[Clinical long-term results after corrective surgery of tetralogy of Fallot].

We studied 246 consecutive patients, mean age 11.9 +/- 6.7 years, with primary (n = 155) or secondary (n = 91) complete repair of tetralogy of Fallot (TOF) between 1961 and 1972.

[Doppler echocardiography analysis of left ventricular inflow patterns in hypertrophic obstructive cardiomyopathy pre- and postoperatively].

The aim of the present study was to assess abnormalities of left ventricular filling by Doppler echocardiography in patients with hypertrophic obstructive cardiomyopathy and to investigate whether a myectomy, in addition to normalizing flow, also improves diastolic function. In part A of the study, 40 patients with diagnosed invasive HOCM (29 patients with a gradient at rest, 11 patients with a gradient only after provocation) were compared with 20 normal subjects. The blood flow in the left ventricular inflow tract was examined by means of Doppler echocardiography.

The natural history of aortic valve stenosis.

Despite different aetiologies, acquired aortic stenosis is a self-maintaining, slowly progressive process with good long-term prognosis. In 142 patients with mild stenosis, there was clinical progression within 10 years of the initial diagnosis in only 12% of patients. Twenty-five years after the diagnosis had been established, the severity of aortic stenosis was clinically unchanged in 38%, while 25% of patients had moderate stenosis and 35% had undergone valve replacement.

[Prosthesis endocarditis: incidence, diagnosis, therapeutic decisions and prognosis].

In 2711 patients with heart valve replacement performed between 1965 and 1986 the cumulative incidence of prosthetic valve endocarditis (PVE) was 1.19 +/- 0.24% (n = 61).

[Indications for coronary angiography in patients with acquired heart valve diseases with reference to risk factors].

The aims of the study were to examine the frequency of coronary artery disease (CAD) in patients with acquired valvular heart disease and to investigate the parameters by which significant coronary artery stenosis can be identified without invasive measures in these patients. For this reason 266 consecutive patients with acquired valvular heart disease (aortic, mitral or combined lesions) were examined retrospectively. In 24 patients (9%) a significant (50% or more reduction of the diameter) coronary artery stenosis was found.

[Clinical significance of Doppler echocardiographic determination of the severity of aortic valve stenoses].

The purpose of the study was to evaluate the clinical significance of Doppler echocardiography in the determination of the severity of aortic stenosis, in particular, to determine to what extent a therapeutic decision in the individual patient is possible solely on the basis of noninvasive investigations. Forty consecutive patients (mean age 53 +/- 13 years, 58% males) with suspected aortic valve disease of purely or mainly stenotic nature, were examined by two-dimensional echocardiography and continuous-wave Doppler echocardiography on average 48 h before cardiac catheterization. An adequate Doppler registration was obtained in 93% (37/40).

Reoperations for malfunction of heart valve prostheses, especially with endocarditis.

Following the increasing number of patients with heart valve replacement and an extended indication (older age groups, acute infective endocarditis, multivalvular procedures) the indicence of malfunction of valve prostheses is continuously growing. The prognosis of patients with a malfunctioning prosthesis mainly depends on early diagnosis and adequate therapy. In a retrospective study (1970 to 1984) 3,533 implanted heart valve prostheses were followed up and the cases with malfunction (n = 150; 4.

[Doppler echocardiography normal values in various types of mitral valve prostheses].

To determine the value of Doppler echocardiography for the normal clinical use in functional diagnostics of prosthetic mitral valves, and to determine normal values for different types of prosthetic valves, 136 patients with different types of prosthetic mitral valves with the same external diameter (29 mm) were examined. For pressure half-time (t1/2) there were higher values for Starr-Edwards (SE) (n = 18) and Lillehei-Kaster (LK) prostheses (n = 10) (113 +/- 29 and 125 +/- 29 ms) than for Saint Jude-Medical (SJM) (n = 56), Björk-Shiley (BS) (n = 40) and Ionescu-Shiley valves (IS) (n = 12) (78 +/- 16, 82 +/- 17 and 93 +/- 28 ms, p less than 0.001), as well as for the orifice and for the mean diastolic gradient (delta p).

Hemodynamic long-term results after medical and surgical therapy of hypertrophic cardiomyopathies.

The therapeutic effectiveness of propranolol, verapamil and surgery (transaortal subvalvular myectomy) in hypertrophic cardiomyopathy was assessed in 100 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) by means of exercise tests with hemodynamic measurements. The effects of propranolol were assessed in 13 HOCM patients, of verapamil in 68 HOCM patients and 12 HNCM patients, and of surgery in 31 HOCM patients after a mean of 3 to 9 months. Of the 68 verapamil-treated patients, 23 were reexamined once more after a mean of 38 months.

[Results of coronary revascularization in occluded coronary arteries].

In a total of 82 patients (age 37-71 years) with an occluded left anterior descending artery (LAD) the results of coronary revascularization were evaluated 7 months postoperatively on average. In all patients the indications for revascularization was given by clinical symptoms (angina pectoris) or by prognostic reasons. In patients with multivessel disease.

[Hemolytic anemia as a result of hemodynamically-insignificant paravalvular dehiscence of St. Jude-Medical aortic valve prosthesis].

The course of a patient with aortic valve replacement is reported in whom increased intravascular hemolysis and auscultatory findings were suspicious of paravalvular dehiscence although other non-invasive examinations did not reveal pathological findings. Heart catheterization showed nearly normal pressures and angiocardiography minimal diastolic transaortic regurgitation. Nevertheless the patient had to be reoperated due to severe hemolytic anemia.

[Percutaneous transluminal coronary angioplasty: determination of left ventricular function in physical stress using intravenous digital subtraction angiocardiography].

24 patients with coronary artery disease underwent intravenous digital subtraction angiocardiography at rest and during exercise before and after percutaneous transluminal coronary angioplasty (PTCA). Before PTCA mean pulmonary artery pressure increased pathologically in 20 patients (on average from 22 +/- 4 to 40 +/- 9 mm Hg, p less than 0.001).

[Course of left-ventricular contraction in left bundle-branch block and its hemodynamic effects].

The aim of the study was to analyse the left ventricular contraction pattern in left bundle branch block (LBBB), to create experimentally a comparable pattern in animals and to relate this to haemodynamic measurements. In 20 normal subjects and 16 patients with LBBB without coronary heart disease we performed computer-assisted segmental left ventricular wall motion analysis during various systolic periods using two-dimensional echocardiography. The normal subjects showed on average a uniform shortening of all segments in systole; in patients with LBBB, however, asynchronous contractions of various types and intensities were found.

[Benefits of endocarditis prevention in patients with prosthetic heart valves].

The beneficial effect of prophylaxis for IE was studied in 229 patients with prosthetic heart valves in whom 287 diagnostic or therapeutic interventions were performed. The prevention used was similar to that recommended by the American Heart Association. Prosthetic valve endocarditis was not observed in any of these patients.

[Transprosthetic catheterization of a Björk-Shiley aortic prosthesis with fatal outcome].

Retrograde transprosthetic catheterization of a Björk-Shiley aortic prosthesis (type ABP) using a Sones catheter resulted in sticking of the tilting disc. Every attempt to withdraw the catheter failed and the patient died before he could be transferred for emergency reoperation. We advise against transprosthetic catheterization of tilting or bileaflet prostheses, which has been reported to be easily to perform without apparent risk.

Doppler versus contrast echocardiography for diagnosis of tricuspid regurgitation.

Sixty-eight patients (mean age 49 years) were studied with contrast echocardiography (CE) and Doppler echocardiography (DE) to evaluate both methods for detecting and grading tricuspid regurgitation (TR). In all patients, right ventricular (RV) angiography was performed. The severity of TR was graded on a 4-point scale.

[Cimetidine and ranitidine in intensive care patients. Double-blind randomized cross-over study on intravenous administration: hemodynamics, plasma coagulation, blood gases and acid-base status].

Intravenous cimetidine 200 mg, and ranitidine 50 mg were administered as 2 minute infusions to 50 intensive-care patients. Cimetidine and ranitidine differed significantly in their effect on systolic arterial blood pressure measured during the second minute (alpha = 0.01).

[Follow-up of patients with minor grades of dilated cardiomyopathy].

It is not known whether dilated cardiomyopathy (DCM) with a slight reduction of left ventricular contractions represents an "early form" and is liable to deterioration. 29 patients (mean age 45 +/- 10 years; 66% women) with mild DCM (angiographic ejection fraction between 50 and 60%, mean 56 +/- 3%) were prospectively studied for 4.0 +/- 1.

Long-term follow-up of pulmonary hypertension in patients with and without anorectic drug intake.

Over a period of up to 18 years, 24 patients (mean age: 33.8 years) with primary vascular pulmonary hypertension (PVPH) of unknown aetiology (group A) and 18 subjects (mean age: 45.3 years) with PVPH due to anorectic drug intake (group B) were comparatively studied.