosthetic mitral valve replacement; this was associated with a significant decrease in right atrial mean pressure and increase in right ventricular ejection fraction. The indication for closed mitral commissurotomy, thus, appears established in patients with symptoms of class III or IV clinical severity. The indication can be established generously since the surgical mortality is low and long-term prognosis is good.(ABSTRACT TRUNCATED AT 400 WORDS)

Anti-Bacterial Agents↗
PubMed1986

[What effect does impaired left ventricular function have on prognosis following prosthetic aortic valve replacement?].

Data of 286 patients with advanced chronic aortic valve disease (NYHA class III or IV) who underwent aortic valve replacement between 1975 and 1982 were retrospectively analyzed using a multivariate Cox regression analysis. Preoperatively, left ventricular volumes and ejection fraction were determined angiographically in all patients. In patients with aortic stenosis and impaired left ventricular ejection fraction survival rate up to 7 years was identical as compared to those with aortic stenosis and normal ejection fraction. Survival rate in patients with aortic stenosis who were operated within 76 days after heart catheterization was better than in those who were operated after a longer time interval (p less than 0.05). In patients with aortic insufficiency and impaired left ventricular ejection fraction, prognosis was poorer after operation than in patients with aortic insufficiency and normal ejection fraction (p = 0.05). Thus, patients with advanced aortic stenosis should be operated as soon as the diagnosis is established. Impaired left ventricular ejection fraction is not a risk factor for prognosis after valve replacement for aortic stenosis. In contrast, in patients with aortic insufficiency left ventricular dysfunction is a risk factor for prognosis after operation.

Adult↗
PubMed1986

[Determinants of long-term prognosis following prosthetic mitral valve replacement].

UNLABELLED: Data of 235 patients with chronic mitral valve disease (NYHA class III or IV) were analyzed retrospectively. Mitral valve replacement was performed in all patients between 1974 and 1983, 46 patients underwent additional tricuspid valve repair during the same operation. Preoperatively, right and left heart catheterization as well as coronary angiography were carried out in all patients. Operative mortality was 8%. For all patients 5 year survival rate was 76% and 10 year survival rate was 72%. Patients with pure mitral insufficiency had a poorer long-term prognosis than patients with mitral stenosis or patients with mixed mitral valve disease (5 year survival rate 54 versus 79%, p less than 0.0014). Patients with previous closed mitral commissurotomy had a poorer long-term prognosis than patients without previous surgery (5 year survival rate 62 versus 81%, p less than 0.0019). Age, NYHA class, associated tricuspid valve repair, pulmonary vascular resistance and mean right atrial pressure had no effect on survival. CONCLUSION: Long-term survival is generally good after mitral valve replacement, but pure mitral insufficiency and previous closed mitral commissurotomy are risk factors for long-term prognosis.

Cardiac Catheterization↗
PubMed1985

[Results of prosthetic heart valve replacement. Primary, secondary and emergency operations].

From 1962 to 1984, 2460 prosthetic valve implantations in the heart were performed at the Department of Surgery of the University of Heidelberg. In addition to 2291 primary surgical interventions, 169 re-interventions were carried out. 153 emergency operations were necessary. The frequency rate of operations increased continuously; 52% of the operations were performed at the aortic valve and 37% at the mitral valve. In 9% of the cases, two valves had to be replaced, and in 2% even three valve prostheses were implanted. The indications for re-intervention included prosthetic thromboses, paravalvular leakages and prosthetic valve endocarditis. The situations requiring emergency intervention differed from case to case. Early mortality, which had been initially high, could be considerably reduced due to increased experience in surgical technique, anaesthesia, intensive care and improved myocardial protection. The extent and quality of medical postoperative care will determine the success of medical rehabilitation and hence the future professional activity of the patient.

Adolescent↗
PubMed1985

Late pulmonary embolization of a retained pacemaker electrode fragment after attempted transatrial extraction.

Embolization of pacemaker electrode fragments into the pulmonary circulation is a rare complication following transvenous pacemaker implantation. One such case is reported here. In a 67-year-old patient, a battery pocket infection developed after transvenous pacemaker implantation and subsequent surgical revision. After removal of the pacemaker and ventricular pacing lead, the atrial lead broke within the superior vena cava when prolonged traction was applied after frustrating attempts to extract the electrode. Attempts to extract the fragment transvenously using endoscopic forceps were unsuccessful. Due to firm fixation of the electrode by extensive fibrous scar tissue in the atrial wall, a further attempt to remove the retained electrode fragment by atriotomy also failed. On the first postoperative day, the fragment migrated to the left pulmonary artery, from where it was successfully extracted by means of a Dormier basket.

Aged↗
PubMed1985

Reduction of postoperative donor blood requirement by use of the cell separator.

In a prospective, randomized study of 20 patients undergoing elective open-heart surgery, up to c. one-third of the total intraoperative and postoperative transfusion requirement could be provided by autologous centrifuged blood. Retransfusion of washed, packed red blood cells freed from cellular debris, heparin and activated clotting factors significantly reduced blood loss during and after surgery. The cell separator is a valuable aid in autotransfusion technique.

Adult↗
PubMed1985

[Long-term prognosis of drug and surgery treated patients with acquired aortic valve diseases: survival statistics and multivariate Cox regression analysis].

Data of 417 patients with advanced chronic aortic valve disease were retrospectively analyzed using a life table and Cox regression analysis. Aortic valve replacement was recommended to all patients based on clinical and hemodynamic findings. While most patients underwent prosthetic aortic valve replacement (n = 349), a minority of patients was treated medically (n = 68). Prognosis was better (p less than 0.01 in the Cox model) in surgically treated as compared to medically treated patients with aortic stenosis (4-year survival rate 82 versus 44%). In patients with aortic insufficiency no significant difference of long-term prognosis was found between surgically and medically treated patients.

Anti-Bacterial Agents↗
PubMed1985

[Aortic ring abscess following bacterial endocarditis of the aortic valve and aortic valve replacement].

Valve replacement was performed in a 30-year-old male patient with acute aortic insufficiency due to bacterial endocarditis. During a routine examination three months later, an aortic ring abscess was found by echocardiography. In the following night, the patient was readmitted with acute anterior myocardial infarction. Coronary angiography showed a compression of the left coronary artery by the large ring abscess of the aortic valve. 48 hours after surgical revision of the aortic valve prosthesis and the ring abscess, the patient died due to pump failure.

Abscess↗
PubMed1982

Tissue glue for sealing plastic valves and bioprostheses in the canine aorta.

In experiments on seven dogs, a fibrin glue was used to seal plastic valves and bioprostheses in the thoracic aorta. Each valves was fixed in place with only four single sutures. Intraoperative and postoperative angiographic checks, with countercurrent aorta filling, gave no indication of perivalvular leak, even after eight weeks. Histologic studies confirmed the angiographic findings and showed only slight changes in the aortic wall. The results indicate that application of fibrin glue, supplementary to conventional suture procedure, may be useful when satisfactory fixation of aortic valves is hampered by pathologic circumstances.

Animals↗
PubMed1982

[The Haemonetics cell saver in open heart surgery (author's transl)].

A prospective study in 20 patients undergoing open heart surgery showed that up to 48 per cent of the required transfusion volume could be provided by autologous centrifuged blood. Re-transfusion of the washed packed red cells free of cell debris, heparin and aggregate significantly reduced blood loss both during and after the operation. The haemonetics cell saver is a valuable aid in the auto-transfusion technique.

Adult↗
PubMed1982

Myocardial catecholamine metabolism in patients with chronic aortic regurgitation.

In 17 patients suffering from severe chronic aortic regurgitation (AR) (New York Heart Association functional class III), right atrial biopsies were taken during aortic valve replacement. In these samples, we determined the myocardial content of norepinephrine (NE), normetanephrine (NM), epinephrine (E) and dopamine (DA). Two to 4 days before valve replacement, plasma catecholamines were measured at rest and during isometric exercise. Fifteen patients with secundum atrial septal defect (ASD) served as controls. In patients with chronic AR who had no clinical signs of cardiac failure, the myocardial content of NE (p less than 0.025), NM (p less than 0.05) and E (p less than 0.05) was significantly reduced compared with that in patients with ASD. The right atrial content of DA was not different in the two groups. All patients had normal levels of plasma catecholamines at rest. During isometric exercise, however, the increase in plasma NE was significantly higher in patients with AR than in the control group (p less than 0.005). We conclude that patients with chronic AR who have an exaggerated increase in sympathetic activity during isometric exercise probably have a decrease in myocardial NE tissue content as well. Therefore, clinical demonstration of a hyperadrenergic response during isometric exercise indicates alteration in myocardial metabolism in patients with severe chronic AR.

Adult↗