Koronares Aneurysma – Eine seltene Komplikation nach Rekanalisation und Bare-metal-Stent-Implanta... more Koronares Aneurysma – Eine seltene Komplikation nach Rekanalisation und Bare-metal-Stent-Implantation M. Lange, M. Wiemer, S. Eckert, L. Faber, T. Bitter, D. Horstkotte Wir berichten über einen 69-jährigen Patienten, der aufgrund eines akuten Hinterwandinfarktes in unsere Klinik aufgenommen wurde. Eine koronare Herzkrankheit (KHK) war anamnestisch nicht bekannt. In der Herzkatheteruntersuchung zeigte sich eine koronare 2-Gefäßerkrankung mit einem Verschluss der rechten Koronararterie (RCA) [Abb. 1]. Es erfolgte eine Rekanalisation des RCA-Verschlusses und eine Bare-metal-Stent-Implantation (Vision; 4,0/15 mm) mit gutem Primärresultat [Abb. 2]. Sechs Wochen später stellte sich der Patient aufgrund zweier Episoden mit linksthorakalen Schmerzen erneut vor. Zum Ausschluss einer Progression der KHK wurde eine Herzkatheteruntersuchung durchgeführt. In dieser Untersuchung zeigte sich ein koronares Aneurysma (KA) in der RCA im Stent-Segment [Abb. 3]. Bezüglich des Aneurysmas wurde ein konse...
Herzschrittmachertherapie Und Elektrophysiologie, Dec 1, 2008
Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congesti... more Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congestive heart failure (CHF) and systolic left ventricular (LV) dysfunction despite a structurally normal valve. This functional or secondary regurgitation results from a dysbalance between closing and opening forces on the mitral leaflets due to reduced LV contractility, geometric distortion of the subvalvular apparatus, and global dilatation of the left ventricle and the mitral annulus. MR in LV dysfunction has a negative impact on both symptoms and prognosis. Surgical correction of secondary MR remained controversial although it was found to be technically feasible and to provide symptomatic benefit in some (mostly) mono-center series. Cardiac resynchronization therapy (CRT) was also found to improve secondary mitral regurgitation. However, the prediction in which patient significant secondary MR will improve with CRT is largely unresolved. The following paper reviews the available data concerning the two major interventional options for significant secondary MR in patients with CHF and systolic LV dysfunction, i.e. mitral valve surgery vs. CRT, and describes our institutional approach to this problem.
Résumé/Abstract Inter-and intraventricular conduction defects may result in unfavourable haemodyn... more Résumé/Abstract Inter-and intraventricular conduction defects may result in unfavourable haemodynamic consequences which may significantly deteriorate preexisting heart failure. Cardiac resynchronization therapy (CRT) has been shown to improve the outcome in ...
Catheterization and Cardiovascular Diagnosis, May 1, 1998
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary arte... more Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the potential complications are taken into account.
European heart journal cardiovascular Imaging, 2014
Left ventricular rotation is an interesting mechanism to investigate patients with heart disease.... more Left ventricular rotation is an interesting mechanism to investigate patients with heart disease. In children, reference values have to be defined prior to assess pathology. One hundred and seventy-four healthy individuals (0-20 years) were investigated by two-dimensional speckle tracking echocardiography, percentiles were created addressing the amount and time-to-peak values (TTP) of rotational parameters normalized to percentage of cardiac cycle (cc). Patients with right ventricular (RV) pacemaker stimulation were integrated into percentiles describing their rotational delay. Feasibility was 87.4% in healthy individuals (8.5 ± 6.2 years), 42 patients (13.0 ± 6.6 years, mean RV-stimulation time: 6.1 ± 4.3 years) were enrolled. Apical rotation (Rot(ap)) varied and was higher than basal rotation (Rot(bas)) throughout all ages. Peak torsion (Tor(max)) normalized to left ventricle (LV) length (Tor(maxi)) was elevated in early childhood and decreased until adulthood. TTP values revealed...
Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congesti... more Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congestive heart failure (CHF) and systolic left ventricular (LV) dysfunction despite a structurally normal valve. This functional or secondary regurgitation results from a dysbalance between closing and opening forces on the mitral leaflets due to reduced LV contractility, geometric distortion of the subvalvular apparatus, and global dilatation of the left ventricle and the mitral annulus. MR in LV dysfunction has a negative impact on both symptoms and prognosis. Surgical correction of secondary MR remained controversial although it was found to be technically feasible and to provide symptomatic benefit in some (mostly) mono-center series. Cardiac resynchronization therapy (CRT) was also found to improve secondary mitral regurgitation. However, the prediction in which patient significant secondary MR will improve with CRT is largely unresolved. The following paper reviews the available data con...
Resynchronization of segmental left ventricular mechanics as well as re-coordination of both atri... more Resynchronization of segmental left ventricular mechanics as well as re-coordination of both atrio-ventricular and inter-ventricular contraction are potential mechanisms responsible for the clinical benefit observed in patients with advanced congestive heart failure treated by cardiac resynchronization therapy (CRT). Initially electrical conduction problems, in the majority of cases a left bundle branch block (LBBB), were considered the target for CRT. However, growing experience with CRT in different patient populations including those with milder degrees of conduction disturbance, and improved cardiac imaging utilizing the tissue Doppler approach, have shown the complexity of CRT and the usefulness of sophisticated echocardiographic imaging techniques for therapeutic decision making and optimization of CRT device settings.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2004
We tested whether procedural success of percutaneous septal ablation for hypertrophic obstructive... more We tested whether procedural success of percutaneous septal ablation for hypertrophic obstructive cardiomyopathy is related to quantitative measurements of intraprocedural myocardial contrast echocardiography. In a study group of 34 patients, the mean area of the contrast depot was 8.5+/-2.5 cm2, its length along the left ventricular endocardial border 3.0+/-0.7 cm and its proximal edge 2.0+/-0.6 cm upstream the point of mitral-septal contact. Clinical and hemodynamic success was achieved in all but one patient 3 months following percutaneous septal ablation. The proximal edge of the ablation lesion correlated weakly (r=0.5) with the proximal edge of the contrast depot with respect to their distance from the mitral valve leaflet tips. No other correlations were found between the efficacy of percutaneous septal ablation and various quantitative measurements of intraprocedural contrast echocardiography. The localization of the ablation lesion 3 months after percutaneous septal ablatio...
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2000
Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion i... more Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion is a new treatment option in symptomatic patients with hypertrophic cardiomyopathy and subaortic, SAM-associated obstruction. We report on a patient with mid-ventricular obstruction and echocardiographic-guided reduction of septal hypertrophy. A 52-year-old woman with NYHA class III and recurrent exercise-induced syncope suffered from hypertrophic cardiomyopathy with mid-ventricular obstruction. She had a systolic gradient of 71 mmHg at rest and 153 mmHg post-extrasystole, and diastolic inflow gradient of 20 mmHg. Echo-guided percutaneous transluminal septal myocardial ablation with occlusion of the fourth septal branch resulted in acute reduction and final elimination of systolic, as well as diastolic resting and provocable gradients. Complications were not seen. At 3 months' follow-up the patient was asymptomatic and without further syncopes. Echocardiographic-guided percutaneous tr...
Catheterization and cardiovascular diagnosis, 1998
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary arte... more Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therape...
Koronares Aneurysma – Eine seltene Komplikation nach Rekanalisation und Bare-metal-Stent-Implanta... more Koronares Aneurysma – Eine seltene Komplikation nach Rekanalisation und Bare-metal-Stent-Implantation M. Lange, M. Wiemer, S. Eckert, L. Faber, T. Bitter, D. Horstkotte Wir berichten über einen 69-jährigen Patienten, der aufgrund eines akuten Hinterwandinfarktes in unsere Klinik aufgenommen wurde. Eine koronare Herzkrankheit (KHK) war anamnestisch nicht bekannt. In der Herzkatheteruntersuchung zeigte sich eine koronare 2-Gefäßerkrankung mit einem Verschluss der rechten Koronararterie (RCA) [Abb. 1]. Es erfolgte eine Rekanalisation des RCA-Verschlusses und eine Bare-metal-Stent-Implantation (Vision; 4,0/15 mm) mit gutem Primärresultat [Abb. 2]. Sechs Wochen später stellte sich der Patient aufgrund zweier Episoden mit linksthorakalen Schmerzen erneut vor. Zum Ausschluss einer Progression der KHK wurde eine Herzkatheteruntersuchung durchgeführt. In dieser Untersuchung zeigte sich ein koronares Aneurysma (KA) in der RCA im Stent-Segment [Abb. 3]. Bezüglich des Aneurysmas wurde ein konse...
Herzschrittmachertherapie Und Elektrophysiologie, Dec 1, 2008
Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congesti... more Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congestive heart failure (CHF) and systolic left ventricular (LV) dysfunction despite a structurally normal valve. This functional or secondary regurgitation results from a dysbalance between closing and opening forces on the mitral leaflets due to reduced LV contractility, geometric distortion of the subvalvular apparatus, and global dilatation of the left ventricle and the mitral annulus. MR in LV dysfunction has a negative impact on both symptoms and prognosis. Surgical correction of secondary MR remained controversial although it was found to be technically feasible and to provide symptomatic benefit in some (mostly) mono-center series. Cardiac resynchronization therapy (CRT) was also found to improve secondary mitral regurgitation. However, the prediction in which patient significant secondary MR will improve with CRT is largely unresolved. The following paper reviews the available data concerning the two major interventional options for significant secondary MR in patients with CHF and systolic LV dysfunction, i.e. mitral valve surgery vs. CRT, and describes our institutional approach to this problem.
Résumé/Abstract Inter-and intraventricular conduction defects may result in unfavourable haemodyn... more Résumé/Abstract Inter-and intraventricular conduction defects may result in unfavourable haemodynamic consequences which may significantly deteriorate preexisting heart failure. Cardiac resynchronization therapy (CRT) has been shown to improve the outcome in ...
Catheterization and Cardiovascular Diagnosis, May 1, 1998
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary arte... more Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therapeutic alternative to a combined surgical intervention in individual cases of symptomatic HOCM and CAD, provided that the potential complications are taken into account.
European heart journal cardiovascular Imaging, 2014
Left ventricular rotation is an interesting mechanism to investigate patients with heart disease.... more Left ventricular rotation is an interesting mechanism to investigate patients with heart disease. In children, reference values have to be defined prior to assess pathology. One hundred and seventy-four healthy individuals (0-20 years) were investigated by two-dimensional speckle tracking echocardiography, percentiles were created addressing the amount and time-to-peak values (TTP) of rotational parameters normalized to percentage of cardiac cycle (cc). Patients with right ventricular (RV) pacemaker stimulation were integrated into percentiles describing their rotational delay. Feasibility was 87.4% in healthy individuals (8.5 ± 6.2 years), 42 patients (13.0 ± 6.6 years, mean RV-stimulation time: 6.1 ± 4.3 years) were enrolled. Apical rotation (Rot(ap)) varied and was higher than basal rotation (Rot(bas)) throughout all ages. Peak torsion (Tor(max)) normalized to left ventricle (LV) length (Tor(maxi)) was elevated in early childhood and decreased until adulthood. TTP values revealed...
Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congesti... more Mitral regurgitation (MR) can be found in a sizeable percentage of patients with chronic congestive heart failure (CHF) and systolic left ventricular (LV) dysfunction despite a structurally normal valve. This functional or secondary regurgitation results from a dysbalance between closing and opening forces on the mitral leaflets due to reduced LV contractility, geometric distortion of the subvalvular apparatus, and global dilatation of the left ventricle and the mitral annulus. MR in LV dysfunction has a negative impact on both symptoms and prognosis. Surgical correction of secondary MR remained controversial although it was found to be technically feasible and to provide symptomatic benefit in some (mostly) mono-center series. Cardiac resynchronization therapy (CRT) was also found to improve secondary mitral regurgitation. However, the prediction in which patient significant secondary MR will improve with CRT is largely unresolved. The following paper reviews the available data con...
Resynchronization of segmental left ventricular mechanics as well as re-coordination of both atri... more Resynchronization of segmental left ventricular mechanics as well as re-coordination of both atrio-ventricular and inter-ventricular contraction are potential mechanisms responsible for the clinical benefit observed in patients with advanced congestive heart failure treated by cardiac resynchronization therapy (CRT). Initially electrical conduction problems, in the majority of cases a left bundle branch block (LBBB), were considered the target for CRT. However, growing experience with CRT in different patient populations including those with milder degrees of conduction disturbance, and improved cardiac imaging utilizing the tissue Doppler approach, have shown the complexity of CRT and the usefulness of sophisticated echocardiographic imaging techniques for therapeutic decision making and optimization of CRT device settings.
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2004
We tested whether procedural success of percutaneous septal ablation for hypertrophic obstructive... more We tested whether procedural success of percutaneous septal ablation for hypertrophic obstructive cardiomyopathy is related to quantitative measurements of intraprocedural myocardial contrast echocardiography. In a study group of 34 patients, the mean area of the contrast depot was 8.5+/-2.5 cm2, its length along the left ventricular endocardial border 3.0+/-0.7 cm and its proximal edge 2.0+/-0.6 cm upstream the point of mitral-septal contact. Clinical and hemodynamic success was achieved in all but one patient 3 months following percutaneous septal ablation. The proximal edge of the ablation lesion correlated weakly (r=0.5) with the proximal edge of the contrast depot with respect to their distance from the mitral valve leaflet tips. No other correlations were found between the efficacy of percutaneous septal ablation and various quantitative measurements of intraprocedural contrast echocardiography. The localization of the ablation lesion 3 months after percutaneous septal ablatio...
European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology, 2000
Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion i... more Percutaneous transluminal septal myocardial ablation by alcohol-induced septal branch occlusion is a new treatment option in symptomatic patients with hypertrophic cardiomyopathy and subaortic, SAM-associated obstruction. We report on a patient with mid-ventricular obstruction and echocardiographic-guided reduction of septal hypertrophy. A 52-year-old woman with NYHA class III and recurrent exercise-induced syncope suffered from hypertrophic cardiomyopathy with mid-ventricular obstruction. She had a systolic gradient of 71 mmHg at rest and 153 mmHg post-extrasystole, and diastolic inflow gradient of 20 mmHg. Echo-guided percutaneous transluminal septal myocardial ablation with occlusion of the fourth septal branch resulted in acute reduction and final elimination of systolic, as well as diastolic resting and provocable gradients. Complications were not seen. At 3 months' follow-up the patient was asymptomatic and without further syncopes. Echocardiographic-guided percutaneous tr...
Catheterization and cardiovascular diagnosis, 1998
Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary arte... more Percutaneous transluminal coronary angioplasty (PTCA) is an established therapy for coronary artery disease (CAD), whereas percutaneous transluminal septal myocardial ablation (PTSMA) is becoming increasingly significant in the therapy of symptomatic patients with hypertrophic obstructive cardiomyopathy (HOCM). We report the first ever simultaneous treatment, in a 62-yr-old patient, of significant HOCM and a 75% LAD stenosis from which the septal branch to be occluded stemmed. Using a double wire technique, first the septal branch was occluded through a fractional injection of 4 ml absolute alcohol, thus ablating the hypertrophied septal myocardium with reduction of the left ventricular outflow tract (LVOT) gradient at rest from 80 to 9 mmHg. Following this, the LAD stenosis was dilated and stented. Complications, in particular a trifascicular block or ventricular dysrhythmia, did not occur during the hospital stay. To conclude, combined PTSMA and PTCA may be considered as a therape...
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