Herz
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Mitral and particularly aortic valve replacements may be complicated by heavy calcification of the anulus, markedly impairing proper valve seating. From 1987 to 1996, we have used ultrasonic energy with the CUSA-device in valvular replacement to debride the aortic anulus in 90 patients and the mitral anulus in 2 patients. Annular debridement using ultrasonic decalcification is superior to other methods of debridement because it is safer, more thorough, and affords improved seating of the valve. ⋯ The operative mortality in our series was 1/92 (1.1%). Other than the fatality, the incidence of permanent stroke was 0%. Ultrasonic debridement to remodel the aortic and mitral valve anulus has been an invaluable adjunct in the heavily calcified anulus.
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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.
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The ultimate goal of any imaging technique for the investigation of the anatomy of the beating heart is a 3D-display of the cardiac morphology throughout a complete heart cycle. The reason for this interest is quite clear: 3D-imaging has the potential for a better understanding of the individual morphology under normal and pathological conditions and especially, if complex therapeutic decisions have to been made. In the clinical practice, the echocardiographer attempts to obtain a spatial information by a mental reassembling of the 2D echocardiographic images, that are obtained from different imaging planes. ⋯ The process of 3D-reconstruction is a sequence of repeated steps of image processing. The first step is the elimination of a problem, that is common to all image reconstruction techniques from tomographic information: the imaging planes are recorded at different time points, and mostly under varying conditions. Although several gating techniques are implemented into the image acquisition, some variability is unavoidable, simply because neither the heart nor the surroundings can be frozen during image acquisition.(ABSTRACT TRUNCATED AT 400 WORDS)
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The extent of myocardial damage occurring during acute myocardial infarction is time dependent, and there is abundant evidence from most clinical trials that mortality reduction is greatest in patients treated early with thrombolytic agents, although beneficial effects have been shown with treatment initiated up to 12 hours after onset of symptoms. This temporal dependence of benefit was most clearly seen with the 47% mortality reduction obtained with streptokinase given within the first hour in the GISSI-1 trial (Table 1). The process of infarction may be completely aborted if reperfusion is initiated within 30 minutes after symptom onset. ⋯ The paramedics then obtained a computer-interpreted ECG which was transmitted to the emergency department in the hospital where a physician made the decision on the form of treatment. The thrombolytic agent was then administered by the paramedic. In the European Myocardial Infarction Project (EMIP) an emergency physician was personally present and responsible in the prehospital setting, whereas in the Grampian Region Early Anistreplase Trial (GREAT) general practitioners made the decision for enrolling the patient.