Zeitschrift für Kardiologie
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The prevalence of left ventricular systolic dysfunction (LVSD) in the general population is poorly defined. Specifically, the number of asymptomatic individuals with LVSD and, thus, the most appropriate strategy to identify and treat such subjects is still unknown. Therefore, the aim of this study was to document LV dysfunction in a middle-aged (25 to 75 years, mean 51.8+/-13.8) population - based sample in Germany (MONICA Augsburg, n=1678; echocardiography technically adequate n=1418) by M-mode and 2D-echocardiography and to analyze the importance of predisposing contributors. ⋯ In conclusion, LVSD is a relatively common finding in the general population. However, severe LVSD is rare in subjects without any concomitant cardiovascular disease. Thus, echocardiographic screening cannot be recommended in the unselected, middle-aged population to identify such patients.
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Case Reports
A coconut left atrium 23 years after mitral valve replacement for chronic mitral stenosis.
We present the case of a 65 year-old female who was admitted to the hospital because of deterioration of chronic dyspnea. Twenty-three years prior to this admission, mitral valve replacement for chronic mitral stenosis was performed using a Starr-Edwards caged-ball prosthesis. ⋯ On transthoracic echocardiography and on cineradiography, the function of the mitral valve prosthesis was unimpaired. However, cineradiography showed extensive mural calcification of the left atrium; we report this remarkable finding.
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Multicenter Study
Pregnancy in congenital cardiac disease: an increasing challenge for cardiologists and obstetricians -- a prospective multicenter study.
Aim of this study was to assess the occurrence of pregnancy-related complications of mother and child during pregnancy, delivery and puerperium in women with CCD prospectively. STUDY DESIGN, POPULATION: This prospective multicenter study included 122 pregnancies in 106 women with CCD (72 with, 34 without previous cardiac surgery). Patient age was 17-44, median 26 years. Cardiac and non-cardiac complications, mode of delivery, abortion, and CCD of the newborn were assessed. ⋯ Most women with CCD and a good functional class before pregnancy tolerate pregnancy without major problems. However, pregnancy may induce serious cardiac and obstetric complications. The specific risks require an individualized multidisciplinary patient-management by experienced physicians.
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Early graft occlusion is a known complication after CABG (Coronary Artery Bypass Grafting). The thromboembolic closure of the bypass occurs at a frequency of 5-15%, depending on the implemented vessel (arterial or venous graft). Fibrinogen as a substrate of thrombus formation plays a major role in both primary and secondary haemostasis. The operative trauma triggers the acute phase-response and also activates the clotting process. This leads to high fibrinogen levels of up to 600 mg/dl postoperatively, providing an impaired haemorrheological pattern which promotes thrombus formation. In a prospective pilot-study we examined whether drastic postoperative lowering of fibrinogen by H.E.L.P.-(Heparin-mediated Extracorporeal LDL-/Fibrinogen Precipitation) apheresis can prevent early graft vessel closure in patients undergoing CABG. ⋯ Early and extensive reduction of postoperatively elevated plasma fibrinogen levels by H.E.L.P. apheresis seems to be an efficient and safe therapeutic approach for preventing early graft occlusion in patients undergoing multivessel CABG.
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After recanalization and stenting of chronic total coronary occlusions (TCO), a reduced coronary flow velocity reserve (CFVR) and rise in collateral resistance (R(Coll)) is frequently observed. Coronary microembolization may account for these observations. In 86 patients (age 64+/-10 years; 77 men, 9 women) with TCO (duration >4 weeks), PTCA was performed with successful stent implantation in all lesions. ⋯ CFVR or rise in R(Coll) did not correlate with CK elevation. Coronary microembolization is not a likely cause of reduced CFVR and increased R(Coll) after PTCA of TCO. Other factors such as microvascular dysfunction and autoregulatory changes in collateral function may account for these observations.