Zeitschrift fur Kardiologie最新文献

{"title":"Catheter inversion to achieve complete isthmus block in patients with typical atrial flutter.","authors":"M Wieczorek,&nbsp;I Djajadisastra,&nbsp;R Hoeltgen","doi":"10.1007/s00392-005-0280-8","DOIUrl":"https://doi.org/10.1007/s00392-005-0280-8","url":null,"abstract":"<p><p>Endocardial catheter ablation is now considered as the therapy of first choice in highly symptomatic patients with recurrent atrial flutter. Despite of primary success rates between 90 and 100% complete isthmus block is sometimes hard to achieve. We present ablation results of 100 consecutive patients suffering from typical right atrial flutter. After a mean of 18 energy applications persistent bidirectional isthmus block could not be achieved in 16 patients and right atrial angiography was performed in all of them. In 9 patients a large Eustachian valve was detected and considered responsible for failure of endocardial catheter ablation of atrial flutter. Catheter manipulation targeting the anterior region of the Eustachian ridge was successful in all patients after looping the ablation catheter within the right atrium. With a mean of 3 additional RF applications, 6 of the 9 affected patients could be successfully ablated. Large Eustachian ridges are not a rare finding in patients undergoing ablation of typical right atrial flutter. Inversion of the ablation catheter within the right atrium is a simple technique providing excellent tissue contact of the ablation electrode with the anterior region of the Eustachian Ridge. Using this approach, the creation of bidirectional isthmus block is possible in the majority of the respective patients.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"674-8"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0280-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coronary surgery in dialysis-dependent patients with end stage renal failure.","authors":"S M Tugtekin,&nbsp;K Alexiou,&nbsp;Ch Georgi,&nbsp;U Kappert,&nbsp;M Knaut,&nbsp;K Matschke","doi":"10.1007/s00392-005-0286-2","DOIUrl":"https://doi.org/10.1007/s00392-005-0286-2","url":null,"abstract":"<p><p>The number of patients with dialysis-dependent end stage renal failure (ESRF) and coronary heart disease (CAD) has increased in recent years. Coronary artery bypass grafting (CABG) has become the standard treatment for CAD in this patient group, but is still considered as a risk procedure due to increased mortality and morbidity. In a retrospective study we analyzed our clinical results of isolated CABG in 40 dialysis-dependent patients with ESRF (5 female and 35 male, mean age 65+/-8.4 years) and the use of extracorporeal circulation. The perioperative control group comprised 51 patients (10 female and 41 male, mean age 67+/-7.3 years) with normal renal function and isolated CABG. Demographic and preoperative data were comparable in both groups. Hospital mortality was 2.5% in patients with ESRF and 0% in patients with normal renal function. Morbidity was comparable in both groups. The mean number of grafts was 3.1+/-0.9 in the dialysis group and 2.9+/-0.8 in the control group. In the follow-up of the dialysis group (34+/-23 months) 8 patients died. CABG in patients with dialysis-dependent ESRF can be performed with good clinical results and morbidity comparable to patients with normal renal function.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"679-83"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0286-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617493","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transcatheter closure of a ruptured ventricular septum after myocardial infarction using a venous approach.","authors":"A Elsässer,&nbsp;H Möllmann,&nbsp;H Nef,&nbsp;T Dill,&nbsp;R Brandt,&nbsp;W Skwara,&nbsp;T Hennig,&nbsp;M Rau,&nbsp;C Hamm","doi":"10.1007/s00392-005-0274-6","DOIUrl":"https://doi.org/10.1007/s00392-005-0274-6","url":null,"abstract":"<p><p>A 65-year old patient was admitted after having sustained a ventricular septum rupture 18 days after an anterior myocardial infarction. He developed acute heart failure. Given the extremely high perioperative risk in surgical approaches in this setting, we decided for a transcatheter closure of the defect with an exclusively venous approach. After a complete recovery, the patient underwent open heart surgery with aorto coronary bypass, aneurysmectomy, and removal of the closure device. This case demonstrates that transcatheter closure of a post infarction ventricular septum rupture is a technically feasible and suitable method.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"684-9"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0274-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Guidelines for heart pacemaker therapy].","authors":"B Lemke,&nbsp;B Nowak,&nbsp;D Pfeiffer","doi":"10.1007/s00392-005-0269-3","DOIUrl":"https://doi.org/10.1007/s00392-005-0269-3","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"704-20"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0269-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25616295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiofrequency catheter septal ablation for hypertrophic obstructive cardiomyopathy in childhood.","authors":"M Emmel,&nbsp;N Sreeram,&nbsp;J V deGiovanni,&nbsp;K Brockmeier","doi":"10.1007/s00392-005-0282-6","DOIUrl":"https://doi.org/10.1007/s00392-005-0282-6","url":null,"abstract":"<p><p>Two patients, a 5 year old boy with progressive hypertrophic obstructive cardiomyopathy and increasing symptoms despite appropriate pharmacologic therapy and an 11 year old girl with symptoms of tiredness and peak instantaneous LVOT gradient of 80 and 90 mmHg respectively were considered for radiofrequency catheter septal ablation, to relieve the left ventricular outflow tract obstruction. Via a femoral arterial approach, the His bundle was initially plotted and marked using the LocaLisa navigation system. Subsequently, using a cooled tip catheter a series of lesions was placed in the hypertrophied septum, commencing distally in the ventricle and proceeding towards the aortic valve, taking care to stay away from the His bundle. The procedure was deemed to be completed when the entire extent of the hypertrophied septum had been treated. In the boy the procedure was complicated by two episodes of ventricular fibrillation, requiring DC cardioversion, but without any neurologic sequelae. The peak to peak gradient between left ventricle and aorta was 50 mmHg and 60 mmHg respectively pre-ablation, and remained unchanged immediately after. Both patients were discharged from the hospital 48 hours later. Serial measurement of serum Troponin T and CK-MB isoenzyme confirmed significant myocardial necrosis. Follow-up echocardiography at 7 days and at 6 weeks post-ablation respectively confirmed a beneficial hemodynamic result, with reduction of left ventricular outflow obstruction and relief of symptoms. In young children, in whom alcohol induced septal ablation is not an option, radiofrequency catheter ablation offers an alternative to surgery, with the benefits of repeatability and a lower risk of procedure-related permanent AV block.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"699-703"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0282-6","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25616294","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Radiation-reducing planning of cardiac catheterisation.","authors":"E Kuon,&nbsp;J B Dahm,&nbsp;D M Robinson,&nbsp;K Empen,&nbsp;M Günther,&nbsp;W Wucherer","doi":"10.1007/s00392-005-0277-3","DOIUrl":"https://doi.org/10.1007/s00392-005-0277-3","url":null,"abstract":"<p><p>Any radiation exposition for medical purposes should be kept as low as is reasonably achievable. Mean patient radiation exposure of diagnostic cardiac catheterisation is high (16-106 Gy x cm2) and for this reason the International Commission on Radiological Protection (ICRP) recommends credentialing radiation protection training programmes. Twenty cardiologists each documented various dose parameters of 10 cardiac catheterisations, before and after a 90-minute mini-course of the ELICIT study group (\"Encourage to Less Irradiating Cardiologic Interventional Techniques\"), and could achieve a reduction of the mean dose-area product by 15.9+/-9.0 Gy x cm2, equivalent to 47%. The presented radiation-reducing planning of invasive cardiac catheterisation for this reason is the first one validated in clinical routine and consists of 6 standard runs--one for the left ventricle, 3 and 2 for the left (LCA) and right coronary artery (RCA), respectively--depending on anatomy and findings supplemented by 1...4 special projections. The caudal posteroanterior (PA) view documents the left coronary main stem, proximal and distal left anterior descending artery (LAD), and proximal and mid circumflex segments. The cranial PA view however is suitable for the left coronary orifice, circumflex periphery, LAD, all diagonal bifurcations, and collateral pathways towards the RCA. LCA standard angiography is completed by lateral 90 degrees/0 degrees left anterior oblique (LAO) angulation. The 60 degrees/0 degrees LAO angulation visualises the right posterolateral artery (RPL) and the RCA to its bifurcation. The more proximal one finds the bifurcation, the more the second standard cranial PA view for RCA should vary towards the cranial right anterior oblique (RAO) and finally 30 degrees/0 degrees RAO view. The efficiency of these less-irradiating angulations are improved by radiation-reducing techniques as follows: restriction to essential radiographic frames and runs, consistent collimation to the region of interest--particularly during coronary intubation--, adequate instead of best possible image quality, short skin-to-image-intensifier distance, inspiration during radiography, preference for projections that rotate out the spine, optimisation of fluoroscopy time, well-experienced and well-rested interventionists.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"663-73"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0277-3","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Huge coronary collateral connection.","authors":"M Lins,&nbsp;N E El Mokhtari,&nbsp;A Reinecke,&nbsp;A Wieckhorst,&nbsp;R Simon","doi":"10.1007/s00392-005-0289-z","DOIUrl":"https://doi.org/10.1007/s00392-005-0289-z","url":null,"abstract":"","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"661-2"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0289-z","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617490","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative endoluminal visualization of TAXUS crush-stenting at 9 months follow-up by intravascular ultrasound and optical coherence tomography.","authors":"L Buellesfeld,&nbsp;V Lim,&nbsp;U Gerckens,&nbsp;R Mueller,&nbsp;E Grube","doi":"10.1007/s00392-005-0276-4","DOIUrl":"https://doi.org/10.1007/s00392-005-0276-4","url":null,"abstract":"<p><p>We report a case of crush-stenting with Paclitaxel-eluting TAXUS stents in a left anterior descending artery (LAD) bifurcation lesion. In order to obtain precise information on the mid-term neointimal response of the main vessel to this approach, we evaluated the patient angiographically 9 months later, including intravascular visualization with optical coherence tomography (OCT), a new high resolution imaging technique, and IVUS. The evaluation revealed that there was a homogeneous neointimal coverage of the main vessel stents without evidence of significant recurrent lumen renarrowing or malappositions. Compared to IVUS, OCT proved the coverage of the stent struts adjacent to the vessel wall with a superior imaging quality and, in addition, provided new insights into the stent performance at the open bifurcation site.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"690-4"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0276-4","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25617495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left atrial myxoma diagnosed and characterized by cardiac magnetic resonance imaging.","authors":"A Deetjen,&nbsp;S Möllmann,&nbsp;T Dill,&nbsp;C W Hamm","doi":"10.1007/s00392-005-0278-2","DOIUrl":"https://doi.org/10.1007/s00392-005-0278-2","url":null,"abstract":"<p><p>A 71 year old man was referred for MRI investigation of the heart. He had a history of progressive dyspnea. Due to his echocardiographical findings and the known history of permanent atrial fibrillation, his cardiologist suspected atrial thrombi. MRI investigation of the heart showed a left atrial mass pedunculated at the atrial septum which showed signal enhancement after intravenous administration of gadolinium-DTPA. Left atrial myxoma was suspected. The patient underwent surgery with resection of the tumor and patch-occlusion of the atrial septum. Histology confirmed a polypoid cardial myxoma.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 10","pages":"695-8"},"PeriodicalIF":0.0,"publicationDate":"2005-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0278-2","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25616293","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transvenous ICD implantation after artificial tricuspid valve replacement. A new approach placing a transvenous ICD lead in the mid cardiac vein of the coronary sinus.","authors":"R Gradaus,&nbsp;L Eckardt,&nbsp;H Wedekind,&nbsp;A Löher,&nbsp;D Böcker","doi":"10.1007/s00392-005-0272-8","DOIUrl":"https://doi.org/10.1007/s00392-005-0272-8","url":null,"abstract":"<p><p>Implantation of a transvenous device in patients with a tricuspid valve replacement or a complex congenital heart disease with no access to the right ventricle represents problems. The lack of access to the right ventricle might preclude transvenous placement of a defibrillation lead at ICD implantation. A young patient (21 years) with a history of severe chest trauma with rupture of the tricuspid valve as well as the right coronary artery and consecutive inferior myocardial infarction was initially treated with tricuspid valve replacement (St Jude Medical artificial prosthesis, 33 mm) and a bypass graft to the right coronary artery. Four years later, the patient was admitted with a hemodynamically not tolerated ventricular tachycardia (VT: CL 250 ms, LBBB, left axis). The VT could be reproduced during electrophysiological testing. An ICD was implanted subpectorally in combination with a transvenous active fixation ICD lead. The transvenous ICD lead was placed via a guiding catheter into a coronary sinus branch (middle cardiac vein). Acceptable pacing and sensing values could be obtained. The defibrillation threshold was 25 J. In conclusion transvenous ICD lead implantation into a side branch of the coronary sinus in combination with a pectorally implanted \"active can\" ICD device seems to be an alternative approach. This approach may avoid implantation of additional subcutaneous defibrillation leads or even thoracotomy for ICD implantation.</p>","PeriodicalId":23757,"journal":{"name":"Zeitschrift fur Kardiologie","volume":"94 9","pages":"588-91"},"PeriodicalIF":0.0,"publicationDate":"2005-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00392-005-0272-8","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25283550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}