PubMed Health⌕ Search

Biomedical subjects

W Seybold-Epting

Publications and source records attributed to W Seybold-Epting.

At least 37 records · Page 2Linked to original sources
PubMed1981

[Systolic time intervals during increasing left ventricular filling pressure following extracorporeal circulation. A comparative impedance-cardiographical study (author's transl)].

In 26 patients invasively measured haemodynamic parameters and impedance cardiographically determined systolic time intervals have been compared after open heart surgery with cardio-pulmonary bypass (aortic valve replacement, AVR (n = 7); mitral valve replacement, MVR (n = 7); aorto-coronary bypass, ACB (n = 10)). In both the AVR and ACB group an increase of left atrial pressure resulted in 1) a significant increase of left ventricular stroke work index (LVSWI), 2) a significant decrease of the relation of the pre-ejection period to left ventricular ejection time (PEP/LVET), and 3) a significant increase of cardiac output (thermodilution technique and impedance cardiography), whereas no significant alterations were found in the MVR group. Furthermore cardiac output determination using both the direct thermodilution technique and the indirect impedance method revealed a close correlation (n = 63, range cardiac output 1.5-12.51/min, r = 0.852). These data clearly demonstrate the utility of the non invasive impedance cardiography method compared with invasive methods with respect to measurement of cardiac and haemodynamic parameters, even in critical situations.

Adult↗
PubMed1980

Clinical experience with enlargement of the aortic anulus by extension of the aortic incision into the anterior mitral leaflet.

Implantation of a small-sized biological prosthesis into a hypoplastic aortic annulus causes significant resting gradients. To make insertion of a suitable biological valve possible, we recommend enlargement of the aortic annulus by extension of the aortic incision into the anterior mitral leaflet for approximately 2 cm. A woven Dacron patch is sutured into the V-shaped defect of the anterior mitral leaflet and the aortic ring. This procedure results in enlargement of the aortic circumference of approximately 20 mm. We have applied this technique in 13 patients with severe aortic valvular disease and a hypoplastic aortic annulus. In all patients a prosthesis with a diameter of at least 25 mm could be implanted. The maximal postoperative pressure gradient measured 18 mmHg. There was no early death related to this operative method. All survivors have excellent clinical results with no evidence of mitral regurgitation. This operation represents a practicable alternative method to left ventricular apico-aortic conduit implantation.

Adolescent↗
PubMed1980

[Influence of left atrial pressure on left ventricular function after extracorporeal circulation (author's transl)].

In 10 patients with coronary heart disease, in 9 with advanced mitral and in 11 with aortic valve disease left ventricular function curves were constructed by volume loading immediately after cardiopulmonary bypass. After aortocoronary bypass surgery an approximately linear correlation between both cardiac index and stroke volume index and left ventricular filling pressure was demonstrated. After aortic and mitral valve replacement increase in left ventricular filling pressure above 15 mm Hg failed to result in significant increase in CI and SVI. Apparently, volume loading has limited effects in regulating left ventricular function in advanced aortic and mitral valve disease.

Atrial Function↗
PubMed1979

Ultrastructural and biochemical changes of human papillary heart muscle during different methods of induced cardiac arrest.

To determine the protective effects of different methods of cardioplegia, studies on ATP/lactate levels and ultrastructure were performed in human papillary muscles obtained during mitral valve replacement. In group I (n = 5), plain ischemic arrest in hypothermia (systemic venous temperature = 24 degrees C) was accomplished. In group II (n =12), the heart was arrested by injection cardioplegia using magnesium-aspartate-procaine at systemic venous and myocardial temperatures of 24 degrees C. In group III (n = 12) Bretschneider infusion cardioplegia at systemic venous and myocardial temperatures of 26 degrees C and 19 degrees C respectively was applied. With regard to ultrastructural changes there were no clearcut differences in the three methods of hypothermic cardiac arrest after 60 minutes of ischemia. Ischemic changes tended to be slightest in group III (infusion cardioplegia). ATP decay and lactate increase were significant in group I and moderate to minimal in groups II and III after the same period of time. It is concluded that for aortic cross-clamp times up to 60 minutes, body hypothermia and injection cardioplegia using magnesium-aspartate-procaine at a myocardial temperature of 24 degrees C provide adequate protection of the myocardium. For ischemia times beyond 70 minutes, profound myocardial hypothermia below 20 degrees C is preferred.

Adenosine Triphosphate↗
PubMed1979

Patch enlargement of the aortic valve ring by extending the aortic incision into the anterior mitral leaflet. New operative technique.

This communication describes a new surgical procedure of enlarging the narrow aortic valve ring by extending the aortic incision through the fibrous origin of the aortic leaflet of the mitral valve into this leaflet. A fusiform patch is sutured to the V-shaped defect in the aortic leaflet of the mitral valve and in the aortic anulus. This procedure permits the replacement of the aortic valve by a suitable prosthesis. Between June of 1976 and February of 1978, eight patients underwent this surgical procedure. At the time of operation the patients were between 8 and 50 years old. The estimated enlargement of the aortic root ranged from 10 to 25 mm. The operative technique is described, peculiarities of this method are discussed, and the results are reported. Six to 27 months following operation, the clinical condition of six patients is good. Four patients show no impairment of mitral valve function. In one case, preoperatively diagnosed mitral incompetence persists. In another patient the pericardial patch broke from the aortic leaflet of the mitral valve, so that the valve had to be replaced on the fourth postoperative day. One patient died of myocardial necrosis because of insufficient myocardial protection during operation. One child with acute aortic insufficiency caused by staphylococcal endocarditis and congestive heart failure died of septicemia 3 months postoperatively. Mitral incompetence was not detectable in this child.

Adolescent↗
PubMed1978

[Myocardial protection utilizing hypothermia and cardioplegin during surgical correction of congenital heart disease (author's transl)].

Our methods of myocardial protection are demonstrated in 846 patients subjected to open heart surgery for correction of congenital heart disease. They include body hypothermia and injection cardioplegia using magnesium-asparate-procaine. The spectrum of myocardial protection reaches from normothermia without cardioplegic arrest during short periods of extracorporeal circulation to profound body hypothermia with multiple injections of the cardioplegic solution in complex cardiac malformations. The results in 586 patients with left to right shunt, 140 patients with cyanotic cardiac malformations and 120 patients with congenital valve lesions are presented. Attention is directed to possible negative sequelae of overdosage of magnesium-asparate.

Aspartic Acid↗
PubMed1978

[The protective effect of magnesium-aspartate-procaine cardioplegia on the hypertrophied left ventricle of the mini-pig (author's transl)].

After induction of left ventricular hypertrophy by supravalvar constriction of the ascending aorta in mini pigs (ATP and lactate) were measured under different cardioplegic conditions. In normothermia and plain anoxic arrest ATP decrease and lactate increase were significantly slower in hypertrophied myocardium compared to normal myocardium. Injection cardioplegia using magnesium-aspartate-procaine at 37 degrees C did not influence the ATP decrease and lactate increase in the hypertrophied ventricle, whereas in the normal heart it showed some protection according to these parameters. Optimal ATP preservation and the lowest lactate increase rate were achieved in left ventricular hypertrophy by combined application of magnesium-aspartate-procaine and hypothermia of 25 degrees C. We conclude that normothermic injection cardioplegia has no protective effect on the hypertrophied left ventricle, whereas additional hypothermia can improve magnesium-aspartate-procaine cardioplegia significantly.

Adenosine Triphosphate↗
PubMed1978

[Monitoring myocardial performance after open heart surgery by calculation of diastolic and systolic pressure time index (author's transl)].

In order to determine the incidence of subendocardial ischemia after open heart surgery, subendocardial blood flow was monitored in 171 patients subjected to mitral and/or aortic valve replacement or coronary revascularization by on-line calculation of Diastolic (DPTI) and Systolic Pressure Time Index (TTI). Body hypothermia with an esophageal temperature of 25 degrees C and magnesium-aspartate-procaine cardioplegia were applied for myocardial protection. Ten patients developed low cardiac output state with two early deaths. In the two patients with fatal low cardiac output DPTI/TTI remained below 0.8. In the remaining 8 patients DPTI/TTI rose to 1.4 after a mean recovery time of 36 hours. In 161 patients (94%) no low cardiac output state evolved and DPTI/TTI rose to 1.3 within 60 min. after termination of cardiopulmonary bypass. Our results indicate that body hypothermia of 25 degrees C combined with magnesium-aspartate-procaine cardioplegia can reduce the incidence of subendocardial ischemia, but does not prevent this complication completely after anoxic times beyond 60-70 minutes.

Blood Pressure↗
PubMed1978

[Behaviour of ATP and lactate in human papillary muscle during profound hypothermia and injection cardioplegia with magnesium-asparatate-procaine (author's transl)].

In 53 patients with mitral- or aortic-mitral valve disease, the content of ATP and lactate of the papillary muscles resected at the time of valve replacement was investigated at the beginning of ischemic arrest and at the time of reperfusion. Profound body hypothermia (25 degrees C) and injection cardioplegia using magnesium-aspartate-procaine were applied for myocardial protection. In hypertrophic papillary muscles the myocardial ATP content decreased at a slower rate (ATP decay 12% of the initial value after 60 minutes of ischemia) than in normal papillary muscles obtained from patients with isolated mitral stenosis (ATP decay 33% of the initial value after 40 minutes of ischemia). 20% of the patients required temporary inotropic circulatory support postoperatively for 12 to 88 hours. The ATP content of the papillary muscles of these patients differed only little from those, in who no myocardial failure occurred. However the myocardial lactate levels were higher in patients in whom a low cardiac output state evolved.

Adenosine Triphosphate↗
PubMed1977

Aneurysm of pericardial right ventricular outflow tract patches.

Among 1,022 patients who underwent repair of tetralogy of Fallot, 252 received a pericardial patch of the right ventricular outflow tract; of these, 10 subsequently developed an aneurysm of the right ventricular outflow tract. Cardiac catheterization and angiography revealed moderate pulmonary insufficiency in all patients, a residual pressure gradient in the right ventricular outflow tract in 7, and a residual ventricular septal defect in 2 patients. Reoperation was indicated in 8 patients because of progressive distention of the aneurysm, residual infundibular or pulmonary artery stenosis, and recurrent ventricular septal defect. Reconstruction of the right ventricular outflow tract was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in 5 patients, primary suture of the pulmonary artery in 2, and implantation of a woven Dacron conduit containing a Björk-Shiley cardiac valve prosthesis in 1 patient. There were no early or late deaths. When reconstruction of the right ventricular outflow tract is necessary, we recommend a woven Dacron patch because pericardium may form an aneurysm.

Cardiac Catheterization↗
PubMed1977

[Combined application of magnesium-aspartate-cardioplegia and general hypothermia in aortic valve replacement (author's transl)].

The surgical results of two similar groups of patients are compared in whom aortic valve replacement was performed utilizing magnesium-aspartate-cardioplegia combined with mild (group A = 71 patients) and profound (group B = 69 patients) hypothermia, respectively. Mortality was 5.6% in group A and 4.3% in group B. Two deaths in group A were due to a severe low cardiac output syndrome, three patients required continuous inotropic circulatory support during the early postoperative course. There was no low cardiac output in group B, no patient required inotropic support. Profound body cooling (esophageal temperature 25 degrees C) and hypothermic injection cardioplegia with magnesium-aspartate provide efficient myocardial protection up to 60 minutes of anoxia.

Aortic Valve↗
PubMed1976

Early and late results after surgical treatment of preinfarction angina.

Among 3,707 patients who underwent aortocoronary bypass, 302 had preinfarction angina. Coronary angiography revealed single-vessel disease in 43 patients, double-vessel disease in 81, and triple in 178 patients. Plane ventriculography showed contractility to be normal in 178 patients, fair in 88, and poor in 36 patients. Left ventricular end-diastolic pressure was normal in 203 patients, 13 to 23 mm Hg in 73, and larger than or equal to 24 mm Hg in 26 patients. Using cardiopulmonary bypass and moderate hypothermia, single coronary bypass was performed in 45 patients, double bypass in 120 patients, triple in 118 patients, quadruple in 15, and quintuple in 4 patients. Right coronary artery endarterectomy was necessary in 22 patients. The early mortality was 6.6% (20 patients) and was strongly related to poor contractility and congestive heart failure. One- to four-year follow-up data were obtained in 126 patients. Late myocardial infarction occurred in 11 patients and caused 4 late deaths; 3 unrelated deaths occurred. Ten patients experienced no benefit from their operations, 56 are completely asymptomatic, and 53 are significantly improved. Our results show that surgical intervention can improve the poor prognosis of preinfarction angina and appears to be superior to medical treatment.

Adult↗
PubMed1976

[Two stage surgical treatment of large ventricular septal defects (author's transl)].

Since March 1971, 51 infants were subjected to pulmonary artery banding (PAB) for a large ventricular septal defect (VSD) with pulmonary hypertension. 41 infants (80%) were under six months of age. Additional defects were present in 41%. Twelve babies died (24%). The lowest mortality was achieved in isolated VSD (6,7%). 28 patients subsequently underwent VSD closure and pulmonary artery debanding. Catheterization data revealed normal or slightly elevated pressures and normal vascular resistance in the pulmonary circuit in 22 children. The operative mortality rate was 10,7%.

Heart Septal Defects, Ventricular↗
PubMed1976

[Aneurysm of pericardial right ventricular outflow tract patches (author's transl)].

Among 1022 patients who underwent total repair of tetralogy of Fallot, 252 patients received a pericardial patch of the right ventricular outflow tract (RVOT); and of these 10 subsequently developed an aneurysm of the RVOT. Cardiac catheterization and angiography revealed moderate pulmonary unsufficiency in all patients, a residual pressure gradient in the RVOT in seven and a residual ventricular septal defect in two patients. Surgery was indicated in eight patients because of progressive distension of the aneurysm. Reconstruction of the RVOT was accomplished by resection of the aneurysm and insertion of a woven Dacron patch in five patients, primary suture of the pulmonary artery in two and implantation of a woven Dacron conduit containing a Björk-Shiley valve in one patient. No early or late death occured. Although aneurysms of the RVOT with pericardial patches represent a rare complication after total correction of tetralogy of Fallot, we recommend primary reconstruction of the RVOT with a woven Dacron patch.

Child↗
PubMed1976

[Palliative and corrective cardiac surgery in Down's syndrome (author's transl)].

Since 1970 46 infants and children with Down's Syndrome were subjected to palliation of congenital heart disease, and 54 mongoloid children underwent correction of their cardiac defects. The most common cardiac malformation was endocardial cushion defect (72%). Palliation consisted in pulmonary artery banding (PAB) with or without division of a patent ductus arteriosus (PDA) in 16 infants, and sole division of a PDA in another 16 infants with large left to right shunts due to common canalis atrioventricularis (avcanal) or ventricular septal defect (VSD). An aorto-pulmonary anastomosis was performed for relief of severe hypoxia due to right ventricular outflow tract obstruction (RVOTO) in 14 patients. Operative mortality was 41% for PAB, 21% for aortopulmonary anastomosis, anastomosis, and 0% for division of a PDA. In the group of corrective cardiac surgery the operative mortality rate was 0% in ostium primum defects and 4% in VSD closure. Correction of complete av-canal and of malformations with RVOTO had a high mortality rate of 20 and 40%, respectively. Similar results were obtained in nonmongoloid children operated upon for the same cardiac defects. The complications and causes of death were due to the complexity of the cardiac malformations and had no relation to the Down's Syndrome itself. Mongoloid children do not pose additional medical problems to management of congenital heart disease. Their results do not differ from those obtained in nonmongoloid children.

Adolescent↗
PubMed1976

Repair of ventricular septal defect after pulmonary artery banding.

Since 1964, 90 patients have undergone two-stage surgical repair of ventricular septal defect (VSD) with pulmonary artery banding (PAB) in early infancy and total repair at an average age of 4 years. Reconstruction of the pulmonary artery was accomplished with a pericardial patch, woven Dacron patch, or transverse angioplasty. The VSD was closed with a knitted Dacron patch in 75 patients and by primary suture technique in 13 patients. The VSD closed spontaneously in 2 patients. The mortality rate for patients who had repair and debanding was 9 per cent (8 patients), including 4 deaths due to severe pulmonary hypertensive disease, 3 from congestive heart failure, and one from atrioventricular block. Twenty patients underwent repeat cardiac catheterization several months to 7 years after total repair. This study revealed no shunt in 16 patients and a minimal shunt not requiring operation in the other 4 children. Slight residual stenosis of the pulmonary artery was found in 2 patients and a residual infundibular stenosis in another 2 patients. We believe two-stage surgical treatment of VSD in severely ill infants under one year of age is safe and reliable.

Blood Vessel Prosthesis↗
PubMed1975

[Surgical treatment of acute dissection of the ascending aorta (author's transl)].

Since 1959, 51 patients underwent open heart surgery for correction of acute dissection of the ascending aorta. Upon admission 33 patients were severely hypotensive or in porgressive heart failure. Acute aortic insufficiency was found in 24 patients, and hemiplegia or hemiparesis in 4. In 45 patients the ascending aorta was reconstructed with a woven graft. After excision of the dissected part of the aorta primary anastomosis or patch aortoplasty was performed in 6 patients. The aortic valve remained intact in 26 cases, and resuspension of the commissures restored competence of the aortic valve in another 9 patients. Sixteen patients required aortic valve replacement because of disrupture of the commissures. Dissection extended into the coronary ostia in 5 cases. Reconstruction of the coronary system was accomplished by reimplantation of the ostia, interposition of a vein graft or aorto-coronary bypass. Nine patients died within the early postoperative course from uncontrollable hemorrhage (4), further dissection (3) and myocardial infarction (2). Within the first year after surgery another 5 patients died from acute aortic dissection (2), pseudomonas-infection causing rupture of the proximal graft anastomosis (1), and myocardial infarction (2). The contraindications of antihypertensive treatment of actue dissection of the ascending aorta are discussed. We recommend prompt surgical intervention in acute dissecting aneurysm of the ascending aorta.

Aortic Aneurysm↗