Herz
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Comparative Study
Diagnostic value of transesophageal compared with transthoracic echocardiography in suspected prosthetic valve endocarditis.
To compare transthoracic (TTE) and transesophageal (TEE) echocardiography specifically in prosthetic valve endocarditis, 73 consecutive patients (age, 7 to 80 years) with 86 prostheses who had TTE and TEE for suspected endocarditis were analyzed retrospectively. Thirty-four patients proved to have endocarditis according to clinical criteria (pathoanatomical confirmation in 16), the remaining 39 served as controls. In the endocarditis group, a total of 38 (25 mitral, 13 aortic) prostheses were investigated. ⋯ These results indicate that TEE is markedly superior to TTE in prosthetic valve endocarditis. The diagnostic advantage is most evident in mitral prostheses. This holds for the detection of both morphologic changes and prosthetic malfunction.
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For the prebypass period various authors have shown that patients on oral or intravenous beta blocking therapy respond to catecholamine treatment with marked increase in afterload and no change in cardiac index. Since positive inotropic therapy is usually not necessary until, but after termination of cardiopulmonary bypass, the question arises as to whether beta-blocking agents administered orally on the morning of the operation, can still have negative effects during this phase of the procedure. ⋯ Our results show, that observations made by various groups in the prebypass period on patients treated with beta blocking agents, which demonstrate dramatic increases in afterload with no improvement in cardiac index following catecholamine administration do not hold true for the post-bypass period. The reason could be a wash out effect of the Bretschneider cardioplegia on cardiac beta receptors.