Zeitschrift für Kardiologie
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Randomized Controlled Trial Comparative Study Clinical Trial
[Differential therapy of cardiogenic shock with dopamine/milrinone in comparison with dopamine/dobutamine].
In cardiogenic shock, combined pharmacotherapy with dopamine/dobutamine was being used as a standard regimen and was compared to dopamine/milrinone in this study. In a total of 20 patients with persistent hemodynamic depression despite mechanical ventilation plus dopamine (10-12 micrograms/kg/min) and nitroglycerin (33 micrograms/min) infusions additional therapy with dobutamine (maximal dose: 9 micrograms/kg/min; n = 10) or milrinone (0.5 microgram/kg/min; n = 10) was started. Dobutamine induced an increase of cardiac index (2.0 +/- 0.1 to 2.9 +/- 0.21/min/m2; p < 0.01; mean +/- SEM) and heart rate (96 +/- 6 to 117 +/- 5 min-1; p < 0.05) while mean arterial pressure (75 +/- 2 to 71 +/- 4 mm Hg) and pulmonary capillary wedge pressure (21 +/- 2 to 19 +/- 2 mm Hg) hardly changed. ⋯ The rate-pressure product declined (11033 +/- 711 to 10555 +/- 929 mm Hg/min). In comparison, dopamine/milrinone appeared to be advantageous in terms of pre- and afterload reduction and myocardial oxygen demand. However, the concomitant decline in arterial pressure might impair end-organ perfusion.
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The case of a quadricuspid aortic valve diagnosed in adult age is reported. A 67-year-old patient, who had no previous diseases or cardiovascular complaints, presented in the clinic for an embolic occlusion of the left retinal artery. Isolated moderate aortic regurgitation was diagnosed clinically and echocardiographically. ⋯ In the short axis view the quadricuspid aortic valve showed in diastole a "X"-configuration, with a persistent central orifice between the commissures, which was the cause of the regurgitation jet in color Doppler examination, and in the systole a trapezoid opening pattern. In the long-axis view the valve showed a tricuspid closing pattern. The quadricuspid aortic valve can be exactly diagnosed by multiplane transesophageal echocardiography.
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Previous Doppler studies of transmitral flow profiles in heart transplant recipients suggested left ventricular (LV) diastolic dysfunction. The influence of left atrial filling and emptying on mitral Doppler profiles in heart transplant recipients has not been studied systematically. In the present study, pulmonary venous flow profiles, mitral flow profiles, left atrial area change and mitral annulus motion were analyzed in 20 orthotopic heart transplant recipient and 20 control subjects by transthoracic and transesophageal echocardiography and Doppler. ⋯ The results of this study indicate that LV diastolic dysfunction is not the only possible cause of altered transmitral Doppler profiles in heart transplant recipients. Atrial abnormalities represent a major contributing factor to altered mitral and pulmonary venous flow patterns. Analysis of transmitral Doppler profiles alone are therefore not adequate for analysis of diastolic LV function in heart transplant recipients.
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Adolescents and adults with congenital heart disease have become a new, continuously growing group of patients, because currently improved diagnostics and therapy allow the majority of newborns with congenital heart disease to survive to adulthood. The objective of this retrospective study was to investigate lethality and morbidity after surgery for congenital heart disease in adolescents and adults. Between 1989 and 1994, we operated 137 patients (age between 15 and 75 years; mean 33.8 +/- 15.1) because of congenital heart disease. ⋯ The general term congenital heart disease describes a very inhomogeneous group of patients with a broad spectrum of different diagnoses. The variable morphology and pathophysiology of the different congenital heart defects require an individual surgical strategy for each patient, in rare cases even the decision for a heart- or heart-lung-transplantation. Furthermore, adequate follow-up and competent ambulatory treatment of these patients require the cooperation of pediatric and adult cardiologists and cardiac surgeons in interdisciplinary outpatient clinics.