Heart and Diabetes Center North Rhine-Westphalia

About: Heart and Diabetes Center North Rhine-Westphalia is a healthcare organization based out in Bad Oeynhausen, Germany. It is known for research contribution in the topics: Vitamin D and neurology & Heart failure. The organization has 288 authors who have published 357 publications receiving 9276 citations.

New aspects on the assessment of left ventricular dyssynchrony by tissue Doppler echocardiography: comparison of myocardial velocity vs. displacement curves

Abstract: The purpose of this study is to assess the incremental value of tissue Doppler (TDI) derived displacement curves (TDint) compared to TDI velocity curves (TDvel) for the evaluation of left ventricular (LV) dyssynchrony (LVD). About 25 patients (pts.) with systolic heart failure were studied by TDvel and TDint. Four TDI sample volumes were placed at the basal and four at the mid ventricular myocardium, utilising two imaging planes. LV dyssynchrony (LVD) was defined as an interregional delay of >40 ms corrected for heart rate. 10 pts. had synchronous contraction, 15 pts. LVD as defined by two experts (EC). To determine diagnostic accuracy and intra-observer variability two identical sets of 100 documents (25 pts. × two imaging planes × two modalities) were produced and presented in random order to one trained (TR) and two untrained (UR) readers. The TR more frequently classified documents as unreadable (7.5 vs. 3.5%, P < 0.05) but more often as correct, i.e., consistent with EC (72.0 vs. 57.8%, P < 0.001). 8.7% of the documents were classified as unreadable using TDvel, 1.0% when applying TDint (P < 0.001). The mean value of correct classification of all 3 readers was 54.3% (TDvel only), 70.7% (TDint only), and 77.7% (combining both modalities), (P < 0.001). The kappa value for TR and TDint was 0.68, for TDvel 0.29. For UR, kappa did not differ (TDint: 0.58; TDvel 0.51). TDint is superior to TDvel in accuracy, reproducibility, and applicability for skilled and unskilled investigators when evaluating LVD by TDI. The combined application of TDint and TDvel is optimal.

Surgical repair of congenital supravalvular aortic stenosis in adult.

Abstract: Supravalvular aortic stenosis is a rare congenital cardiac anomaly occurring mainly as a part of Williams-Beuren syndrome. Aortic narrowing above the level of the aortic valve causes obstruction of the left ventricular outflow tract, and a pressure gradient between the left ventricle and the aorta causes left ventricle hypertrophy. We report here a case of a 22-year-old man who underwent extended patch aortoplasty because of supravalvular aortic stenosis accompanying Williams-Beuren syndrome. He was in New York Heart Association functional class III with localized hourglass type supravalvular aortic stenosis. Related to arterial hypertension he was in a cardiac decompensation. Mean pressure gradient was 73 mm Hg and maximum gradient 104 mm Hg. Electrocardiography indicated left ventricle hypertrophy, which was also seen in x-ray, as heart enlargement. We successfully treated this patient with extended patch aortoplasty and immediate postoperative echocardiography showed reduction of gradient. Good surgical outcome of congenital supravalvular aortic stenosis in adults can be achieved with this treatment. This technique provides symmetric reconstruction of the aorta with good postoperative results and no gradient across aortic valve and aortic valve insufficiency remains, providing excellent long-term relief of localized supravalvular gradients and preservation of aortic valve competence.

Delayed coronary ischemia after transfemoral aortic valve implantation.

Abstract: Transcatheter aortic valve implantation (TAVI) offers a less invasive treatment alternative to surgical aortic valve replacement for high-risk patients. Although the procedure can be performed at low risk, life-threatening complications may arise in single cases during or even months after the procedure. Here, the details are presented of two patients who underwent TAVI by a transfemoral approach with Medtronic CoreValve prostheses and suffered myocardial ischemia months later. The patients' anatomy with small aortic root, narrow sinus of Valsalva and small distance between the annulus base and coronary arteries and/or the relative oversizing of the CoreValve prosthesis with a high positioning may have contributed to this late complication. Hence, caution is mandatory in this type of patient, with exact pre-procedural planning and close follow up required.

Complete resection of undifferentiated cardiac sarcoma and reconstruction of the atria and the superior vena cava: case report

Abstract: Primary cardiac tumors are rare with an incidence ranging from 0.001% to 0.03% in autopsy series. The prognosis of cardiac sarcomas remains poor because it proliferates rapidly and distant metastases are often found at diagnosis. A 47-year-old male complained of persistent cough. The chest roentgenogram was normal. Subsequent computed tomography revealed a mass in the right atrium. Echocardiography and magnetic resonance imaging confirmed also a right atrial mass (34 x 35 mm) infiltrating the atrial septum. The tumor was completely resected en bloc, including the anterior and lateral right atrial walls, the left atrial dome, and a large segment of the superior vena cava, and reconstructed the atria and superior vena cava with bovine pericardium. The tumor was histologically and immunohistochemically diagnosed as undifferentiated pleomorphic sarcoma. This type of cardiac sarcoma is very rare and usually found in the left atrium. Twenty-seven months after surgery, the patient is doing well without metastasis or local tumor recurrence.