0000000000207984
AUTHOR
Nixdorff U
Prediction of rapid versus prolonged healing of infective endocarditis by monitoring vegetation size.
The diagnostic value of transesophageal echocardiography in monitoring the clinical course has been evaluated in 83 patients with echocardiographic evidence of infective endocarditis. A total of 103 vegetations attached to the aortic or mitral valves were detected by use of the transesophageal approach. The patients were monitored for a mean of 74 weeks and underwent a minimum of two consecutive transesophageal echocardiographic examinations. Group A included patients with increasing or remaining constant size of vegetation (8.2 +/- 1.5 to 11.2 mm, p less than 0.05) during 4 to 8 weeks of antimicrobial therapy, whereas group B was formed by patients with decreasing vegetation size (8.3 +/- …
Intensivtherapie des Myokardinfarktes — Limitierung der Infarktgröße
Der akute Myokardinfarkt gehort mit der instabilen Angina pectoris und dem plotzlichen Herztod zu den drei akuten Koronarsyndromen, die sich nur im Ausmas und der Geschwindigkeit der Thrombusentstehung unterscheiden [16]. Ein solcher Koronarverschlus (Abb. 1) fuhrt zu einem akuten Ausfall der Myokardperfusion und innerhalb weniger Sekunden zum Ausfall der Funktion des nicht mehr perfundierten Myokards. Wird das Gefas innerhalb weniger Minuten wieder geoffnet [34, 37, 38, 48], erholt sich das Myokard vollstandig. Bleibt die Durchblutung langere Zeit blockiert, entwickelt sich ein Infarkt, der von subendokardial nach epikardial sich ausbreitet [24, 46, 47, 52, 53]. t bedeutet eine kurze Ischa…
Myokardperfusion und -funktion nach Koronarinterventionen
Ein bei Belastung zunehmender Sauerstoffbedarf des Myokards kann im wesentlichen nur durch eine Steigerung der Koronardurchblutung gedeckt werden. Dies geschieht zu ca. 90% durch Dilatation der arteriolaren Widerstandsgefase und nur zu ca. 10% durch Dilatation der epikardialen Koronargefase, die angiographisch sichtbar gemacht werden konnen. Die Differenz zwischen Ruhe- und maximal moglichem Blutflus wird als Koronarreserve bezeichnet. Die Messung des koronaren Blutflusses, der Perfusion, des myokardialen Stoffwechsels sowie der Auswirkung auf die Myokardfunktion erfolgt durch verschiedenste Verfahren: Thallium-Szintigraphie, Positionen-Emissions-Tomographie, Magnetresonanztomographie, Clea…
Beta-adrenergic stimulation enhances left ventricular diastolic performance in normal subjects.
To determine the effects of beta-adrenergic stimulation on transmitral Doppler echocardiography flow characteristics of left ventricular diastolic filling, we studied 10 healthy volunteers aged 23-31 years (mean age, 26.6 years) during intravenous infusion of isoprenaline in consecutive steps of 0.1, 0.2, 0.4, 0.75, and 1.5 micrograms/min (each for 15 min). Saline control infusion was given in the same manner in a crossover and blinded protocol. Compared with the infusion of placebo, stepwise increasing doses of isoprenaline caused a dose-related increase in early and late diastolic filling velocities and velocity-time integrals, a lengthening of the acceleration time, and a shortening of t…
Combined aortic and mitral stenosis in mucopolysaccharidosis type I-S (Ullrich-Scheie syndrome)
The genetic mucopolysaccharidosis syndromes (MPS) are autosomal recessive inborn errors of metabolism. Heart valve involvement in MPS is not uncommon but only a few case reports of successful cardiac surgery are available. In particular, reports of combined aortic and mitral stenosis associated with MPS type I-S are very rare. Both type I and type VI MPS are associated with significant left sided valvar heart disease that requires surgical valve replacement because of irregular valve thickening, fibrosis, and calcification. A 35 year old man had severe mitral valve stenosis after successful surgical replacement of a stenotic aortic valve. Valvar heart disease was investigated by cardiac ult…
Intraventrikuläre Obstruktionen bei der Dobutamin-Streßechokardiographie: Determinanten ihrer Entstehung und klinische Folgen (Dynamic intraventricular obstruction during dobutamine stress echocardiography. Determinants of the phenomenon and clinical consequences)
Die Dobutamin-Stresechokardiographie (DSE) fuhrt zu einer starken Hyperkontraktilitat des Myokards bei Tachykardie und Vesodilatation. Diese Effekte konnen zu einer unphysiologischen Abnahme des endsystolischen Volumenindex (ESVI) mit Obstruktion des linksventrikularen Ausflustraktes (LVOT) fuhren. Bei 100 Patienten (Pat.), die sich einer DSE (5–40) μg/kg/min) unterzogen, wurde die kontinuierliche Dopplerregistrierung (DW-Doppler) vor Infusion und bei maximaler Herzfrequenz durchgefuhrt. Eine dynamische, spat-systolische, Flusakzeleration auf mehr als 2 Meter/Sekunde (m/s) unter maximaler Stimulation wurde als systolische Obstruktion des LVOT interpretiert. Manifestationsfaktoren systolisch…
Clinical relevance of vegetation localization by transoesophageal echocardiography in infective endocarditis
Infective endocarditis is associated with significant morbidity and mortality, with valvular destruction and congestive heart failure being more common in patients with echocardiographically discernible vegetations. The transoesophageal approach affords consistently high quality images with excellent structural resolution. Two-hundred and eighty-one patients with clinically suspected infective endocarditis were studied, to evaluate the prognostic value of ascertaining the site of vegetations. Among them were 118 patients with vegetations attached to the aortic or mitral valve. These patients were followed for a mean period of 14 months. Mitral valve vegetations were associated with a signif…
Hochfrequenz-Rotationsatherektomie bei koronarer Herzkrankheit
Percutaneous high frequency coronary rotational ablation (PTCR) was used in 10 patients with significant coronary artery disease. PTCR removes arteriosclerotic material from the vessel wall. A diamond-coated (60-80 micron) brass burr-drill, fastened to a flexible drive shaft rotating and tracking along a central coaxial guide wire, was used. The turbine rotates the drive shaft in excess of 150,000-190,000 revolutions per minute. PTCR was successful in all patients, but in three additional percutaneous transluminal coronary angioplasty (PTCA) was then successfully performed. Coronary dissection occurred only once, requiring surgery which was successful. No vessel perforation was observed. Al…
Sum of ST-segment elevations on admission electrocardiograms in acute myocardial infarction predicts left ventricular dilation.
In summary, ST-segment elevations on the admission electrocardiogram not only diagnose acute myocardial infarction but also provide predictive information with respect to developing infarct size and left ventricular remodeling as well as survival.
Dobutamine stress Doppler echocardiography: reproducibility and physiologic left ventricular filling patterns
Qualitatively, dobutamine stress echocardiography has become an established procedure. Quantitative results are in great demand but this is still difficult due to limited endo- and epicardial border definition. Transmitral Doppler variables are strictly quantitative and less subjective. Furthermore, ischemic alterations precede systolic ones (ischemic cascade). There are preliminary reports of the utility of dobutamine stress Doppler echocardiography, but proof of reproducibility and left ventricular filling patterns are still lacking. Fourteen healthy volunteers (10 men, 4 women, median age 25.9 years, range 21-32 years) were investigated according to the usual dobutamine stress echocardio…
Normalwerte für die Dobutamin-Streßechokardiographie*
UNLABELLED Dobutamine stress echocardiography having established itself as a sensitive method for diagnosing coronary heart disease, even in the absence of normative values, the physiological haemodynamics as well as the physiological values for global and regional left ventricular myocardial function were measured. TEST PERSONS AND METHODS 14 healthy subjects (ten men, four women; median age 25 [range 21-32] years) underwent dobutamine stress echocardiography according to an internationally practised dosage steps protocol (5-40 micrograms/kg/min with additional 0.5 mg atropine at 40 micrograms). RESULTS Maximal infusion rate achieved a serum dobutamine level of 1.67 micrograms/ml with mini…
Exercise echocardiography for the evaluation of patients after nonsurgical coronary artery revascularization.
Objectives. The purpose of this study was to demonstrate the accuracy of stress echocardiography for detecting the progression of coronary artery disease after nonsurgical revascularization. Background. The expanding role of nonsurgical coronary revascularization procedures mandates the development of sensitive noninvasive techniques for tbe detection of recurrent ischemia. Methods. Bicycle stress echocardiography was performed in a series of 86 patients 6.5 ±1.3 months after a revascularization procedure. Seven patients were excluded from analysis because of poor echocardiographic image quality. Results. Digital analysis achieved a sensitivity of 83% for the entire group and a specificity …
Diagnose eines intramyokardialen Hämatoms nach traumatischem Myokardinfarkt durch Magnetresonanztomographie
Thoraxverletzungen treten bei etwa 30% aller traumatisierten Patienten auf, wobei in den meisten Fallen Verkehrsunfalle die Ursache sind. Wir berichten uber den Fall eines Patienten, der nach einem Skiunfall einen traumatischen Vorderwandinfarkt erlitt. Im weiteren Verlauf kam es zu einer ausgedehnten intramyokardialen Einblutung. Differentialdiagnostisch kam zunachst ein linksventrikulares Pseudo- bzw. Pseudopseudoaneurysma in Frage, kernspintomographisch konnte jedoch durch den Nachweis eines schmalen Myokardsaums sowohl ventral als auch dorsal der Raumforderung die Diagnose eines intramyokardialen Hamatoms gestellt werden. Bei dem Patienten wurde daraufhin eine aortokoronare Bypass-Opera…
Reinfarction Related to PTCA-Induced Coronary Embolism after Successful Thrombolytic Therapy
Coronary embolism originating from residual thrombotic material is one of the complications arising during acute percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction. This case report describes a symptomatic embolization of the right posterolateral and right posterior descending branch during success-ful PTCA of a subtotal stenosis of the midright coronary artery after acute inferior myocardial infarction. Typical ECG signs of reinfarction were recorded. We succeeded in recanalizing these branches by superselective thrombolysis and angioplasty.
Evaluation of post-myocardial infarction regional and global left ventricular function by monoplane ventriculography: superiority of right versus left anterior oblique projection at any infarct location.
OBJECTIVES To study the significance of serial quantitative regional wall motion analysis, volumes, and ejection fraction findings as well as their prognostic implications derived from cineventriculography in 30 degrees right anterior oblique (RAO) projection in comparison with 60 degrees left anterior oblique (LAO) projection in post-myocardial infarction patients. Ventriculographic left ventricular parameters are accepted surrogates of mortality in myocardial infarction. Nowadays, in contrast to a biplanar approach in most institutions and clinical trials, the investigation is reduced to monoplanar ventriculography. However, it is not known whether the relevance of the two established pro…