Zeitschrift für Kardiologie
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The present case will focus on the potential of hypoperfusion detection with myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI). PDHI is normally performed in a triggered mode. Microbubbles were destroyed by the ultrasound energy in the myocardium, and myocardium has to be refilled with microbubbles within the time interval between the ultrasound pulses to obtain repetitive information about perfusion. ⋯ The present case suggests that different MCE techniques can analyze different compartments of the myocardial vasculature in clinical practice. This methodological comparison between triggered and real-time PDHI shows obviously differences in the DI signal detection due to the different microbubble behavior. Clinicians should be aware of the potentials of MCE to improve noninvasive diagnostic procedures in patients with ischemic heart disease.
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Comparative Study Clinical Trial
[Ebstein's anomaly: long-term results after modified reconstruction of tricuspid valve without ventricle plication].
Ebstein's anomaly is a rare congenital heart defect in which the hinges of the septal and/or posterior leaflets are displaced downward to the right ventricle. The anterior leaflet is usually not displaced but is enlarged and sail-like and valve closure is likewise displaced downwards. Since 1988 we have operated on 22 patients with Ebstein's anomaly using a modified repair technique of the tricuspid valve. ⋯ A severe reduction in functional capacity seems to be an additional risk factor for mortality beside a cardiothoracic ratio greater than 0.65. We conclude that reconstruction of the tricuspid valve without ventricle plication not only achieves good functional results immediately after the operation but that follow-up examinations demonstrate stable or improved functional capacity in the long term. We postulate that incorporation of the atrialized chamber into the right ventricle may contribute to right ventricular contraction and thereby account for the improved functional capacity of the patients.
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We report on an asymptomatic 2 1/4 year old girl. Echocardiography revealed cor triatriatum with a membrane separating the left atrium. Transesophageal echocardiography demonstrated 3 large perforations of the intraatrial membrane. ⋯ Follow-up over 18 months revealed no development of an obstruction across the intraatrial membrane. Our case shows that immediate surgical correction is not necessary in all patients with cor triatriatum. Conservative management of these patients requires full evaluation of the hemodynamics and careful follow-up examinations by echocardiography.
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Nonsteroidal anti-inflammatory drugs (NSAIDs) are a frequently prescribed group of highly effective drugs of which the most well-known side effect is gastrointestinal peptic ulcer. However, NSAIDs have additional renal, cardiovascular, hematological, dermatological, and neurological side effects. Although the spectrum of side effects is slightly different between the conventional NSAIDs and the recently developed cyclooxygenase 2 (COX-2) inhibitors, their overall spectrum is quite similar. ⋯ COX- 2 inhibitors should be avoided in patients with known coronary or cerebrovascular disorders. In patients with uncontrolled hypertension or worsening of heart failure, unreported NSAID-use should be considered. Generally, there is a need to develop further analgetic drugs without the described side effects for patients with cardio- and cerebrovascular disorders.
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Randomized Controlled Trial Comparative Study Clinical Trial
Effect of bisoprolol on perioperative complications in chronic heart failure after surgery (Cardiac Insufficiency Bisoprolol Study II (CIBIS II)).
In patients with coronary artery disease undergoing noncardiac surgery, beta-blockers decrease perioperative mortality and nonfatal myocardial infarction. It is presently unknown whether beta-blockers reduce perioperative risk in patients with chronic heart failure. Thus, data of the CIBIS II study were analyzed regarding the effect of bisoprolol on perioperative outcome in patients with moderate to severe heart failure. ⋯ Neither postoperative hospital admission (placebo, 24.4%; bisoprolol, 34.5%, p = 0.17) nor time to postoperative hospital admission (placebo, < or =30 days, n = 2; 31-180 days, n=11; >180 days, n = 6; bisoprolol, n = 9/ 10/11; p = 0.14) were reduced by bisoprolol. Compared to coronary artery disease, perioperative beta-blockade has little effect in patients with chronic heart failure. Therefore, a controlled randomized trial with perioperative beta-blocker treatment in heart failure patients is warranted to further test this hypothesis.