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[ { "id": "ZfuerKardiologie.70860251.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Praevalenz der arteriellen Hypertension und das Blutdruckverhalten bei Patienten mit Williams-Beuren-Syndrom ( WBS ) , einem Retardierungssyndrom mit typischen kardiovaskulaeren Fehlbildungen , ist unbekannt . Durch die retrospektive Analyse von Gelegenheitsblutdruckmessungen bei n = 142 Kindern Jugendlichen und jungen Erwachsenen , mit einem WBS ( weiblich n = 62 , maennlich n = 80 ; Alter 0,1-34,3 Jahre , Median 6,5 Jahre ) sowie durch die Auswertung von Langzeitblutdruckmessungen bei n = 45 Patienten ( weiblich n = 21 , maennlich n = 24 ; Alter 1-23 , 8 Jahre , Median 7,8 Jahre ) sollte die Haeufigkeit einer arteriellen Hypertension und das zirkadiane Blutdruckverhalten dieser Patienten ermittelt werden ." ], "offsets": [ [ 0, 721 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860258.ger.abstr-passage-0", "type": "abstract", "text": [ "Beschaeftigte bei interventionellen radiologischen Massnahmen sind in einer besonders hohen Strahlenexposition am Arbeitsplatz ausgesetzt . Dies gilt insbesondere fuer Taetigkeiten im Herzkatheterlabor . In der vorliegenden Untersuchung wurden durch Messungen der Ortsdosisleistung unter charakteristischen Betriebsbedingungen an einer modernen Anlage die zu erwartende jaehrliche Strahlenexposition fuer die Beschaeftigten in einem Herzkatheterlabor abgeschaetzt . Es konnte gezeigt werden , dass die resultierende Strahlenexposition stark von den verwendeten Schutzmassnahmen sowie von den Betriebsbedingungen der Anlage abhaengt . Die effektive Dosis am Arbeitsplatz des Arztes wurde bei Verwendung von Bleischuerze und Schilddruesenschutz zu etwa 1,7 mSva bestimmt . Ohne Tragen eines Schilddruesenschutzes ergibt sich ein Wert von etwa 3,5 mSva . Diese Werte entsprechen ungefaehr der natuerlichen Strahlenexposition von 2,4 mSva in der BRD . Bezieht man die Exposition auf die in einem Jahr durchgefuehrte Zahl der Untersuchungen , so ergibt sich unter den speziellen Umstaenden dieser Studie eine Strahlenexposition fuer den Arzt von etwa 1-2 µSv pro Anwendung , gemittelt ueber alle Untersuchungstypen . Es wird weiter gezeigt , dass die Ablesewerte der Filmplaketten die tatsaechliche Strahlenexposition unterschaetzen , da der Beitrag der unabgeschirmten Koerperteile zur effektiven Dosis von der Filplakette nicht beruecksichtigt wird . Aus der jaehrlichen Strahlenexposition wurde unter Annahme einer 40jaehrigen beruflichen Taetigkeit sowie bei der Verwendung aller Schutzmassnahmen die Lebenszeitdosis fuer den Arzt zu 68 mSv bestimmt . Mit dem ICRP-Risikofaktor fuer das Mortalitaetsrisiko durch strahleninduzierten Krebs ergibt sich daraus ein Lebenszeitrisiko von etwa 0,3% am Arbeitsplatz des Arztes . Nach NCRP-Standard gilt daher der Arbeitsplatz im Herzkatheterlabor unter Beruecksichtigung aller Schutzmassnahmen als sicherer Arbeitsplatz . Aenderungen bei den verwendeten Schutzmassnahmen sowie bei den Betriebsbedingungen der Anlage koennen jedoch zu starken Abweichungen bei der Strahlenexposition und damit bei der Risikoabschaetzung fuehren ." ], "offsets": [ [ 0, 2169 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.70860273.ger.abstr-passage-0", "type": "abstract", "text": [ "MITRA Maximale Individuelle TheRapie ( beim Akuten Myokardinfarkt ) ist eine Anwendungsbeobachtung fuer den stationaeren und poststationaeren Verlauf eines nicht selektierten Patientenkollektivs mit akutem transmuralem Infarkt . Es sollen die Praktikabilitaet , der optimale Einsatz und die Sicherheit einer individuell optimierten \" Infarkttherapie \" untersucht werden . Zusaetzlich soll die Qualitaet der Infarkttherapie in bezug auf jeden einzelnen Therapiebaustein abgeschaetzt werden . An der multizentrischen Studie beteiligen sich fast flaechendeckend 54 Kliniken einer umschriebenen Region im Suedwesten Deutschlands . In der Pilotphase wurden konsekutiv 1303 Patienten mit akutem transmuralem Infarkt eingeschlossen . Im Median betrug das Alter 66 Jahre , 2/3 waren Maenner . Die Praehospitalzeit war 2,7 Stunden , 64% erreichten die Klinik innerhalb der ersten 4 Stunden nach Symptombeginn . Bei 47% bestand ein Vorderwandinfarkt . In den Subgruppen der Patienten , die keine absolute Kontraindikationen hatten , erhielten : 53,4% das Thrombolytikum , 87,6% ASS , 37,1% den Betablocker und 17,4% der Patienten den ACE-Hemmer . In einer gesonderten Betrachtung wurden Patienten als optimal \" behandelt \" definiert , wenn sie in der Akutphase Thrombolyse , ASS und Betablocker nur dann erhielten , wenn sie absolute Kontraindikationen hatten . Bekamen die Patienten mindestens eines dieser drei Therapeutika nicht , obwohl absolute Kontraindikationen nicht vorlagen , wurden sie als suboptimal \" behandelt \" klassifiziert . Nur 29% ( n = 383 ) der Patienten wurden \" optimal \" , waehrend 71% ( n = 775 ) suboptimal behandelt wurden . Die univariate Analyse ergab , dass die optimal therapierten Patienten juenger waren , sie hatten haeufiger ein eindeutiges EKG oder einen Linksschenkelblock , einen Vorderwandinfarkt , eine manifeste Herzinsuffizienz , AV-Block , Bradykardie oder eine fortgeschrittene COLD . Die Praehospitalzeit war haeufiger verfuegbar . Im optimal behandelten Kollektiv betrug die 48-h-Mortalitaet 5,0% vs. 9,3% im suboptimal behandelten Kollektiv und die Krankenhausmortalitaet 10,9% vs. 17,7% . Die multivariate Analyse zeigte , dass die Variable \" optimale Therapie \" ein unabhaengiger Praediktor sowohl fuer die Frueh- als auch fuer die Krankenhausmortalitaet ist ." ], "offsets": [ [ 0, 2299 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.70860284.ger.abstr-passage-0", "type": "abstract", "text": [ "1994 wurden von der Europaeischen Gesellschaft fuer Kardiologie ( ESC ) , der Europaeischen Artheriosklerose-Gesellschaft ( EAS ) und der Europaeischen Gesellschaft fuer Hypertonie ( ESH ) Empfehlungen zur Sekundaerpraevention der koronaren Herzkrankheit ( KHK ) herausgegeben . Die EUROASPIRE-Studie ( European Action on Secondary Prevention by Intervention to Reduce Events ) wurde durchgefuehrt , um festzustellen , inwieweit die in den Empfehlungen dargelegten Massnahmen bei Patienten mit KHK umgesetzt werden . Methodik : In der Region Muenster wurden in drei Kliniken anhand von Krankenaktendaten 524 Patienten ( 70 Jahre , im Durchschnitt 58,6 Jahre ) gemaess dem akuten Ereignis , welches die stationaere Aufnahme begruendete , rekrutiert . Dabei wurde mit dem Ziel , bei der Nachuntersuchung mindestens 100 Patienten in jeder Gruppe zu haben , eine vorher festgesetzte Anzahl von Patienten aus vier Gruppen in folgender Reihenfolge ausgewaehlt 1. aortokoronare Bypass-Operation ( : ACB ) , 2. perkutane transluminale Koronarangioplastie ( PTCA ) , 3. akuter Myokardinfarkt , 4. akute Ischaemie . Durchschnittlich 20 Monate nach dem akuten Ereignis wurden die Patienten hinsichtlich des Fortbestehens ihrer Risikofaktoren nachuntersucht . Ergebnisse : Zu diesem Zeitpunkt rauchten 15,6% der Patienten , 22,7% waren adipoes , 54,6% wiesen Blutdruckwerte ueber 14090 mm Hg und 31,3% einen Gesamtcholesterin-HDL-Cholesterin-Quotienten ueber 5 auf . Eine Verminderung der Risikofaktoren im Behandlungsverlauf war zwar zu beobachten , jedoch lagen nur bei einem Fuenftel der Patienten alle Risikofaktoren im von den Empfehlungen vorgegebenen Bereich . Schlussfolgerung : Es besteht eine deutliche Diskrepanz zwischen dem angestrebten Ziel und der bisher erreichten Reduktion koronarer Risikofaktoren . Dabei besteht Handlungsbedarf fuer Verhaltensaenderungen und fuer eine verbesserte medikamentoese Behandlung . Das Potential an sekundaerpraeventiven Massnahmen wird in der Region Muenster gegenwaertig nicht in vollem Umfang ausgeschoepft ." ], "offsets": [ [ 0, 2046 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860292.ger.abstr-passage-0", "type": "abstract", "text": [ "In der Differentialdiagnose zwischen Myokarditis und dilativer Kardiomyopathie ist die Endomyokardbiopsie ein wesentlicher Untersuchungsbestandteil geworden . Anhand wichtiger immunhistologischer Befunde gelingt oft die sichere Diagnosestellung . Therapie und damit weiterer Verlauf sind von einer fruehen Diagnose abhaengig ." ], "offsets": [ [ 0, 326 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860298.ger.abstr-passage-0", "type": "abstract", "text": [ "Die chronische Myokarditis praedisponiert zum Auftreten spontaner ventrikulaerer Arrhythmien . Ob eine immunosuppressive Behandlung im Sinne einer moeglichen Kausaltherapie zu einer Arrhythmiesuppression fuehrt , ist unbekannt ." ], "offsets": [ [ 0, 228 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860313.ger.abstr-passage-0", "type": "abstract", "text": [ "Die stetig wachsende Flut von klinischen Studienergebnissen ueberfordert die Faehigkeit des einzelnen Arztes , die aktuell vorhandene biomedizinisch-wissenschaftliche Evidenz fruehzeitig und in valider Weise fuer die aerztliche Entscheidungsfindung zu nutzen . Die evidenz-basierte Medizin stellt die zentrale Forderung , dass die individuelle , klinische Expertise des Arztes stets mit der besten , aktuell verfuegbaren Evidenz aus der Wissenschaft zu einer optimalen Patientenversorgung verknuepft werden soll . Sie hat die Entwicklung wissenschaftlicher Techniken forciert , welche es gestatten , die mit grossem Aufwand in Einzelprojekten gesammelten wissenschaftlichen Evidenzen in einer klaren , nachvollziehbaren und der kritischen Bewertung zugaenglichen Form zusammenzufassen und auf einem aktuellen Stand zu halten . Diese formalisierten Zusammenfassungen werden als Systematische Studienuebersichten oder Systematischer Review bezeichnet und schliessen in der Regel auch meta-analytische Techniken mit ein . Fuer viele Probleme , die in der kardiologischen Diskussion in letzter Zeit das Thema , \" Meta-Analysen \" dominiert haben , bieten die Techniken der Systematischen Reviews hoffnungsvolle Loesungsansaetze . Die Arbeit an ihrer Verbesserung befindet sich in einem stetigen Entwicklungsprozess . Die Internationale Cochrane Collaboration wird vorgestellt als ein globales Netzwerk von Wissenschaftlern und Medizinern , das sich allein der Aufgabe qualitativ hochstehender Systematischer Reviews widmet , und ihre Struktur wird beschrieben . Leider finden sich bisher kaum Kardiologen bereit , in dieser Kollaboration mitzuwirken ." ], "offsets": [ [ 0, 1646 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860327.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Dobutamin-Stressechokardiographie ( DSE ) fuehrt zu einer starken Hyperkontraktilitaet des Myokards bei Tachykardie und Vesodilatation . Diese Effekte koennen zu einer unphysiologischen Abnahme des endsystolischen Volumenindex ( ESVI ) mit Obstruktion des linksventrikulaeren Ausflusstraktes ( LVOT ) fuehren . Bei 100 Patienten ( Pat . ) , die sich einer DSE ( 5-40 ) µg/kg/min) unterzogen , wurde die kontinuierliche Dopplerregistrierung ( DW-Doppler ) vor Infusion und bei maximaler Herzfrequenz durchgefuehrt . Eine dynamische , spaet-systolische , Flussakzeleration auf mehr als 2 Meter/Sekunde ( m/s ) unter maximaler Stimulation wurde als systolische Obstruktion des LVOT interpretiert . Manifestationsfaktoren systolischer Flussobstruktionen sollten untersucht werden . Analyseparameter waren die Ejektionsfraktion ( EF 2D-Volumetrie , mittels Scheibchensummationsmethode ) , die Wanddicke des linken Ventrikels , klinische Symptome und das Auftreten von Herzrhythmusstoerungen . Zur invasiven Abklaerung diente die femorale Katheterisierung nach Judkins mit semiquantitativer Schaetzung des Stenosegrades . Stenosen > 50% galten als signifikant ." ], "offsets": [ [ 0, 1159 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860336.ger.abstr-passage-0", "type": "abstract", "text": [ "Die echokardiographische Schnittbildtechnik ist in den letzten Jahren um die Moeglichkeit der dreidimensionalen Rekonstruktion , juengst auch um die Echtzeit-3D-Echokardiographie erweitert worden . Rekonstruktionsverfahren basieren entweder auf der akustischen oder elektromagnetischen Ortung des Schallkopfs waehrend der Datenakquisition oder auf einer praedefinierten Schallstrahlbewegung von einer ortsfesten Position aus . Hierdurch lassen sich bewegte 3D-Bilder kardialer Strukturen erzeugen . Als Technik zur Veranschaulichung komplexer raeumlicher Beziehungen ist die 3D-Echokardiographie insbesondere zur Untersuchung des Mitralrings und bei kongenitalen Fehlbildungen des Herzens eingesetzt worden . Die 3-D-Datensaetze erlauben die nachtraegliche Analyse in jeder gewuenschten Schnittfuehrung und somit sehr genaue Volumen- und Massenberechnungen , wie mehrere Arbeitsgruppen mit unterschiedlichen Methodiken uebereinstimmend gezeigt haben . Die prinzipielle quantitative Ueberlegenheit der Methode beruht auf dem vollstaendigeren Datensatz im Vergleich zur 2D-Echokardiographie. Auch Farbdopplerbilder koennen dreidimensional rekonstruiert werden , allerdings derzeit nur als Grauwertbilder . Der breite klinische Einsatz der Methode ist derzeit durch den grossen manuellen Aufwand zur Gewinnung quantitativer Daten und zum Teil noch unzureichende Bildqualitaet limitiert . Die rasche technische Entwicklung einschliesslich der Echtzeit-3D-Technik weisen der Methode jedoch einen sicheren Platz im echokardiographischen Instrumentarium der Zukunft zu ." ], "offsets": [ [ 0, 1563 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860346.ger.abstr-passage-0", "type": "abstract", "text": [ "Zur Schweregradeinteilung der Mitralinsuffizienz stehen verschiedene Methoden in der transoesophagealen Echokardiographie zur Verfuegung . Zum Vergleich der Methoden wurden 36 Patienten ( 60 +/- 13 Jahre ) mit angiographisch gesicherter Mitralinsuffizienz ( Einteilung nach Sellers ) innerhalb von 5 Tagen multiplan transoesophageal untersucht . Gemessen wurde : 1. die maximale Farbdopplerjetflaeche der Mitralinsuffizienz , 2. der Quotient aus maximaler systolischer und diastolischer pulmonalvenoeser Flussgeschwindigkeit in der linken oberen Pulmonalvene , 3. die proximale Jetbreite der Mitralinsuffizienz , 4. der maximale momentane Regurgitationsfluss Qmax , gemessen mit der proximalen Flusskonvergenz-Methode , 5. die Regurgitationsflaeche Areg aus dem Quotienten Qmax und der maximalen Regurgitationsgeschwindigkeit ." ], "offsets": [ [ 0, 827 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860363.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Punktion der Arteria radialis ist als ein alternativer Zugang fuer die Koronarangiographie oder Koronarangioplastie beschrieben . Aufgrund des kleinen Gefaessdurchmessers und der stark variierenden arteriellen Versorgung der Hand sind einige Probleme zu beruecksichtigen , um so da Risiko moeglicher Spaetschaeden zu reduzieren . Eine Punktion sollte nicht erfolgen , wenn die arterielle Versorgung ueberwiegend von der Arteria radialis abhaengt . Die Versorgung der Hand ist durch doppler- oder duplexsonographische Untersuchung zu klaeren . Nach erfolgreicher Punktion ist zunaechst eine angiographische Dokumentation der Punktionsstelle sinnvoll , um Fehllagen zu erkennen und die ausreichende Perfusion der Hand nachzuweisen . Falls eine akute Ischaemie auftritt , ist die zuegige Entfernung der eingelegten Schleuse nicht immer indiziert , da das Punktionsloch z.B. eine intraarterielle Lyse als adaequate Therapie verhindern wuerde ." ], "offsets": [ [ 0, 943 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860367.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einem 64jaehrigen Patienten mit progredienter Angina-pectoris-Symptomatik zeigte die koronare Angiographie eine Muskelbruecke im Ramus interventricularis anterior . Auch die anschliessend durchgefuehrten intrakoronare Ultraschall- ( ICUS ) und Doppler-Untersuchungen zeigten eine signifikante systolische Flaechenreduktion um 35,9% und eine eingeschraenkte koronare Flussgeschwindigkeitsreserve ( CFGR ) von 2,6 ." ], "offsets": [ [ 0, 417 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860373.ger.abstr-passage-0", "type": "abstract", "text": [ "Patienten mit terminaler Niereninsuffizienz weisen eine erhoehte Inzidenz der koronaren Herzkrankheit auf . Bei 30-60% dieser Patienten kann angiographisch eine koronare Herzkrankheit diagnostiziert werden . Ueber die Myokardrevaskularisation mittels PTCA bei chronisch dialysepflichtigen Patienten liegen nur geringe Fallzahlen vor , die ingesamt eine hohe periinterventionelle Komplikationsrate sowie eine hohe Restenoserate vermuten lassen . Wir untersuchten die Restenoserate bei 23 Patienten mit terminaler Niereninsuffizienz ( 17 Maenner , 6 Frauen , mittleres Alter : 52,5 +/- 18,3 Jahre ) . Nach primaer erfolgreicher PTCA wurde bei allen Patienten innerhalb von 6-12 Monaten eine Rekoronarangiographie durchgefuehrt . Bei computergestuetzter quantitativer Auswertung der Koronarstenosen wiesen 13 Patienten ( 56% ) eine Restenose auf , bei 11 Patienten wurde die Indikation zur erneuten Myokardrevaskularisation gestellt ( 6 x PTCA , 5 x ACB-Operation ) . Vor angiographischer Kontrolle klagten 12 Patienten ueber das erneute Auftreten von pektanginoesen Beschwerden . Die Sensitivitaet der klinischen Symptomatik fuer eine angiographische Reststenose betrug 69% . Laborchemisch lag bei den Patienten eine Hypertriglyzeridaemie ( 265 +/- 160 mg/dl und Hypercholesterinaemie ( 258 +/- 53 ) mg/dl ) mit niedriger HDL-Fraktion ( 34 +/- 14 mg/dl ) bei deutlicher Erhoehung der Fibrinogenkonzentration ( 481 +/- 114 mg/dl ) vor ." ], "offsets": [ [ 0, 1433 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860380.ger.abstr-passage-0", "type": "abstract", "text": [ "Systemikopulmonale Kollateralarterien ( SPKA ) ermoeglichen einerseits bei vielen Kindern mit einer Pulmonalatresie und Ventrikelseptumdefekt oder einer Fallotschen Tetralogie eine ausreichende kollaterale Lungenperfusion . Andererseits komplizieren sie die Korrekturoperation durch ihre operativ unguenstige Lage . Wir berichten ueber unsere Erfahrung mit dem interventionellen Verschluss von SPKA bei 10 Patienten . Bei diesen Patienten ( Alter 13 Monate -19 , 5 Jahre ) wurden insgesamt 27 SPKA angiographisch nachgewiesen . 16 dieser SPKA wurden mit Hilfe von Metallspiralen interventionell verschlossen . In 15 Faellen erzielten wir einen vollstaendigen Verschluss , in einem Fall bestand angiographisch noch ein geringgradiger Restshunt . Zur Okklusion der SPKA verwendeten wir in 2 Faellen Platinspiralen , in 11 Faellen Gianturco-Spiralen sowie in 4 Faellen ( davon 1 Pat . mit inkompletter vorangegangener Okklusion ) abloesbare Stahlspiralen . 4 Patienten benoetigten zwei interventionelle Herzkatheteruntersuchungen . Komplikationen wurden nur bei Verwendung konventioneller Metallspiralen beobachtet ( periphere pulmonale Embolisation von Platinspiralen 2 Patienten , Rueckschlag des Einbringkatheters in die Aorta bei teilausgestossener Spirale 1 Patient ) . In 6 Faellen erfolgte eine operative Ligatur , da die SPKA zum interventionellen Verschluss nicht geeignet erschienen . 5 SPKA zeigten eine spontane Verkleinerung , so dass ein Verschluss nicht notwendig wurde . Bei 8 der 10 Patienten war am Ende des Beobachtungszeitraumes die operative Korrektur des Herzfehlers bereits erfolgt , die restlichen 2 Patienten sind zu diesem Eingriff angemeldet . Unsere Ergebnisse zeigen , dass der interventionelle Verschluss von SPKA bei einem selektierten Kollektiv von Kindern mit einer Pulmonalatresie und VSD sowie mit Fallotscher Tetralogie ganz wesentlich die Durchfuehrung der operativen Korrektur erleichtert . Die Technik des interventionellen Verschlusses wird erheblich vereinfacht durch die Verwendung von replazierbaren Stahlspiralen ." ], "offsets": [ [ 0, 2055 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860406.ger.abstr-passage-0", "type": "abstract", "text": [ "Endotheline sind Peptide mit vasokonstriktorischen und mitogenen Effekten . Endothelin-1 hat vielfaeltige kurz- und langfristige Wirkungen in kardiovaskulaeren Regulationsmechanismen . In vielen Faellen ist jedoch unklar , ob die Veraenderungen des Endothelinmetabolismus primaerer Pathomechanismus oder lediglich adaptiv sind . Durch die Entwicklung von Endothelin-Rezeptor-Antagonisten und Tiermodellen mit veraendertem Endothelinstoffwechsel wurden neue Ansaetze zur Untersuchung der Endothelineffekte ermoeglicht , die zu neuen Konzepten in der Therapie von kardiovaskulaeren Erkrankungen fuehren koennten . In der vorliegenden Arbeit werden die aktuellen Daten ueber die Bedeutung der Endotheline bei wichtigen kardiovaskulaeren Erkrankungen vorgestellt ." ], "offsets": [ [ 0, 760 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860417.ger.abstr-passage-0", "type": "abstract", "text": [ "Das primaere Chyloperikard ist eine seltene Erkrankung mit sehr unterschiedlichem klinischem Verlauf ." ], "offsets": [ [ 0, 102 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860427.ger.abstr-passage-0", "type": "abstract", "text": [ "Die hypertrophe Kardiomyopathie ( HCM ) ist eine primaere Erkrankung des Herzmuskels mit einer Praevalenz von ca. 0,17% . Die Hauptmerkmale der Erkrankung sind ein systolisch und diastolisch kleiner linker Ventrikel mit hypertrophierter Muskulatur und eine normale bis uebernormale linksventrikulaere Funktion mit gestoerter diastolischer Relaxation . Als prognostisch wesentliche Komplikation und im wesentlichen verantwortlich fuer eine Mortalitaet von ca. 3,5% im Kindesalter gilt der ploetzliche Herztod . Waehrend ein grosser Teil der Patienten ueber Jahre klinisch stabil bleibt , sind in einzelnen Faellen Uebergaenge innerhalb von Jahren von einer hypertrophen Kardiomyopathie in eine dilatative Form beschrieben ." ], "offsets": [ [ 0, 722 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860433.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einer 73jaehrigen Patientin ist seit 1989 eine hypertrophe obstruktive Kardiomyopathie ( HOCM ) bekannt . Nach transmuralem Anterolateralinfarkt mit Ausbildung eines grossen Vorderwandspitzenaneurysmas ist ein zuvor gemessener Druckgradient von 110 mm Hg im linksventrikulaeren Ausflusstrakt nicht mehr nachweisbar . Es wird im folgenden diese Kasuistik einer durch Myokardinfarkt hervorgerufenen \" Pseudo-Myektomie \" als Beispiel eines ungewoehnlichen Spontanverlaufes einer HOCM veschrieben ." ], "offsets": [ [ 0, 498 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860450.ger.abstr-passage-0", "type": "abstract", "text": [ "Der Nutzen einer postoperativ routinemaessig durchgefuehrten Ueberpruefung der Defibrillationsfunktion implantierbarer Kardioverter/Defibrillatoren ( ICDs ) ist unklar ." ], "offsets": [ [ 0, 169 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860460.ger.abstr-passage-0", "type": "abstract", "text": [ "Alle 181 Patienten , die an der Universitaetsklinik Muenster in den letzten 3 Jahren mit einem implantierbaren Kardioverter-Defibrillator ( ICD ) versorgt worden waren , wurden mit einem klinischen Fragebogen zur Lebensqualitaet untersucht . 132 Patienten antworteten und konnten in die Studie aufgenommen werden ( Ruecklaufquote 73% ) . Das Durchschnittsalter der Patienten betrug 55 +/- 11,8 Jahre , 73 % waren maennlich 60% , zum Zeitpunkt der Erhebung berentet . In der Gesamtschau berichten 51% der Patienten gute bis ausgezeichnete Lebensqualitaet , demgegenueber beschrieben 24% ihre Lebensqualitaet eher negativ . 26% der Patienten litten unter Nebenwirkungen der Behandlung , vor allem im Sinne allgemeiner psychischer Beschwerden und ICD-bezogener Missempfindungen ." ], "offsets": [ [ 0, 776 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860469.ger.abstr-passage-0", "type": "abstract", "text": [ "Bis zu 30% aller Patienten mit akuter Dissektion der thorakalen Aorta werden auch heute trotz der Verfuegbarkeit bildgebender Verfahren wie transoesophageale Echokardiographie , Computertomographie oder Kernspintomographie nicht in vivo diagnostiziert . Der Nachweis erhoehter Serumspiegel von Schwerkettenmyosin ( charakteristisch fuer Gefaessmuskulatur ) koennte in Zukunft die rechtzeitige Erkennung dieser Faelle ermoeglichen . Wir setzten den Test bei zwei Patienten mit akuter thorakaler Aortendissektion ein , bei denen zunaechst kein Verdacht auf das Vorliegen einer derartigen Erkrankung vorlag . Beide Patienten hatten thorakale Schmerzen bei bekannter koronarer Herzerkrankung und zeigten echokardiographisch unauffaellige Befunde . Im ersten Fall wurde trotz Vorliegen einer seit Jahren bekannten Dilatation der Aorta ascendens und einer arteriellen Hypertonie die gezielte Evaluation der thorakalen Aorta erst mit 48stuendiger Verspaetung eingeleitet . Die Serumkonzentration des Schwerkettenmyosins war zu diesem Zeitpunkt bereits annaehernd wieder im Normbereich . Im zweiten Fall gab es weder anmnestisch noch klinisch Hinweise auf das Vorliegen einer Aortendissektion , und die Diagnose einer Typ-B-Dissektion wurde zufaellig sonographisch vermutet uns anschliessend computertomographisch gesichert . Der daraufhin ( zwoelf Stunden nach Beginn der Symptomatik ) durchgefuehrte serologische Test zeigte eine erhoehte Serumkonzentration des Schwerkettenmyosins ." ], "offsets": [ [ 0, 1477 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860474.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Diagnose eines flottierenden Thrombus im offenen Foramen ovale ( sog . Transit-Thrombus ) ohne arterielle Embolie ist selten . In dem hier geschilderten Fall wurde die Diagnose durch eine transthorakale Routineechokardiographie gestellt . Ursaechlich lag eine klinisch nicht manifeste Beinvenenthrombose zugrunde , die phlebographisch gesichert wurde . Nach Implantation eines Cava-Schirms erfolgte die herzchirurgische Entfernung des Thrombus ." ], "offsets": [ [ 0, 449 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860485.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei 123 konsekutiven Patienten mit akutem Myokardinfarkt und systemischer Lyse wurde 7-10 Tage nach Infarkt in gleicher Sitzung wie der Linksherzkatheter auch ein Rechtsherzkatheter ( RHK ) mit ergometrischer Belastung durchgefuehrt . Nach 6 Monaten wurden beide Untersuchungen wiederholt . Es sollte untersucht werden , ob der RHK das Ergebnis der Koronarographie , d.h. das Vorliegen einer 1- , 2- oder 3-Gefaess-Erkrankung, das Ergebnis der Ventrikulographie , speziell die globale Ventrikelfunktion , und insbesondere den moeglichen Profit von einer Intervention ( PTCAOP ) beim Postinfarktpatienten voraussagen kann . Ergebnisse : 1. Ruhe- und Belastungshaemodynamik korrelieren nicht zum Ausmass der Koronarerkrankung . Es gibt jedoch eine Korrelation zwischen Belastbarkeit und Anzahl der stenosierten Koronarien . 2. Ruhe- und Belastungshaemodynamik korrelieren nur schwach zur angiographischen Ventrikelfunktion . 3. Nur Patienten mit pathologischer Belastungshaemodynamik profitieren von der Revaskularisation ( definiert als Anstieg der Ejektionsfraktion > 5% ) . Dieser Profit ist allerdings eng zum Ausmass der postinfarziellen Ventrikelschaedigung korreliert . Folgerungen : Die individuelle Belastbarkeit kann einfach durch die Ergometrie erfasst werden , die Ventrikelfunktion und damit das Ausmass der postinfarziellen Ventrikelschaedigung werden zuverlaessig nichtinvasiv durch die Echokardiographie dargestellt . Die Belastungsuntersuchung mit RHK fuehrt in der Planung der weiteren Strategie fuer den Postinfarktpatienten ( insbesondere in der Frage nach der Notwendigkeit einer Koronarographie und evtl. Revaskularisation ) nicht entscheidend weiter und ist u.E. deshalb verzichtbar ." ], "offsets": [ [ 0, 1705 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860496.ger.abstr-passage-0", "type": "abstract", "text": [ "In einer retrospektiven Erhebung in den bayerischen und zwei grenznahen Kinderkliniken wurden die Lebendgeborenen der Geburtsjahrgaenge 1984-1991 mit Wohnsitz in Bayern erfasst , die waehrend ihrer ersten beiden Lebensjahre wegen einer kardiovaskulaeren Fehlbildung behandelt wurden . Die Klassifikation der Herz- und Gefaessanomalien erfolgte nach einem an der Stoerung embryonaler Entwicklungmechanismen orientierten Schema ." ], "offsets": [ [ 0, 427 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860505.ger.abstr-passage-0", "type": "abstract", "text": [ "Die chirurgische Versorgung von Neugeborenen mit hypoplastischem Linksherz-Syndrom ( HLHS ) wird immer noch zurueckhaltend betrachtet . Die komplette herzerhaltende Palliation beinhaltet neben der Norwood-Operation im Neugeborenenalter auch die spaetere Kreislauftrennung nach Fontan . Unsere Erfahrungen mit den einzelnen operativen Teilschritten werden vorgestellt . 43 Saeuglinge mit anatomischem ( n = 33 ) oder funktionellem ( n = 10 ) HLHS erhielten von 1989 bis 1996 eine Norwood-Operation . Funktionelle HLHS waren : Mitralatresie mit doppeltem Ausgang aus der rechten Kammer und subaortaler Stenose ( n = 2 ) , atrioventrikulaerer Septumdefekt mit hypoplastischer linker Kammer , Subaortenstenose und Aortenkoarktation ( n = 1 hypoplastischer , subaortaler rechter Ventrikel ) , mit restriktivem Ventrikelseptumdefekt und Aortenhypoplasie ( n = 7 ) . Das mediane Operationsalter betrug 15 Tage ( 5 bis 182 Tage ) , das mittlere Gewicht war 3,3 kg ( 3,0 bis 4,9 kg ) . Die operative Sterblichkeit lag bei 32% ( n = 14 ) , wobei sie seit 1994 auf 16% ( 3 von 19 Patienten ) gesenkt werden konnte . 5 Patienten ( 12% ) verstarben 2 Wochen bis 6 Monate spaeter , 2 Kinder wurden herztransplantiert . Von den 22 lang Ueberlebenden erhielten bisher 19 Patienten im medianen Alter von 7 Monaten ( 2 bis 14 Monate ) die obere , bidirektionale kavopulmonale Anastomose als Hemi-Fontan . 2 Kinder verstarben ( 10% ) . Von den 17 Ueberlebenden erhielten bisher 12 nach einem mittleren Intervall von 12 Monaten die ergaenzende kavopulmonale Anastomose . Alle Kinder ueberlebten den Eingriff und sind damit fertig palliiert . Die laengste Nachbeobachtung nach kompletter Fontan-Operation liegt bisher bei 6 Jahren . Zusammenfassung : Die Ergebnisse der Norwood-Operation werden mit wachsender Erfahrung guenstiger . Die nachfolgende zweischrittige Fontan-Operation hat dann nur noch ein relativ geringes Risiko und fuehrt zu einer sehr guten Lebensqualitaet ." ], "offsets": [ [ 0, 1955 ] ] } ]

[ { "id": "ZfuerKardiologie.70860505.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "herzerhaltende" ], "offsets": [ [ 150, 164 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Neugeborenenalter" ], "offsets": [ [ 218, 235 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0021289" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Stenose" ], "offsets": [ [ 600, 607 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s5-t2", "type": "umlsterm", "text": [ "Subaortenstenose" ], "offsets": [ [ 689, 705 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003500" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s5-t3", "type": "umlsterm", "text": [ "Aortenkoarktation" ], "offsets": [ [ 710, 727 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003492" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Sterblichkeit" ], "offsets": [ [ 991, 1004 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026565" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s7-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1069, 1078 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s8-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1107, 1116 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s8-t2", "type": "umlsterm", "text": [ "Kinder" ], "offsets": [ [ 1170, 1176 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008059" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s9-t1", "type": "umlsterm", "text": [ "Ueberlebenden" ], "offsets": [ [ 1221, 1234 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0206194" }, { "db_name": "UMLS", "db_id": "C0038952" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s9-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1255, 1264 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s10-t1", "type": "umlsterm", "text": [ "Kinder" ], "offsets": [ [ 1389, 1395 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008059" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s12-t1", "type": "umlsterm", "text": [ "Kinder" ], "offsets": [ [ 1556, 1562 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008059" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s13-t1", "type": "umlsterm", "text": [ "Fontan-Operation" ], "offsets": [ [ 1667, 1683 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0190010" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s14-t1", "type": "umlsterm", "text": [ "wachsender" ], "offsets": [ [ 1778, 1788 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0043076" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s15-t1", "type": "umlsterm", "text": [ "Fontan-Operation" ], "offsets": [ [ 1844, 1860 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0190010" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s15-t2", "type": "umlsterm", "text": [ "Risiko" ], "offsets": [ [ 1900, 1906 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0035647" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s15-t3", "type": "umlsterm", "text": [ "Lebensqualitaet" ], "offsets": [ [ 1938, 1953 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0034380" } ] }, { "id": "ZfuerKardiologie.70860505.ger.abstr-s15-t4", "type": "umlsterm", "text": [ "Lebensqualitaet" ], "offsets": [ [ 1938, 1953 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0376558" } ] } ]

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[ { "id": "ZfuerKardiologie.70860521.ger.abstr-passage-0", "type": "abstract", "text": [ "Autocapture ist ein neuartiger Algorithmus fuer implantierbare Herzschrittmacher , mit dessen Hilfe eine automatische Anpassung der Ausgangsleistung an die jeweilige Reizschwelle realisiert wird . Die Effektivitaet der Stimulation wird dabei durch die Wahrnehmung des myokardialen evozierten Potentials kontrolliert . Schwankungen der vom Schrittmacher kontinuierlich ausgezeichneten Reizschwelle koennen somit ueber einen laengeren Zeitraum erfasst werden . Der vorliegende Fall schildert eine Sondendislokation , die mittels Autocapture detektiert und zeitlich genau zugeordnet werden konnte ." ], "offsets": [ [ 0, 595 ] ] } ]

[ { "id": "ZfuerKardiologie.70860521.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Ausgangsleistung" ], "offsets": [ [ 132, 148 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001072" } ] }, { "id": "ZfuerKardiologie.70860521.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Wahrnehmung" ], "offsets": [ [ 252, 263 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030971" } ] }, { "id": "ZfuerKardiologie.70860521.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Sondendislokation" ], "offsets": [ [ 495, 512 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012691" } ] } ]

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[ { "id": "ZfuerKardiologie.70860530.ger.abstr-passage-0", "type": "abstract", "text": [ "Auf Vorhofebene wurden zwei aktiv fixierte steroidfreisetzende Schraubelektroden ( CapSureFix 4068 , Medtronic , n = 17 ; Accufix II DEC 033-812 , Telectronics , n = 16 ) und auf Ventrikelebene zwei aktiv fixierte Schraub- ( Cap SureFix 4068 , Medtronic , n = 11 ; Accufix II DEC 033-212 , Telectronics , n = 20 ) und eine passiv fixierte Ankerelektrode ( Encor DEC 033-448 , Telectronics , n = 18 ) miteinander verglichen . Die Messungen erfolgten intraoperativ ( = akut ) , nach 7 +/- 3 Tagen ( = subakut ) sowie im Langzeitverlauf nach 3 und 6 Monaten . Im Vorhof zeigten sich akut keine Unterschiede der Reizschwellen ( Accufix II DEC : 0,76 +/- 0,23 V - CapSureFix : 0,75 +/- 0,16 V ) . Im weiteren Verlauf kam es in beiden Gruppen zu einem statistisch nicht signifikanten Reizschwellenanstieg ( Accufix II DEC : subakut 0,99 +/- 0,45 V ; 3 Monate 0,79 +/- 0,43 V ; 6 Monate : 0,84 +/- 0,45 V - CapSureFix : subakut 0,76 +/- 0,18 V ; 3 Monate 0,87 +/- 0,31 V ; 6 Monate 0,88 +/- 0,32 V ) . Auffaellig waren die akut signifikant niedrigeren Reizschwellen im Bereich des rechten Herzohrs im Vergleich zur rechtslateralen Wand , wobei im chronischen Verlauf diese Unterschiede nicht laenger nachweisbar waren ( Herzohr n = 20 akut , 0,69 +/- 0,11 V ; rechtslaterale Wand n = 13 akut 0,85 +/- 0,25 V ) ." ], "offsets": [ [ 0, 1304 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860538.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir berichten ueber einen 61jaehrigen Patienten mit betraechtlicher Aortenklappeninsuffizienz bei quadricuspider Aortenklappe und koronarer Dreigefaesserkrankung . Die angeborene quadricuspide Aortenklappe wurde durch Entwicklung einer postendokarditischen ) Insuffizienz ( erst im fortgeschrittenen Lebensalter symptomatisch . Die Behandlung bestand aus Aortenklappenersatz und Bypass-Myokardrevaskularisation . Die Physiopathologie der quadricuspiden Aortenklappe wird diskutiert ." ], "offsets": [ [ 0, 483 ] ] } ]

[ { "id": "ZfuerKardiologie.70860538.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 38, 47 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Aortenklappeninsuffizienz" ], "offsets": [ [ 68, 93 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003504" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Aortenklappe" ], "offsets": [ [ 113, 125 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003501" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "angeborene" ], "offsets": [ [ 168, 178 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009678" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Aortenklappe" ], "offsets": [ [ 193, 205 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003501" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Behandlung" ], "offsets": [ [ 332, 342 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" } ] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Aortenklappe" ], "offsets": [ [ 453, 465 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003501" } ] } ]

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[ { "id": "ZfuerKardiologie.70860538.ger.abstr-s1-r1-t2.1-t1.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860538.ger.abstr-s2-t2", "arg2_id": "ZfuerKardiologie.70860538.ger.abstr-s4-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860538.ger.abstr-s1-r2-t3.1-t2.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860538.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70860538.ger.abstr-s2-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860541.ger.abstr-passage-0", "type": "abstract", "text": [ "Berichtet wird ueber einen Fall von Ballvarianz einer Smeloff-Cutter-Prothese in Aortenposition 24 Jahre nach Implantation . Nach vorausgegangenen embolischen Komplikationen verstarb der Patient im kardiogenen Schock . Der Silikon-Kautschuk-Ball der Prothese zeigte eine ausgepraegte Degeneration mit gelblicher Verfaerbung , Rillen- und Rissbildung bei Schwellung und subtotaler Fraktur . Daraus resultierte eine terminale Prothesenfunktionsstoerung mit kompletter Thrombose der Klappe ." ], "offsets": [ [ 0, 488 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860545.ger.abstr-passage-0", "type": "abstract", "text": [ "Ein Fall eines 73jaehrigen Patienten mit rezidivierender Angina pectoris bei Belastung , verursacht durch eine Haemangiom zwischen der Arteria pulmonalis und dem linken Herzohr , wird vorgestellt . Nach einer pathologischen Ergometrie wurde in der invasiven Diagnostik ein Herztumor diagnostiziert . Der Tumor wurde mittels medianer Sternotomie ohne extrakorporale Zirkulation entfernt . Der postoperative Verlauf war unauffaellig , und der Patient war beschwerdefrei . Haemangiome des Herzens sind seltene Tumoren , die durch eine Operation kurativ behandelt werden koennen ." ], "offsets": [ [ 0, 576 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860549.ger.abstr-passage-0", "type": "abstract", "text": [ "Als sehr seltene Ursache einer subvalvulaeren Aorteninsuffizienz wurde bei einem zehnjaehrigen Patienten akzessorisches Mitralklappengewebe nachgewiesen . In der zweidimensionalen Echokardiographie zeigte sich im linksventrikulaeren Ausflusstrakt der charakteristische Befund eines flottierenden , fallschirmartigen Gebildes , das in der Systole bis in die Aortenklappenbene hochgeschalgen wurde und einen dopplersonographischen Gradienten von 70 mm Hg zwischen linkem Ventrikel und Aorta sowie eine geringe Aorteninsuffizienz verursachte . Ueber eine Aortotomie konnte das akzessorische Klappengewebe vollstaendig ohne Schaedigung der normalen Aorten- und Mitralklappe entfernt werden . Mit Hilfe der zweidimensionalen Echokardiographie ist eine detaillierte Evaluierung der morphologischen Beziehung zwischen dem akzessorischen Klappengewebe und der Mitral- bzw. Aortenklappe moeglich , wodurch ein erfolgreiches , chirurgisches Vorgehen bei dieser seltenen Fehlbildung wesentlich erleichtert wird ." ], "offsets": [ [ 0, 1001 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860557.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Katheterablation beim Praeexzitationssyndrom ist eine interventionelle Behandlung mit kurativem Anspruch . Akzessorische Leitungsbahnen zwischen Strukturen des spezifischen oder des Arbeitsmyokards sind die anatomischen Voraussetzungen fuer orthodrome oder antidrome Reentrytachykardien unterschiedlicher Inzidenz , Dauer und Frequenz . Das Verstaendnis von Tachykardiemechanismus und Rolle der akzessorischen Bahn in der Tachykardie , die Identifizierung ihrer Topographie , die Funktion der anderen Strukturen des Erregungsleitungssystems und der Nachweis weiterer paraspezifischer Fasern sind Voraussetzungen fuer eine erfolgreiche Katheterablation . Anomalien der Trikuspidalklappe oder des Koronarsinus und koinzidierende Erkrankungen des Herzens sollten vor der Intervention mittels Echokardiographie und ggfs . zu Beginn des Eingriffs mit Kontrastdarstellung untersucht sein . Bei 300 Patienten mit versehiedenen Varianten des Praeexzitationssyndroms werden eigene Ergehnisse der Katheterablation dargestelit ." ], "offsets": [ [ 0, 1021 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860572.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Restenosierung bleibt ein wesentliches Problem nach rekonstruktiven Gefaesseingriffen . Als zugrundeliegende Pathogenesemechanismen sind die Proliferation glatter Muskelzellen , extrazellulaere Matrixbildung und Remodellierungsprozesse akzeptiert . Verminderter programmierter Zelltod ( Apoptose ) koennte ebenfalls zur Restenosierung beitragen , indem die Ueberlebenszeit intimaler Zellen verlaengert wird mit der Folge von Zell-Akkumulierung und der Entstehung hyperplastischer Laesionen . Die Ziele der vorliegenden Studie waren ( i ) Zelltod zu identifizieren , ( ii ) dabei Apoptose von Nekrose zu unterscheiden und zu quantifizieren sowie iii ) Restenose- ( mit Primaerstenoselaesionen zu vergleichen . Zu diesem Zweck wurden humane Atherektomieproben von 25 Primaer- und 14 Restenoselaesionen koronarer und peripherer Herkunft mittels TUNEL-Test ( TdT-mediated dUTP Nick End Labeling ; Nachweis von Zelltod durch Detektion fragmentierter DNA ) untersucht und zusaetzlich mit Transmissionselektronenmikroskopie und Morphometrie analysiert . Intimale Hyperplasie korrelierte mehr mit Re- als mit Primaerstenoseherkunft und war dabei auf eine erhoehte Dichte an glatten Muskelzellen zurueckzufuehren mittlere Zelldichten : ( 649 vs. 219 Zellen/mm2; p 0,001 ) . Als wesentlicher Befund dieser Studie zeigte hyperzellulaeres Restenosegewebe weniger TUNEL+-Zellen als hypozellulaere Plaques ( 14% vs. 27% ; p 0,05 ) . Ultrastrukturelle Untersuchungen wiesen hier interessanterweise einen signifikant geringeren Anteil intimaler Plaquezellen , insbesondere glatter Muskelzellen , mit distinkten morphologischen Merkmalen fuer Apoptose aus ( 3% vs. 13% ; p 0,001 ) . Bei der Inzidenz von Nekrosen war dagegen kein Unterschied zwischen beiden Plaquetypen erkennbar 0,13 vs. 0,12 Nekrosen/Zelle ; ( p = 0,49 ) . Damit weisen unsere Daten auf die Apoptose und nicht die Nekrose als zugrundeliegende Zelltodform hin mit Unterschieden zwischen beiden Laesionstypen bei signifikant verminderter Apoptose in zellreichen Restenosen . Die vorliegenden Befunde legen nahe , dass verminderte Apoptose einen wichtigen Regulationsmechanismus darstellt , der zu intimaler Hyperplasie fuehrt , wie ueblicherweise in humanen Restenosen nach Angioplastie nachweisbar ." ], "offsets": [ [ 0, 2254 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860581.ger.abstr-passage-0", "type": "abstract", "text": [ "Ziel der REDUCE-Studie war es , den therapeutischen Effekt von niedermolekularem Heparin ( Reviparin ) bezueglich einer Reduktion von klinischen Ereignissen nach transluminaler koronarer Angioplastic ( PTCA ) zu untersuchen . Standard-Heparin und seine niedermolekularen Fraktionen besitzen antiproliferative Eigenschaften . Es konnte gezeigt werden , dass sie die neointimale Proliferation glatter Muskelzellen , welche als Folge der Gefaessschaedigung nach Angioplastie auftritt , vermindern kann . Methodik : Die REDUCE-Studie ist eine internationale , prospektive , randomisierte , doppelblinde , multizentrische Studie . 26 Zentren in Europa und Kanada haben 625 Patienten mit einer einzigen dilatierbaren Stenose eingeschlossen . 306 Patienten erhielten Reviparin als einen 7000-E-Bolus unmittelbar vor PTCA , gefolgt von einer Infusion ( 10500 E ) ueber 24 Stunden und einer subkutanen Applikation von 3500 E ueber einen Zeitraum von 28 Tagen . Die 306 Patienten der Kontrollgruppe erhielten einen Bolus mit 10000 IE Standard-Heparin sowie eine Infusion mit 24000 IE Heparin ueber 24 Stunden . Diesen Patienten wurde in der Folgezeit subkutan Plazebo ueber 28 Tage appliziert . Die primaeren Endpunkte dieser Studie waren definiert als eine Reduktion der Inzidenz klinischer Ereignisse ( Tod Myokardinfarkt , , Notwendigkeit einer Reintervention oder Bypass-OP ) , absoluter Verlust des minimalen Gefaessdurchmessers der dilatierten Stenose sowie die Restenoserate waehrend des Beobachtungszeitraums von 30 Woehen nach PTCA . Ergebnisse : 102 Patienten ( 33,3% ) in der Reviparingruppe und 98 32,0% ) ( in der Kontrollgruppe haben einen primaeren klinischen Endpunkt erreicht relatives Risiko 1,04 ; ( 95%-Konfidenzintervall 0,83 bis 1,31 ; p = 0.707 ) . Des weiteren konnte kein Unterschied in der spaeten Abnahme des minimalen Gefaessdurchmesser in beiden Gruppen nachgewiesen werden . Fruehe Ereignisse waehrend oder innerhaib von 24 Stunden nach PTCA traten bei 12 Patienten ( 3,9% ) in der Reviparingruppe und bei 25 ( 8,2% ) in der Kontrollgruppe auf ( RR 0,49 ; KI 0,26 bis 0,92 ; p = 0,027 ) . In der Kontrollgruppe wurden 8 schwere Blutungen beobachtet , waehrend in der Reviparingruppe 7 schwere Blutungen bis 35 Tage nach PTCA auftraten . Die Reviparintherapie waehrend und nach PTCA fuehrt nicht zu einer Reduktion der Inzidenz klinischer Ereignisse oder einer Reduktion der Restenoserate nach PTCA ." ], "offsets": [ [ 0, 2419 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860608.ger.abstr-passage-0", "type": "abstract", "text": [ "Im Rahmen der zunehmenden Zahl von diagnostischen Herzkatheteruntersuchungen , insbesondere auch bei aelteren Patienten , sowie der Vielzahl von Koronarinterventionen , werden bei einem nicht unbetraechtlichen Teil der Patienten auch periphere Komplikationen im Zusammenhang mit der Punktion der Arteria und Vena femoralis beobachtet . Hierbei stehen die Entwicklung groesserer lokaler Punktionshaematome sowie Bildung von arteriovenoesen Fisteln und Aneurysma spuria im Vordergrund . Ziel der vorliegenden Studie war es zu untersuchen , inwieweit eine verbesserte Punktionstechnik zur Reduktion peripherer Gefaesskomplikationen fuehren kann . Dabei kam in dieser vergleichenden Studie neben der konventionellen Judkins-Punktionstechnik eine neuartige , spezielle Punktionsnadel - \" Smart Needle \" - mit einer im Mandrin integrierten Ultraschallsonde zum Einsatz . Untersucht wurden 114 Patienten ( 91 diagnostisch , 23 PTCAs ) im Alter von 23 bis 82 Jahren . Bei allen Patienten wurde ueber die Vena femoralis ein Rechtsherzkatheter angeschlossen . Konsekutiv wurden bei 50 Patienten Arteria und Vena femoralis ultraschallgefuehrt mit Smart Needle \" \" punktiert , konsekutiv wurden daraufhin 64 Patienten konventionell punktiert . Im Gegensatz zur konventionell punktierten Patientengruppe war bei der Ultraschallpunktionsnadel bei allen Patienten die Punktion der Arterie im ersten Versuch moeglich . Hingegen war dies bei der Patientengruppe mit konventioneller Punktionstechnik nur in 72% der Fall . Bei der venoesen Punktion bestand bei beiden Gruppen kein signifikanter Unterschied . Dies laesst sich aufgrund der besseren Identifizierung arterieller Dopplersignale im Vergleich zu venoesen Flusssignalen erklaeren . Bezueglich der postinterventionellen Komplikationen war nach ultraschallgesteuerter Punktion das Haematom signifikant kleiner als nach konventioneller Punktion . Waehrend in erster Gruppe bei 46% kein Haematom auftrat , war dies in der zweiten Gruppe bei nur 25% der Fall . Der Anteil der Patienten mit einer Haematomgroesse ueber 5 cm war in der konventionellen Gruppe mit 28% doppelt so gross wie in der \" Smart Needle \" -Gruppe mit 14% . lnsgesamt wiesen Patienten mit arterieller Hypertonie und Gerinnungsstoerungen ein erhebliches Risiko fuer Gefaesskomplikationen auf . Unter Beruecksichtigung der Kosten-Nutzen-Relation besteht die Indikation dieser neuen Punktionstechnik insbesondere bei uebergewichtigen Patienten und Patienten mit Aortenstenose oder kardiogenem Schock ." ], "offsets": [ [ 0, 2504 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860615.ger.abstr-passage-0", "type": "abstract", "text": [ "Ziel der Untersuchung war es , den Einfluss eines standardisierten Pelottendruckverbandes auf die Fussverhaeltnisse der unteren Extremitaeten nach Herzkatheteruntersuchung zu erfassen ." ], "offsets": [ [ 0, 185 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860622.ger.abstr-passage-0", "type": "abstract", "text": [ "Die pulmonale Hypertonie stellt eine schwerwiegende therapeutisch schlecht beherrschbare Erkrankung unterschiedlicher Aetiologie dar . Obwohl haemodynamische Parameter weitgehend mit morphologischen Befunden korrelieren , besteht aus differentialdiagnostischer Sicht haeufig die Notwendigkeit zur histologischen Beurteilung . Eine adaequate Materialgewinnung ist aufgrund der hohen Blutungsbereitschaft in der Regel nur ueber thoraxchirurgische Verfahren moeglich . In der vorliegenden Arbeit werden tierexperimentelle und erste klinische Daten einer neuen Biopsietechnik ( perkutane transvasale Biopsie , PTB ) , zur Gewinnung von Gefaesswandproben bei pulmonaler Hypertonie vorgestellt . Bei einem Teil der Versuchstiere wurde der pulmonale Hochdruck experimentell erzeugt . Die klinischen Befunde resultieren von Patienten mit einem Bronchialkarzinom . Die ersten Ergebnisse zeigen , dass mit der vorgestellten Biopsietechnik ausreichendes Material zur histologischen und immunologischen Beurteilung gewonnen werden kann . Neben Anteilen der Pulmonalarterienwand kann haeufig repraesentatives Lungenparenchym nachgewiesen werden . Komplikationen im Zusammenhang mit der Biopsietechnik traten waehrend unserer Untersuchungen nicht auf ." ], "offsets": [ [ 0, 1238 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860630.ger.abstr-passage-0", "type": "abstract", "text": [ "Ein 47jaehriger Patient wurde mit einem akuten Vorderwandinfarkt eingewiesen . Eine dringlich durchgefuehrte koronarangiographische Untersuchung zeigte einen proximalen Verschluss des Ramus interventricularis anterior ( RIVA ) . Nach mechanischer Rekanalisation stellte sich eine Kaliberreduktion des Gefaesses an der Verschlussstelle dar ; es wurde eine Ballondilatation ( PTCA ) mit konsekutiver Stent-Implantation aufgrund einer Dissektion durchgefuehrt . Danach verblieb bei normalem Koronarfluss ( TIMI 3 ) eine langstreckige Lumenreduktion des gesamten Gefaesssegments distal des Stents ohne erkennbare Stenose . Der RIVA wies am Beginn des mittleren Drittels eine Muskelbruecke auf , die auch einen abgehenden Diagonalast systolisch subtotal verschloss . Eine Dipyridamol-Thallium-Szintigraphie zeigte eine inkomplette anteroseptale Vernarbung und eine reversible anterolaterale Myokardischaemie . Wir entschlossen uns daraufhin zur Implantation eines 3,0 mm-Stents im Bereich der Muskelbruecke . Die Wahl der Ballongroesse wurde anhand der quantitativen koronarangiographischen Bestimmung des proximalen Referenzdurchmessers vorgenommen ; es resultierte ein Missverhaeltnis zwischen Gefaess- und Ballondurchmesser im distalen Dilatationssegment mit konsekutiver Koronararterienperforation in den rechtsventrikulaeren Ausflusstrakt . Der Patient blieb im Verlauf auch unter Ergometrie asymptomatisch und haemodynamisch stabil . In einer Kontroll-Koronarangiographie nach einer Woche war die Koronarfistel unveraendert nachweisbar ; der RIVA wurde rasch und vollstaendig angefaerbt ( TIMI 3 ) . Innerhalb von drei Monaten schloss sich die Fistel spontan ." ], "offsets": [ [ 0, 1661 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860639.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Poland-Syndrom ist gekennzeichnet durch eine einseitige Fehlbildung im Bereich der ventralen Thoraxwand mit Aplasie des sternokostalen Anteils des M. pectoralis major , eine ipsilaterale Symbrachydaktylie und gelegentlich assoziierte weitere Defekte der Thoraxwand , Mamille und Mamma . Nach unserer Kenntnis wurden bislang insgesamt sieben Faelle des gemeinsamen Auftretens einer Dextrokardie mit einem Poland-Syndrom beschrieben . Wir berichten ueber einen weiteren Patienten mit dieser seltenen kombinierten Fehlbildung ." ], "offsets": [ [ 0, 528 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860657.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Magnetresonanz-Bildgebung ist ein nichtinvasives Verfahren , dessen klinische Bedeutung in den letzten Jahren aufgrund technischer Fortschritte rapide gewachsen ist . Wichtige Vorteile der Methode sind die grosse Flexibilitaet in der Bildebenenwahl und die Moeglichkeit , neben anatomischen auch funktionelle Informationen zu erhalten . Magnetresonanz-Imaging ( MRI ) basiert auf der Applikation und Detektion von hochfrequenten elektromagnetischen Wellen im Radiofrequenzspektrum und arbeitet ohne jegliche Strahlenbelastung fuer den Patienten . Dies macht es zu einer sicheren Bildgebungsmethode , die auch in der modernen Kardiologie immer groessere Anwendung findet . Durch die Entwicklung neuer Bildgebungssequenzen und Computer-Hardware werden kontinuierliche Verbesserungen von raeumlicher und zeitlicher Bildaufloesung erzielt . Gerade die hohe zeitliche Aufloesung ist Voraussetzung fuer eine MR-Bildgebung bewegter Strukturen und macht den Einsatz von MRI in der kardiologischen Diagnostik erst moeglich ." ], "offsets": [ [ 0, 1019 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860669.ger.abstr-passage-0", "type": "abstract", "text": [ "Anomalien im Bereich der oberen Hohlvene kommen haeufig vor . Sie koennen Krankheitswert haben , technische Probleme bei Untersuchungen oder Behandlungen verursachen und intra- oder postoperativ den Erfolg komplexer Operationen ( z.B. Vorhofumkehr- Fontan-OP ) , gefaehrden ." ], "offsets": [ [ 0, 275 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860676.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei 24 Erwachsenen ( mittleres Alter 41 Jahre ) , bei welchen eine Aortenisthmusstenose vorlag oder frueher reseziert worden war , wurde zwischen 1961 und 1990 ein Aortenklappenersatz wegen eines schweren Aortenvitiums vorgenommen . Die Aortenisthmusstenose wurde bei 10 ( 710 mit einer Aortenstenose ) 14 Jahre vorher und bei 14 ( 1914 mit einer Aorteninsuffizienz ) gleichzeitig ( 8 ) oder innerhalb eines halben Jahres ( 6 ) operiert 4% ( aller wegen einer Aortenisthmusstenose operierten Patienten ) . Bei 2/3 der Patienten lag eine bikuspide Aortenklappe vor . Zusaetzlich zu den Aortenklappen wurden bei 8 Patienten die Operation eines Aneurysmas der Aorta ascendens , bei 2 ein Ersatz der Mitralklappe und bei einem ein aortokoronarer Bypass vorgenommen . Nach der Resektion der Aortenisthmusstenose lag bei keinem der Patienten ein haemodynamisch signifikanter Druckgradient vor praeoperativ 54 ( mmHg , postoperativ 3 mmHg ) . Die perioperative Mortalitaet der Aortenklappenoperation betrug 8% . Die 10-Jahre-Ueberlebensrate war niedriger als bei 72 gleichaltrigen Patienten der Kontrollgruppe , die waehrend derselben Zeitperiode wegen eines Aortenvitiums aehnlichen Schweregrades operiert wurden 70% vs. 88 % , ( p 0,01 ) . 67 Todesfaelle im Spaetverlauf waren kardial bedingt . Alle 55 Patienten mit einem praeoperativen linksventrikulaeren enddiastolischen Volumen > 299 mlm2, 44 mit einem endsystolischen Volumen > 90 mlm2 und 22 mit einer Auswurffraktion 41 % verstarben im postoperativen Verlauf ." ], "offsets": [ [ 0, 1513 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860684.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Veraenderungen des linken Ventrikels nach Infarkt sind charakterisiert durch geometrische , strukturelle und vaskulaere Umbauprozesse , die unter dem Begriff \" Remodeling \" zusammengefasst werden . Dieser Vorgang findet sowohl im Infarktgebiet selbst als auch im Restmyokard statt . In Abhaengigkeit von Infarktausdehnung und neurohumoraler Gegenregulation kann eine Stoerung der diastolischen und bei fortgeschrittener Erkrankung auch eine Stoerung der systolischen linksventrikulaeren ( LV ) Funktion beobachtet werden . Je nach Schweregrad weist das Restmyokard eine zunehmende Hypertrophie und Myokardfibrose auf , die Folge der veraenderten Nachlastbedingungen und Aktivierung des neurohumoralen Systems sind . Para- und autokrine Faktoren spielen ebenfalls eine wichtige Rolle in diesem Umbauprozess ." ], "offsets": [ [ 0, 811 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860712.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir berichten ueber die Ergebnisse der Ballondilatation beim akuten Myokardinfarkt ( AMI ) an grossen kommunalen Kliniken zwischen 1992 und 1995. An 68 Zentren der ALKK wurden in diesem Zeitraum 4625 Dilatationen im Rahmen eines AMI durchgefuehrt . Das Alter der Patienten betrug 60,8 +/- 11,3 Jahre , und es handelte sich in 75,1% der Faelle um Maenner . Das Infarktgefaess war in 43% der Ramus interventricularis anterior , in 37% die Arteria coronaria dextra , in 16% die Arteria circumflexa , in 2,3% ein Bypassgefaess und in 1,4% der Hauptstamm der linken Koronararterie . Nach der Intervention wurde die Residualstenose in 86% der Faelle mit weniger als 50% beurteilt . In den verschiedenen Zentren wurden zwischen einer und 365 Infarktdilatationen durchgefuehrt , mit einem Median von 40 Infarktdilatationen pro Jahr und Zentrum . Der Anteil der Infarktdilatationen an allen durchgefuehrten Interventionen stieg von 5,2% 1992 auf 5,9% 1995 an ( p = 0,01 ) . Die Zahl der lokalen Komplikationen betrug 3,2% . Bei 1,1% der Untersuchungen erfolgte eine chirurgische Intervention am Gefaesszugang . Bei 273 ( 5,9% ) der Patienten wurde waehrend des Klinikaufenthaltes eine zweite Ballondilatation durchgefuehrt , eine aortokoronare Bypassoperation bei insgesamt 3% der Patienten . Waehrend des Klinikaufenthaltes verstarben 438 9,5% ) ( der 4625 Patienten . Die Mortalitaetsrate blieb ueber die Jahre hinweg konstant ( 1992 : 10,6% ; 1993 : 8,6% ; 1994 : 9,7% ; 1995 : 9,8% : p = ns ) . Eine hoehere Mortalitaet ergab sich bei aelteren Patienten , bei Patienten mit einer Dreigefaesserkrankung , wenn das Infarktgefaess der Ramus interventricularis anterior oder ein Bypassgefaess war und bei schlechtem Ergebnis der Ballondilatation , d.h. einer Residualstenose ueber 50% . Krankenhaeuser , an denen mehr als 40 Infarktdilatationen pro Jahr durchgefuehrt wurden , hatten eine niedrigere Mortalitaet ." ], "offsets": [ [ 0, 1904 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860722.ger.abstr-passage-0", "type": "abstract", "text": [ "Durch den Einsatz unterschiedlicher bildgebender Verfahren ( CT MRT und TEE ) , ist es moeglich , eine rasche und genaue Diagnose einer Aortenruptur zu erreichen . Wir berichten ueber einen 36jaehrigen Patienten , der bei einem Autounfall eine gedeckte Ruptur der Aorta thoracalis im Isthmusbereich erlitt . Nachdem computertomographisch der Verdacht einer Aortenruptur gestellt wurde , konnte durch die TEE die Rupturstelle zweifelsfrei dargestellt werden . Nach der intraoperativen Befundbestaetigung erfolgte die erfolgreiche Implantation eines Aortenprothesen-Interponates . Der fruehzeitige Einsatz der TEE koennte die hohe Mortalitaetsrate guenstig beeinflussen . Auf eine praeoperative Angiographie kann verzichtet werden ." ], "offsets": [ [ 0, 730 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70860727.ger.abstr-passage-0", "type": "abstract", "text": [ "Therapiebeduerftige Stenosierungen der Koronararterien sind im Kindesalter selten . Bei einem 15 Jahre alten Maedchen mit einer homozygoten Hypercholesterinaemie Typ IIa waren seit dem 6. Lebensjahr in regelmaessigen Abstaenden Lipidapheresen durchgefuehrt worden . Das Maedchen gelangte mit Ruhestenokardien sowie signifikanten ST-Strecken-Senkungen in den inferioren EKG-Ableitungen zur stationaeren Aufnahme . In der Myokardszintigraphie fand sich eine infero-laterale Ischaemie . Die selektive Koronarangiographie zeigte eine umschriebene 90%-Stenosierung unmittelbar jenseits des Ostiums der rechten Koronararterie . Distal davon bestand eine poststenotische Dilatation , zusaetzlich fanden sich diffuse 10%ige Einengungen in den proximalen und mittleren Abschnitten der rechten Koronararterie . Die linke Koronararterie stellte sich unauffaellig dar . Nach Vordilatation erfolgte die Implantation eines 6-mm-Microstents II in den stenosierten Bereich . Durch diese Intervention konnte die Auspraegung der Stenose von 90 auf 40% reduziert werden . 12 Monate postinterventionell ist die Patientin beschwerdefrei . Zur Zeit wird neben unveraendert regelmaessigen Lipidapheresen eine Thrombozytenaggregationshemmung mit Ticlopidin 2 x 250 mg durchgefuehrt ." ], "offsets": [ [ 0, 1259 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860732.ger.abstr-passage-0", "type": "abstract", "text": [ "Es wird die Krankheitsgeschichte eines 42jaehrigen Patienten vorgestellt , bei dem es 14 Tage nach operativer Versorgung einer traumatischen Unterschenkelfraktur trotz Prophylaxe mit niedermolekularem Heparin zu einer angiographisch nachgewiesenen Phlebothrombose mit rezidivierenden Lungenembolien sowie zu einer paradoxen zerebralen Embolie gekommen war . In der transthorakalen Echokardiographie konnte ein grosser , im offenen Foramen ovale inkarzerierter Thrombus dargestellt werden , der diastolisch gut sichtbar durch beide AV-Klappen in die Ventrikel prolabierte . Dieser Befund wurde nach der systemischen Notfallysetherapie mit rtPA wegen einer fulminanten Lungenembolie erhoben . Anschliessend wurde der intrakardiale Thrombus operativ entfernt , das offene Foramen ovale primaer verschlossen und beide Lungenarterien thrombektomiert . Anhand des vorliegenden Falles wird die Bedeutung eines offenen Foramen ovale fuer paradoxe Embolien sowie die differentialtherapeutischen Moeglichkeiten bei einem sogenannten Transitthrombus ( operative Thrombusentfernung , thrombolytische Therapie und Antikoagulation ) diskutiert ." ], "offsets": [ [ 0, 1131 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860788.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Beteiligung immunologischer Mechanismen bei Krankheitsbildern mit Stoerung der kardialen Pumpfunktion ist in den letzten Jahren verstaerkt in den Vordergrund gerueckt . In verschiedenen pathophysiologischen Situationen wie Herzinsuffizienz , Herzoperation , Herztransplantation , Herzinfarkt und Angina pectoris wurden Muster mit Erhoehung von proinflammatorischen Zytokinen wie Tumor-Nekrose-Faktor- , Interleukin-1 und Interleukin-6 und reversibler kardialer Dysfunktion beschrieben , die moeglicherweise Ausdruck einer gemeinsamen biologischen Endstrecke sind . Dabei legen die verfuegbaren Daten eine Beeinflussung wichtiger Determinanten der Pumpfunktion , d.h. von Kontraktilitaet , Vorlast , Nachlast und Herzfrequenz , durch Zytokine nahe . Moegliche Mechanismen schliessen den -Adrenozeptor-Weg , den Stickstoff-Monoxid-Weg sowie eine direkte Wirkung auf die Kalzium-Homooestase ein . Therapeutische Konzepte , die auf diesem neuen Verstaendnis basieren , stehen am Anfang der Entwicklung ." ], "offsets": [ [ 0, 1003 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.70860803.ger.abstr-passage-0", "type": "abstract", "text": [ "Die dilatative Kardiomyopathie ist eine Herzmuskelerkrankung , die durch eine Vergroesserung vor allem des linken Ventrikels , eine eingeschraenkte systolische Funktion und auffaellig duenne Myokardwaende charakterisiert ist . Histologisch findet sich eine Abnahme der Zahl der Herzmuskelfasern , eine Hypertrophie der Myozyten und eine intersitielle Fibrose . Die Wandspannung ist aufgrund der geringen Wanddicke und des grossen Durchmessers des Ventrikels erhoeht und steigt im Verlauf der Erkrankung weiter an . Die progrediente Zunahme der Wandspannung ist mit verantwortlich fuer die Abnahme der linksventrikulaeren Funktion ." ], "offsets": [ [ 0, 631 ] ] } ]

[ { "id": "ZfuerKardiologie.70860803.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Kardiomyopathie" ], "offsets": [ [ 15, 30 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027049" } ] }, { "id": "ZfuerKardiologie.70860803.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Myokardwaende" ], "offsets": [ [ 191, 204 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027061" } ] }, { "id": "ZfuerKardiologie.70860803.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Herzmuskelfasern" ], "offsets": [ [ 278, 294 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018787" } ] }, { "id": "ZfuerKardiologie.70860803.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Herzmuskelfasern" ], "offsets": [ [ 278, 294 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0242697" } ] }, { "id": "ZfuerKardiologie.70860803.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Hypertrophie" ], "offsets": [ [ 302, 314 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020564" } ] } ]

[]

[]

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[ { "id": "ZfuerKardiologie.70860812.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einer 71jaehrigen Patientin mit Makroglossie und kardialer Dekompensation ( NYHA III ) wurde immunelektrophoretisch im Serum eine Vermehrung von Kappa-Leichtketten nachgewiesen . In der Echokardiographie sowie angikardiographisch wurde eine restriktive Kardiomyopathie diagnostiziert . Die Knochenmarkzytologie ergab eine Plasmazelldyskrasie , die Histologie der Zungenbiopsie eine Amyloidose . Die Diagnostik erbrachte die seltene Diagnose einer restriktiven Kardiiomyopathie bei primaerer Amyloidose AL ." ], "offsets": [ [ 0, 510 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.70860818.ger.abstr-passage-0", "type": "abstract", "text": [ "Studienziel : Es galt die Genauigkeit des intravasalen Ultraschalls ( IVUS ) in der Darstellung kalzifizierender arteriosklerotischer Wandveraenderungen zu ermitteln . Methode : 181 Arteriensegmente wurden mit 20/30-MHz-IVUS in vitro untersucht . Die Ultraschallbilder wurden mit den Roentgenbildern ( 30 kV ) und den histologischen Schnitten der korrespondierenden Querschnittsegmente verglichen . Ergebnisse : Verkalkte Wandveraenderungen stellten sich sonographisch mit einem echogenen Oberflaechenreflex und dahinterliegendem Schallschatten dar . 13 von 161 in den Roentgenaufnahmen diagnostizierten Kalkherden konnten auf den IVUS-Bildern nicht erkannt werden . In fuenf Faellen liess sich die sonographische Diagnose Kalkherd radiologisch nicht bestaetigen . Hieraus berechnete sich eine Sensitivitaet von 91,6% , eine Spezifitaet von 94,7% und eine Genauigkeit von 93,0% . Schlussfolgerungen : Aufgrund der akustischen Eigenschaften verkalkter Gewebestrukturen laesst sich mit einer hohen Genauigkeit die Diagnose \" verkalkte Plaque \" mittels IVUS stellen . Eine genaue Kenntnis des morphologischen Aufbaues einer Gefaessstenose kann eine differenzierte Planung eines angioplastischen Eingriffes ermoeglichen ." ], "offsets": [ [ 0, 1217 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860839.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Analyse des pulmonalvenoesen Dopplerflussprofils ist hilfreich in der Schweregradabschaetzung einer Mitralinsuffizienz sowie in Kombination mit dem transmitralen Flussprofil bei der Beurteilung einer linksventrikulaeren diastolischen Dysfunktion . In etwa einem Drittel der Faelle gelingt es jedoch nicht , ein adaequat interpretierbares Lungenvenenflussprofil mittels transthorakaler Beschallung aufzuzeichnen ." ], "offsets": [ [ 0, 416 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860857.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Koronarangiographie gilt als wichtigster Baustein in der Diagnosestellung der koronaren Herzkrankheit . Die Roentgenkontrastdarstellung der Koronargefaesse erlaubt jedoch nur eine Darstellung des Gefaesslumens . Dagegen ist es mit dem intravaskulaeren Ultraschall moeglich , pathologische Veraenderungen der Gefaesswand zu erfassen . Trotz typischer Beschwerdesymptomatik weist gelegentlich die angiographische Darstellung der Koronararterien keinen eindeutigen Befund im Sinne einer stenosierenden koronaren Herzkrankheit auf . In diesen Faellen ermoeglicht der intravaskulaere Ultraschall neue ergaenzende Perspektiven , in der Diagnostik , um gegebenenfalls auch Fruehformen der Arteriosklerose oder auch angiographisch unterschaetzte Koronarbefunde aufzudecken . Dies soll anhand zweier Fallbeispiele erlaeutert werden , bei denen die angiographische Darstellung der Koronararterien trotz typischer klinischer Symptomatik einen nicht eindeutigen Befund zeigte und erst durch die intravaskulaere Ultraschalluntersuchung bedeutsame atherosklerotische Wandveraenderungen nachgewiesen werden konnten ." ], "offsets": [ [ 0, 1105 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860863.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir berichten ueber eine 28jaehrige Patientin , die aufgrund eines Ventrikelseptumdefektes ( VSD ) mit Eisenmengerreaktion und nachfolgender Herzinsuffizienz NYHA-Stadium IV Herz-Lungen-transplantiert wurde und an den Folgen einer akuten GvHD am 34. postoperativen Tag verstarb ." ], "offsets": [ [ 0, 279 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860868.ger.abstr-passage-0", "type": "abstract", "text": [ "Ein Hauptproblem im Langzeitverlauf nach Herztransplantationen stellt die Entwicklung einer Transplantatvaskulopathie dar . In dieser prospektiven Studie wurde die Wertigkeit der quantitativen Dobutamin-Stressechokardiographie zur Diagnostik der Transplantatvaskulopathie ( TVP ) mit der Koronarangriographie und dem intravaskulaeren Ultraschall verglichen . Insgesamt wurden bei 80 Patienten in der Spaetphase nach Herztransplantation ( > = 12 Monate postoperativ 144 Dobutamin-Stressechokardiogramme ) durchgefuehrt . Neben der ueblichen regionalen Wandbewebungsanalyse im 2D-Echokardiogramm wurde auch die systolische Wanddickenzunahme von Septum und linksventrikulaerer Hinterwand im M-Mode-Echokardiogramm ausgewertet . Bei Patienten mit invasiv bestaetigter TVP war die Wanddickenzunahme von Septum und Hinterwand in Ruhe wie auch unter maximalem Stress signifikant niedriger als bei Patienten ohne TVP . Bei einer Untergruppe von Patienten ohne TVP und ohne sonstige kardiale Auffaelligkeiten ( n = 23 ) wurden Normwerte fuer die M-Mode-Parameter erstellt und folgende Untergrenzen ermittelt : systolische Wanddickenzunahme des Septums in Ruhe 17,2 % , unter maximaler Dobutaminzufuhr 45,9 % ; systolische Dickenzunahme der Hinterwand in Ruhe 41,6 % , unter maximalem Stress 67,6 % . Im Vergleich zu den invasiven Verfahren zeigte die 2D-Analyse eine Sensitivitaet von 76 % ( Spezifitaet 82 % ) zur Erkennung der TVP . Die alleinige M-Mode-Auswertung der Wanddickenzunahme hatte eine Sensitivitaet von 63 % ( Spezifitaet 76% ) , die Kombination beider echokardiographischer Verfahren ergab eine Sensitivitaet von 85 % ( Spezifitaet 71 % ) . Zusammenfassend stellt die Dobutamin-Stressechokardiographie eine zuverlaessige nichtinvasive Methode zur Diagnostik der TVP dar ; die M-Mode-Analyse verbessert die Sensititvitaet der 2D-Auswertung. Die beschriebenen Normwerte der M-Mode-Stressechokardiographie koennen als Referenz bei anderen Untersuchungen herzplantierter Patienten dienen ." ], "offsets": [ [ 0, 1992 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860883.ger.abstr-passage-0", "type": "abstract", "text": [ "Ziel der prospektiven Studie ist die Korrelation ventrikulaerer Spaetpotentiale mit klinischen Parametern bei Patienten nach akutem Myokardinfarkt . Es wurde die prognostische Wertigkeit dieser Methode hinsichtlich der Risikostratifizierung bezueglich des ploetzlichen Herztodes in der spaeten Postinfarktphase im Vergleich mit herkoemmlichen diagnostischen Moeglichkeiten ueberprueft . Zudem wurde untersucht , welche klinischen Symptome die potentiell gefaehrdeten Patienten charakterisieren ." ], "offsets": [ [ 0, 495 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860891.ger.abstr-passage-0", "type": "abstract", "text": [ "Berichtet wird ueber fuenf Patienten mit konstantem ventrikulaerem Bigeminus des rechtsventrikulaeren Ausflusstraktes , fehlenden Kammertachykardien , Ausschluss einer strukturellen Herzerkrankung und erheblicher subjektiver Beeintraechtigung , die mittels Radiofrequenzablation des ektopen Fokus erfolgreich behandelt wurden . Die Katheterablation wird vor dem Hintergrund der vieldiskutierten Indikation von Klasse-I-Antiarrhythmika als alternatives therapeutisches Verfahren bei ventrikulaeren Extrasystolen des rechtsventrikulaeren Ausflusstraktes vorgestellt ." ], "offsets": [ [ 0, 565 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860891.ger.abstr-s1-r1-t1.1-t4.1", "type": "uses", "arg1_id": "ZfuerKardiologie.70860891.ger.abstr-s2-t1", "arg2_id": "ZfuerKardiologie.70860891.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860891.ger.abstr-s1-r2-t2.1-t1.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860891.ger.abstr-s1-t2", "arg2_id": "ZfuerKardiologie.70860891.ger.abstr-s2-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860891.ger.abstr-s1-r3-t3.1-t2.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860891.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70860891.ger.abstr-s1-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860896.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei 49 Patienten , bei denen eine Ablation der langsamen Leitungsbahn bei AV-Knoten-Reentry-Tachykardie ( AVNRT ) durchgefuehrt wurde , wurden die vom Ablationskatheter bei erfolgreichen und nicht erfolgreichen Hochfrequenzstromapplikationen abgeleiteten lokalen Elektrogramme retrospektiv analysiert . Sie wurden auf folgende Kriterien untersucht : 1. Quotient aus der Amplitude des atrialen ( A ) und des ventrikulaeren Potentials ( V ) ; 2. Vorhandensein von fraktionierter atrialer Aktivitaet ( FAA ) oder eines Potentials der langsamen Leitungsbahn ( PLB ) ; 3. Breite der lokalen atrialen Elektrogramme . Anhand der Kriterien 1. und 2. wurden 3 Gruppen gebildet : Gruppe 1 : keine FAA/PLB , A/V-Quotient > = 0,25 ; Gruppe 2 : FAA/PLB oder A/V-Quotient 0,25 Gruppe 3 : ; FAA/PLB und A/V-Quotient 0,25 . Zusammenfassung : 1. Bei der Ablation der langsamen Leitungsbahn ist der A/V-Quotient an erfolgreichen Ablationsorten signifikant niedriger als an nicht erfolgreichen . 2. Die Dauer der lokalen atrialen Potentiale unterscheidet sich nicht signifikant zwischen erfolgreichen und nicht erfolgreichen Orten . 3. Der Applikationserfolg korreliert mit dem Vorhandensein von FAA oder PLB und einem A/V-Quotienten von 0,25 ." ], "offsets": [ [ 0, 1225 ] ] } ]

[ { "id": "ZfuerKardiologie.70860896.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 7, 16 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] } ]

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[ { "id": "ZfuerKardiologie.70860902.ger.abstr-passage-0", "type": "abstract", "text": [ "Arteriosklerotische Plaques bei akutem Koronarsyndrom zeigen vermehrt Entzuendungszellen und eine geringere Dichte an glatten Muskelzellen . Die zugrundeliegenden pathogenetischen Prozesse sind unklar ; postuliert wird vermehrter programmierter Zelltod ( Apoptose ) . Koronare Atherektomieproben von 26 Patienten mit instabiler Angina ( Gruppe 1 ) und von 24 Patienten mit stabiler Angina ( Gruppe 2 ) wurden immunhistochemisch ( TUNEL-Test zum Nachweis fragmentierter DNA ) sowie elektronenmikroskopisch untersucht . Ziele dieser Studie waren die Evaluierung moeglicher Gruppenunterschiede in der zellulaeren Zusammensetzung der Plaques , Nachweis und Quantifizierung von Zelltod-Ereignissen sowie die Abgrenzung von Apoptose und Nekrose ." ], "offsets": [ [ 0, 740 ] ] } ]

[ { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Koronarsyndrom" ], "offsets": [ [ 39, 53 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039082" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Muskelzellen" ], "offsets": [ [ 126, 138 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0026845" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Muskelzellen" ], "offsets": [ [ 126, 138 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007634" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Zelltod" ], "offsets": [ [ 245, 252 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007587" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "programmierter Zelltod" ], "offsets": [ [ 230, 252 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0162638" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 303, 312 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 359, 368 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "DNA" ], "offsets": [ [ 469, 472 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012854" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s3-t4", "type": "umlsterm", "text": [ "elektronenmikroskopisch" ], "offsets": [ [ 481, 504 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013852" } ] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Nekrose" ], "offsets": [ [ 731, 738 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0027540" } ] } ]

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[ { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-r1-t2.1-t3.1", "type": "surrounds", "arg1_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-r2-t3.1-t1.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t3", "arg2_id": "ZfuerKardiologie.70860902.ger.abstr-s4-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-r3-t1.1-t2.1", "type": "produces", "arg1_id": "ZfuerKardiologie.70860902.ger.abstr-s4-t1", "arg2_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-r4-t2.1-t1.1", "type": "location_of", "arg1_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t2", "arg2_id": "ZfuerKardiologie.70860902.ger.abstr-s4-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860902.ger.abstr-s1-r5-t3.1-t2.1", "type": "part_of", "arg1_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t3", "arg2_id": "ZfuerKardiologie.70860902.ger.abstr-s3-t2", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860920.ger.abstr-passage-0", "type": "abstract", "text": [ "Die pulmonale Thrombendarteriektomie ist ein potentiell kuratives Operationsverfahren bei Patienten mit chronischer thromboembolischer pulmonaler Hypertonie . Von Juni 1989 bis Dezember 1994 wurden in unserer Klinik 109 Patienten einer pulmonalen Thrombendarteriektomie unterzogen . Seit Januar 1995 wurden vielfaeltige Veraenderungen des operativen und postoperativen Therapiekonzepts vorgenommen . Wir berichten ueber die Fruehergebnisse von 32 Thrombendarteriektomien , die von Januar 1995 bis Januar 1997 durchgefuehrt worden sind ." ], "offsets": [ [ 0, 536 ] ] } ]

[ { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Thrombendarteriektomie" ], "offsets": [ [ 14, 36 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014099" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 90, 99 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Hypertonie" ], "offsets": [ [ 146, 156 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020538" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "pulmonaler Hypertonie" ], "offsets": [ [ 135, 156 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020542" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 220, 229 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Thrombendarteriektomie" ], "offsets": [ [ 247, 269 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014099" } ] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Therapiekonzepts" ], "offsets": [ [ 369, 385 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" }, { "db_name": "UMLS", "db_id": "C0039798" } ] } ]

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[ { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r1-t1.1-t2.1", "type": "affects", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r2-t2.1-t1.1", "type": "performs", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r3-t3.1-t4.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r4-t4.1-t1.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r5-t3.1-t2.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r6-t3.1-t1.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r7-t4.1-t2.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r8-t1.1-t4.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r9-t1.1-t3.1", "type": "treats", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r10-t1.1-t3.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s1-r11-t4.1-t3.1", "type": "associated_with", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t4", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s2-r1-t1.1-t2.1", "type": "performs", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70860920.ger.abstr-s2-r2-t2.1-t1.1", "type": "affects", "arg1_id": "ZfuerKardiologie.70860920.ger.abstr-s2-t2", "arg2_id": "ZfuerKardiologie.70860920.ger.abstr-s3-t1", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70860928.ger.abstr-passage-0", "type": "abstract", "text": [ "Durch pulmonale Thrombendarteriektomie kann bei Patienten mit chronischer embolisch bedingter pulmonaler Hypertonie eine akute rechtsventrikulaere Nachlastsenkung erzielt werden . Der Einfluss auf die rechts- und linksventrikulaere Geometrie und Haemodynamik wurde prospektiv mit Hilfe der transthorakalen Echokardiographie an einem Kollektiv von 14 Patienten ( 8 Frauen , 6 Maenner ; Alter 55 +/- 20 Jahre ) vor und nach 18 +/- 12 Tagen postoperativ untersucht ." ], "offsets": [ [ 0, 463 ] ] } ]

[ { "id": "ZfuerKardiologie.70860928.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Thrombendarteriektomie" ], "offsets": [ [ 16, 38 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0014099" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 48, 57 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Hypertonie" ], "offsets": [ [ 105, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020538" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "pulmonaler Hypertonie" ], "offsets": [ [ 94, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020542" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "Haemodynamik" ], "offsets": [ [ 246, 258 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0019010" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Echokardiographie" ], "offsets": [ [ 306, 323 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013516" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 350, 359 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s2-t4", "type": "umlsterm", "text": [ "Frauen" ], "offsets": [ [ 364, 370 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0043210" } ] }, { "id": "ZfuerKardiologie.70860928.ger.abstr-s2-t5", "type": "umlsterm", "text": [ "Maenner" ], "offsets": [ [ 375, 382 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0025266" } ] } ]

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[ { "id": "ZfuerKardiologie.70860945.ger.abstr-passage-0", "type": "abstract", "text": [ "Hintergrund : Patienten nach atrialen Umkehroperationen ( Mustard- oder Senning-Operation ) zur Korrektur einer Transposition der grossen Arterien ( TGA ) unterscheiden sich in einem wesentlichen Punkt von anderen Patienten mit kongenitalen Vitien : Der anatomisch rechte ( vorne gelegene ) Ventrikel fungiert bei ihnen als Systemventrikel . Da eine wachsende Zahl derart operierter Patienten das Erwachsenenalter erreicht , gewinnt die Frage , ob eine Schwangerschaft fuer die so operierten Patientinnen wegen der dabei auftretenden , ausgepraegten haemodynamischen Veraenderungen eine Gefaehrdung darstellt , zunehmende Bedeutung . Patienten : Initiiert durch die Vorstellung einer schwangeren Patientin in unserer Klinik konnten durch Literatursuche in MEDLINE weitere 26 Kasuistiken ueber Schwangerschaften nach Mustard-Operation identifiziert werden . Bei den somit insgesamt 27 Patientinnen wurde ueber 39 Schwangerschaften berichtet . Fetale Komplikationen : Es kam zu drei Fruehaborten im 1. Trimenon und einer Fehlgeburt in der 23. Schwangerschaftswoche . Weiterhin wurde ein elektiver Abort im 1. Trimenon durchgefuehrt . 35 Kinder ( ein Zwillingspaar ) wurden lebend geboren ohne kardiovaskulaere Fehlbildungen . Muetterliche Komplikationen : Von den Muettern verstarb keine . Acht Patientinnen entwickelten eine therapiebeduerftige Herzinsuffizienz , wobei alle drei Patientinnen mit vormals komplexer TGA ( zusaetzliche andere kardiale Fehlbildungen ) betroffen waren . Von diesen erholten sich vier Patientinnen innerhalb der Nachbeobachtungszeit , die anderen vier Patientinnen zeigten eine anhaltende Verschlechterung ihrer koerperlichen Leistungsfaehigkeit oder klinische Zeichen einer Herzinsuffizienz . Als weitere Komplikationen kam es bei fuenf Patienten zu supraventrikulaeren Tachykardien und bei 22% der Patientinnen zu einer Hypertonie/Prae-Eklampsie . Schlussfolgerung : Zusammenfassend zeigt sich eine gute Prognose fuer Muetter nach Mustard-Operation und ihre Kinder , ein intensives und spezielles Monitoring vorausgesetzt ." ], "offsets": [ [ 0, 2053 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860961.ger.abstr-passage-0", "type": "abstract", "text": [ "Trotz zunehmender Etablierung der intrakoronaren Stent-Implantation stellt der akute Koronargefaessverschluss unveraendert eine der schwerwiegendsten Komplikationen der PTCA dar . Insbesondere im Rahmen einer bereits zuvor bestehenden Aktivierung des lokalen Gerinngungssystemes mit nachfolgender Bildung intrakoronarer Thromben ist das Risiko eines akuten Koronargefaessverschlusses erhoeht . Dipyridamol fuehrt neben einer Hemmung der Thrombozytenaggregation zu einer ausgepraegten Steigerung der Koronarperfusion . In der vorliegenden Studie wurde untersucht , ob durch eine intrakoronare Applikation von Dipyridamol PTCA-assoziierte Komplikationen vermieden werden koennen . Als primaerer Studienendpunkt wurde die Inzidenz des akuten Koronargefaessverschlusses analysiert ; als zusaetzliche sekundaere Endpunkte wurden die Entwicklung eines Myokardinfarktes , die Notwendigkeit einer ACVB-Operation und Todesfolge nach PTCA untersucht ." ], "offsets": [ [ 0, 941 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860968.ger.abstr-passage-0", "type": "abstract", "text": [ "Eine groessere Anzahl von PTCA-Ballons verschiedener Hersteller wurde nach ihrer Anwendung untersucht . Es wurden auch Ballons beruecksichtigt , die nur zur Versteifung des PTCA-Fuehrungsdrahtes gedient hatten . Jeder Ballon wurde ab 8 at geprueft . Die stufenweise Steigerung des Druckes um je eine Atmosphaere bis zum Platzen wurde auf jeder Stufe mit einer Roentgenkinofilmszene dokumentiert . Das die Ballons umgebende Medium war Luft . Kein Ballon ist unterhalb seines rated burst pressure geplatzt . Einige wenige Ballons platzten auch bei geschaetzten 27 at nicht . Die Ballons verformten sich mit steigendem Druck , am haeufigsten bananenfoermig , nur wenige blieben zylindrisch . Die geprueften Ballons rupturierten meist punktfoermig . Bei allen Ballons stieg mit zunehmendem Druck der Durchmesser am haeufigsten linear . Bei den meisten Ballons ueberschritt der Durchmesser unmittelbar vor dem Platzen den Nenndurchmesser um etwa 15% . Dilatationsmodus , angewendeter Maximaldruck , Gesamtdauer der Dilatation und Ballonlaenge beeinflussten nicht den Berstdruck . Ballons mit kleinem Ballondurchmesser rupturierten bei hoeheren Druecken als Ballons mit groesserem Ballondurchmesser . Die untersuchten PTCA-Ballons hatten alle eine ausreichende Sicherheitsreserve bezueglich der empfohlenen Arbeitsdruecke ." ], "offsets": [ [ 0, 1317 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860975.ger.abstr-passage-0", "type": "abstract", "text": [ "Der monoklonale Antikoerper c7E3 ( ReoPro ) ist ein hochselektiver Thrombozytenaggregationshemmer , der an den Fibrinogenrezeptor auf der Oberflaeche von Thrombozyten ( GP IIb/IIIa ) bindet und dosisabhaengig zu einer nahezu kompletten Hemmung der Thrombozytenaggregation fuehrt . Der klinische Nutzen von c7E3, ischaemische Ereignisse zusaetzlich zu Heparin und ASS nach einer PTCA zu reduzieren , konnte in der EPIC- , EPILOG- und CAPTURE-Studie belegt werden . In diesen Studien war jedoch die c7E3-Therapie mit einem erhoehten Blutungsrisiko nach der koronaren Intervention verbunden ." ], "offsets": [ [ 0, 589 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860982.ger.abstr-passage-0", "type": "abstract", "text": [ "Trotz zunehmender Etablierung der interventionellen Kardiologie stellt der akute Koronargefaessverschluss unveraendert die schwerwiegendste Komplikation der PTCA dar . Die intrakoronare Stent-Implantation und die pharmakologische Blockade des GP-IIb/IIIa-Rezeptors repraesentieren wirksame Mechanismen zur Praevention des akuten Koronargefaessverschlusses , ohne allerdings diese Problematik komplett vermeiden zu koennen . Bei etwa 50% der Patienten mit akutem Gefaessverschluss kommt es zu postinterventionellen Komplikationen , wie beispielsweise zum Auftreten eines Myokardinfarktes . Die Letalitaet betraegt bis zu 10% . Ziel der Untersuchung war es zu analysieren , ob klinische laborchemische Parameter , und durch quantitative Koronarangiographie ( QCA bestimmte Determinanten ) der prae- und postinterventionellen Stenosemorphologie praediktive Faktoren der Inzidenz des akuten Koronargefaessverschlusses darstellen ." ], "offsets": [ [ 0, 926 ] ] } ]

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[ { "id": "ZfuerKardiologie.70860990.ger.abstr-passage-0", "type": "abstract", "text": [ "Parallel zum Anstieg der Implantation von Koronarstents wurden 1996 fast monatlich Neu- und Weiterentwicklungen von Koronarstents in die Klinik eingefuehrt . In der vorgelegten Arbeit werden Architektur Oberflaechen und Umformungsprozesse , von 16 verschiedenen Koronarstents analysiert . Ziel war die Charakterisierung moeglicher spezifischer Design- und Oberflaechenmerkmale , , die einen Einfluss auf Einheilungsphasen , Stentrestenosen und -thrombosen haben koennten . Rasterelektronenmikroskopisch wiesen fuenf Stents eine ultraglatte Oberflaeche auf . Bei den uebrigen Stentsystemen fanden sich , mit individuellen Unterschieden , polymorphe und teilweise scharfkantige Oberflaechenunregelmaessigkeiten . Videomorphometrisch betrug das \" covering \" je nach Stenttyp zwischen 8,3% und 26,4% . Stentverkuerzungen von 0% bis 10,5% der Ausgangslaenge konnten nach In-vitro-Stentdilatationen gemessen werden . Bei mehreren Systemen fuehrte die Ballondilatation zu einer \" Ueberentfaltung \" der Randzonen . Dadurch ueberschritten die Stentdurchmesser die Ballondurchmesser um bis zu 20% , und die Stents entfalteten sich nicht homogen , sondern bikonkav . Dieses Phaenomen konnten wir auch bei 20 postmortal vorgenommenen Koronarstent-Implantationen nachweisen ." ], "offsets": [ [ 0, 1262 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70861010.ger.abstr-passage-0", "type": "abstract", "text": [ "In dieser Untersuchung wurde der Einfluss einer 3monatigen ACE-Hemmer-Therapie mit Cilazapril ( 2,5-5 mg ) bei 13 Patienten mit chronischer Aortenklappeninsuffizienz spiroergometrisch und echokardiographisch untersucht ." ], "offsets": [ [ 0, 220 ] ] } ]

[ { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Cilazapril" ], "offsets": [ [ 83, 93 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0055723" } ] }, { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 114, 123 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Aortenklappeninsuffizienz" ], "offsets": [ [ 140, 165 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0003504" } ] } ]

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[ { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-r1-t1.1-t3.1", "type": "diagnoses", "arg1_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t1", "arg2_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t3", "normalized": [] }, { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-r2-t3.1-t2.1", "type": "occurs_in", "arg1_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t3", "arg2_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t2", "normalized": [] }, { "id": "ZfuerKardiologie.70861010.ger.abstr-s1-r3-t1.1-t3.1", "type": "affects", "arg1_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t1", "arg2_id": "ZfuerKardiologie.70861010.ger.abstr-s1-t3", "normalized": [] } ]

[ { "id": "ZfuerKardiologie.70861017.ger.abstr-passage-0", "type": "abstract", "text": [ "Embolische Komplikationen mit einer Inzidenz von 30-50% sind von entscheidender Bedeutung fuer die Prognose der bakteriellen Endokarditis . Um die Umstaende embolischer Ereignisse , zeitliche Inzidenz und moegliche Risikofaktoren bei bakterieller Endokarditis zu untersuchen , wurde der klinische Verlauf von 177 Patienten mit Nativklappenendokarditis ( NVE ) oder Prothesenklappenendokarditis ( PVE ) analysiert . 43% der Patienten waren Frauen , 57% Maenner , eine PVE lag bei 24% der Patienten vor und betraf ausschliesslich das linke Herz , bei NVE waren 11% Rechtsherzendokarditiden ." ], "offsets": [ [ 0, 589 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.70861026.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Behandlung von valvulaeren Pulmonalstenosen mittels Ballondilatation ist heute die Therapie der Wahl im Kindes- und Erwachsenenalter . Wir berichten ueber das Dilatationsergebnis von 46 erwachsenen Patienten ( mittleres Alter 37 +/- 17 Jahre ) mit Pulmonalstenose , die zwischen 1984 und 1994 mit diesem Verfahren behandelt worden sind . 34 von 46 Patienten wurden 3 Monate bis 9 Jahre ( im Mittel 3,4 Jahre ) nach Intervention mittels Rechtsherzkatheterisierung und Echokardiographie nachuntersucht . Diese 34 Patienten waren bezueglich Alter , Schwere der Pulmonalstenose und Akutergebnis nach Dilatation repraesentativ fuer das Gesamtkollektiv . Der maximale Druckgradient wurde durch Ballonvalvuloplastie akut von 86 +/- 35 auf 38 +/- 17 mm Hg ( p 0,0001 ) ( n = 46 ) reduziert und war 32 +/- 10 mm Hg ( n.s. ) ( n = 34 ) zum Zeitpunkt der jeweils letzten Nachuntersuchung . 8 von 13 Patienten mit einem maximalen Druckgradienten > = 100 mm Hg zeigten eine weitere spontane Reduktion des Gradienten infolge Rueckbildung einer subvalvulaeren muskulaeren Hypertrophie des rechten Ausflusstraktes innerhalb von 3 Monaten nach dem Eingriff . Eine fahrradergometrische Untersuchung im Liegen wurde bei 9 Patienten durchgefuehrt . Hierbei stieg der invasiv gemessene maximale Gradient signifikant von 29 +/- 10 auf 52 +/- 23 mm Hg ( p 0,01 ) an . Saemtliche Patienten hatten ein normales Herzzeitvolumen in Ruhe und unter Belastung . Keiner zeigte elektro- oder echokardiographisch die Zeichen einer rechtsventrikulaeren Hypertrophie . Die Ballonvalvuloplastie der valvulaeren Pulmonalstenose ist die Therapie der Wahl bei Erwachsenen ." ], "offsets": [ [ 0, 1638 ] ] } ]

[ { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Behandlung" ], "offsets": [ [ 4, 14 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Pulmonalstenosen" ], "offsets": [ [ 31, 47 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Ballondilatation" ], "offsets": [ [ 56, 72 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004704" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "Ballondilatation" ], "offsets": [ [ 56, 72 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012356" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t5", "type": "umlsterm", "text": [ "Therapie" ], "offsets": [ [ 87, 95 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" }, { "db_name": "UMLS", "db_id": "C0039798" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t6", "type": "umlsterm", "text": [ "Kindes-" ], "offsets": [ [ 108, 115 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0008059" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s1-t7", "type": "umlsterm", "text": [ "Erwachsenenalter" ], "offsets": [ [ 120, 136 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001675" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s2-t1", "type": "umlsterm", "text": [ "erwachsenen" ], "offsets": [ [ 190, 201 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0001675" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s2-t2", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 202, 211 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s2-t3", "type": "umlsterm", "text": [ "Pulmonalstenose" ], "offsets": [ [ 252, 267 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 352, 361 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Echokardiographie" ], "offsets": [ [ 471, 488 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0013516" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s4-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 515, 524 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s4-t2", "type": "umlsterm", "text": [ "Pulmonalstenose" ], "offsets": [ [ 562, 577 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s4-t3", "type": "umlsterm", "text": [ "Dilatation" ], "offsets": [ [ 600, 610 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012356" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s5-t1", "type": "umlsterm", "text": [ "Ballonvalvuloplastie" ], "offsets": [ [ 692, 712 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004708" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s6-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 892, 901 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s6-t2", "type": "umlsterm", "text": [ "Druckgradienten" ], "offsets": [ [ 922, 937 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0033095" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s6-t3", "type": "umlsterm", "text": [ "Hypertrophie" ], "offsets": [ [ 1061, 1073 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020564" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s7-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1207, 1216 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s9-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 1360, 1369 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s9-t2", "type": "umlsterm", "text": [ "Herzzeitvolumen" ], "offsets": [ [ 1390, 1405 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0007165" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s9-t3", "type": "umlsterm", "text": [ "Belastung" ], "offsets": [ [ 1424, 1433 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0015264" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s10-t1", "type": "umlsterm", "text": [ "Hypertrophie" ], "offsets": [ [ 1523, 1535 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0020564" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s11-t1", "type": "umlsterm", "text": [ "Ballonvalvuloplastie" ], "offsets": [ [ 1542, 1562 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0004708" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s11-t2", "type": "umlsterm", "text": [ "Pulmonalstenose" ], "offsets": [ [ 1579, 1594 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0009814" } ] }, { "id": "ZfuerKardiologie.70861026.ger.abstr-s11-t3", "type": "umlsterm", "text": [ "Therapie" ], "offsets": [ [ 1603, 1611 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0039796" }, { "db_name": "UMLS", "db_id": "C0039798" } ] } ]

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[ { "id": "ZfuerKardiologie.80120135.ger.abstr-passage-0", "type": "abstract", "text": [ "" ], "offsets": [ [ 0, 0 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870001.ger.abstr-passage-0", "type": "abstract", "text": [ "Kardiomyozyten koennen sich im Gegensatz zur quergestreiften Skelettmuskulatur nicht teilen und regenerieren , so dass ein irreversibles Zelltrauma automatisch irreversiblen Zell- und Funktionsverlust zur Folge hat . Im Falle eines Myokardinfarktes bedeutet dies Ersatz differenzierter Herzmuskulatur durch funktionsloses Bindegewebe mit Bildung einer Narbe . Ein theoretisch vielversprechender Therapieansatz ist die Transplantation foetaler oder genetisch manipulierter Kardiomyozyten in geschaedigtes , dysfunktionierendes oder abgestorbenes Myokard . Durch Transplantation von Myoblasten , Skelettmuskel-Satellitenzellen und foetaler Kardiomyozyten ist die technische Durchfuehrbarkeit einer zellulaeren Transplantation in syngene und xenogene Versuchstiere wie Maus , Ratte und Hund durch relativ einfache Injektionstechnik in gesundes und geschaedigtes Myokard gezeigt worden . Histologisch-morphologische Studien zeigen , dass sowohl Myoblasten als auch foetale Kardiomyozyten myokardiale Transplantate mit interzellulaeren Konnektionen wie gap junctions und Desmosomen ausbilden und bis zu Beobachtungszeitraeumen von 8 bis 10 Wochen ueberleben . Erfolgreich transplantierte und ueberlebende Zellen koennen theoretisch drei Funktionen ausueben : 1. eine Stabilitaetsfunktion zur Verhinderung struktureller Umbauvorgaenge , 2. eine Carrierfunktion zur lokalen Applikation rekombinanter Proteine und Wachstumsfaktoren , zum Beispiel zur Induktion molekularer Veraenderungen des Empfaengermyokards und 3. eine Unterstuetzung regionaler oder globaler Kontraktilitaet durch mit dem Empfaengermyokard koordinierter Eigenkontraktionen . Inwieweit allerdings diese Funktionen und vor allem eine funktionelle Unterstuetzung des Myokards durch transplantierte Zellen moeglich und therapeutisch anwendbar sind , ist zum jetzigen Zeitpunkt ungeklaert ." ], "offsets": [ [ 0, 1848 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870008.ger.abstr-passage-0", "type": "abstract", "text": [ "Bislang existieren keine standardisierten Richtlinien zur Methodik eines koerperlichen Trainings fuer Patienten mit schwerer chronischer Herzinsuffizienz . Patienten , die in der Vergangenheit in Trainingsstudien involviert wurden , zeigen eine grosse Variabilitaet der kardialen und funktionellen Einschraenkungen , bei mittleren Werten der Ejektionsfraktion zwischen 18 und 35% und der peak VO2 zwischen 12,2 und 25,4 ml/kg/min . Zur Bestimmung der Trainingsbelastung wurde eine VO2 zwischen 40 und 70% der peak VO2 und/oder eine Herzfrequenz zwischen 60 und 80% der maximalen Herzfrequenz gewaehlt . Ferner variierten die Haeufigkeit ( zwischen 3- und 7x pro Woche ) und die Dauer des Trainings ( zwischen 20 und 60 min/Trainingseinheit ) stark . Das Ausdauertraining wurde ausschliesslich in der kontinuierlichen Dauermethode angewandt . Wir entwickelten eine neue Intervall-Trainingsmethode , die intensive Belastungsreize auf die periphere Muskulatur erlaubt , die kardiale Belastung jedoch gering haelt . Nach nur 3 Wochen dieses Intervalltrainings zeigte sich die Verbesserung der aeroben Kapazitaet in einer Groessenordnung , wie sie erst nach laengeren Trainingsphasen bei Anwendung der Dauertrainingsmethode berichtet wurde . Zur Bestimmung der Belastung fuer die Belastungsphasen des Intervalltrainings wurde ein spezifischer steiler Rampentest entwickelt . Eine Analyse der akuten koerperlichen Reaktionen waehrend des steilen Rampentests und waehrend des Intervalltrainings ergab , dass beide Belastungsformen selbst fuer solche Patienten tolerabel waren , die eine Ejektionsfraktion von nur 13% , einen maximalen Herzindex von nicht mehr als 1,6 l/m2/min oder eine peak VO2 von lediglich 8,5 ml/kg/min aufwiesen ." ], "offsets": [ [ 0, 1728 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870015.ger.abstr-passage-0", "type": "abstract", "text": [ "Eine naechtliche Cheyne-Stokes-Atmung ( CSA ) ist bei Patienten mit schwerer Herzinsuffizienz haeufig zu beobachten . Die dabei repetitiv auftretenden Sauerstoffentsaettigungen und Arousal-Reaktionen bewirken nicht nur eine Stoerung des Schlafes , sie fuehren auch ueber eine Aktivierung des sympathischen Nervensystems zu einem Anstieg des arteriellen Blutdruckes und der Herzfrequenz . Es ist daher moeglich , dass die CSA einen unguenstigen Einfluss auf den Verlauf der Herzinsuffizienz ausuebt . Wenn die CSA ueber groessere Teile der Nacht nachweisbar und mit einem gestoerten Schlaf und einer erhoehten Tagesmuedigkeit verbunden ist , bietet sich als wirksame und sichere Therapie die naechtliche Sauerstoffgabe mittels Nasensonde an . Zur Zeit laufende multizentrische Studien werden in Zukunft Aufschluss darueber geben , ob die erfolgreiche Therapie der CSA die kardiale Leistungsfaehigkeit oder Mortalitaet verbessert ." ], "offsets": [ [ 0, 929 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870022.ger.abstr-passage-0", "type": "abstract", "text": [ "Da sich die Stimulationsimpedanz invers zum Stimulationsstrom verhaelt , senken hohe Impedanzwerte bei gleichbleibenden Stimulationsimpulsen zusaetzlich den Stimulationsstrom . Inwieweit der intraoperativ gemessene Impedanzwert der Ventrikelstimulation repraesentativ fuer den Langzeitverlauf ist , wurde bei 87 Patienten untersucht , die die VDD-Einzelelektrode UniPass 425 und den Schrittmacher Unity ( Sulzer Intermedics ) erhalten hatten . Es wurden die Impedanzaenderungen zwischen Implantations- und 6-Monats-Zeitpunkt ermittelt . Als gleiche Impedanzwerte wurde definiert , wenn beide Messwerte = +/- 100 voneinander abwichen . Kleinere bzw. groessere Impedanzwerte lagen 6 Monate nach Implantation vor , wenn sie sich > +/- 100 vom Implantationswert unterschieden . Intraoperativ betrug die Impedanz 535 +/- 98 ( Spannweite : 333-811 ) und war nach 6 Monaten signifikant auf 604 +/- 160 ( Spannweite : 361-1150 ) angestiegen . Der Unterschied zwischen den beiden Impedanzwerten betrug 69 +/- 162 ( Spannweite : -336 bis +560 ) . Gleiche Impedanzwerte lagen bei 43 ( Implantation : 527 +/- 75 , 6 Monate : 531 +/- 87 kleinere ) , bei 11 ( Implantation : 660 +/- 83 6 Monate : , 494 +/- 73 ) und groessere bei 33 Patienten ( Implantation : 503 +/- 99 , 6 Monate : 735 +/- 168 ) vor . Im Vergleich zu den Patienten mit gleichbleibenden Impedanzwerten hatten Patienten mit niedrigeren Impedanzen bei Implantation signifikant hoehere Ausgangswerte . Schlussfolgerungen : Die Stimulanzimpedanz nimmt im Laufe von 6 Monaten nach Implantation signifikant zu . Bei 51% der Patienten kommt es zu deutlichen Veraenderungen der Stimulationsimpedanz . Diese lassen sich in der Tendenz , aber nicht im Einzelfall voraussagen ." ], "offsets": [ [ 0, 1720 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870032.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Ziel dieser retrospektiven Untersuchung ist die Beurteilung der Notwendigkeit einer Neuimplantation eines Kardioverter/Defibrillator-Generators ( ICD ) bei Patienten mit Batterieerschoepfung des Impulsgenerators und keiner klinischen Arrhythmieepisode waehrend der Funktionsdauer des erstimplantierten Systems ." ], "offsets": [ [ 0, 315 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870038.ger.abstr-passage-0", "type": "abstract", "text": [ "Der Katheterverschluss des offenen Ductus arteriosus Botalli mittels Rashkind-Doppelschirmchen hat sich als alternative Methode zum operativen Verschluss etabliert . Wohingegen ein Restshunt nach Katheterverschluss wohl bekannt ist , wurde die Rekanalisation eines komplett verschlossenen Duktus lediglich bei 3 Patienten beobachtet . Wir berichten ueber einen weiteren Fall von einem jungen Erwachsenen , bei dem ein erneuter Shunt auftrat , nachdem er sein Sporttraining kurze Zeit nach dem Katheterverschluss wieder begonnen hatte . Die Rekanalisation war moeglicherweise auf eine Verlagerung des Doppelschirmchens zurueckzufuehren . Ein zweites Doppelschirmchen wurde erfolgreich 6 Monate nach dem Erstverschluss implantiert und fuehrte zum dauerhaften , kompletten Verschluss des Restshunts ." ], "offsets": [ [ 0, 797 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870041.ger.abstr-passage-0", "type": "abstract", "text": [ "Der Einfluss der Gefaessdissektionen auf das Langzeitergebnis nach PTCA ist in den vergangenen Jahren kontrovers diskutiert worden . Waehrend zahlreiche tierexperimentelle Untersuchungen einen Einfluss des Dissektionsausmasses auf die Inzidenz einer Rezidivstenose zeigten , war der Einfluss von Dissektionen in klinischen Langzeitstudien nur gering . Dabei wurde meist keine Differenzierung der morphologisch unterschiedlichen Schweregrade der Gefaessdissektionen vorgenommen . Im Rahmen der vorliegenden Untersuchung sollte daher der Einfluss einer Dissektion sowie deren Schweregrad und Konfiguration auf die Restenosierung nach PTCA untersucht werden . Dabei sollte die prognostische Bedeutung der Dissektionsklassifikation nach den National-Heart-Lung-and-Blood-Institute-Kriterien und nach einer weiteren Einteilung angiographischer Komplikationen ueberprueft werden , um so Aufschluss ueber moegliche Pathomechanismen als Ursache der Restenosierung zu erhalten . Die Studie erfolgte bei 141 Patienten mit 143 stabilen Dissektionen nach PTCA . Eine Nachuntersuchung wurde im Mittel 13 Monate nach erfolgter PTCA durchgefuehrt . Im Rahmen dieser Untersuchung wurden klinische symptomatische und funktionelle Aspekte , der Patienten erhoben . In diesem Patientenkollektiv zeigten Typ-C-Dissektionen nach der Klassifikation nach Dorros et al. ein erheblich erhoehtes Risiko fuer ein klinisches Ereignis ( 41,0% ) innerhalb der ersten 7 bis 25 Monate nach PTCA . Typ A erwies ein nur geringes Risiko ( 10,0% ) , bei Typ B stellte sich ein maessiggradiges Risiko ( 18,0% ) fuer ein nachteiliges Langzeitergebnis heraus . Typ-D-Dissektionen zeigten im Vergleich zu Typ-C-Dissektionen eine geringere klinische Ereignisrate von 33,3% ." ], "offsets": [ [ 0, 1733 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870051.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Entfernung der arteriellen Schleuse unmittelbar nach PTCA wird von Patienten als angenehm empfunden , verringert die Arbeitsbelastung des medizinischen Personals und kann die Krankenhauskosten durch verkuerzte Aufenthaltsdauer senken . Obwohl die Sicherheit und Effizienz solcher hierzu speziell verwendeter Haemostasesysteme , gut dokumentiert ist , besteht grundsaetzlich die Moeglichkeit eines akzidentellen intraluminalen Gefaessverschlusses . Waehrend akute periphere Ischaemiesyndrome fuer den \" Prototyp \" des Kollagens , das VasoSeal , in zahlreichen Berichten veroeffentlicht wurden , sind uns aehnliche Publikationen zum steuerbaren Angio-SealTM nicht bekannt . Wir berichten ueber eine 54jaehrige Patientin ( Groesse : 150 cm , Gewicht : 42,5 kg ) , die nach akutem Vorderwandinfarkt zur PTCA verlegt wurde . Unmittelbar nach Ende der PTCA erfolgte die Applikation von Angio-SealTM in Standardtechnik . Nachdem zunaechst waehrend der Applikation keine Besonderheiten auffielen , trat nach der Applikation ueberraschenderweise keinerlei Blutstillung ein . Zur Vermeidung weiterer moeglicher Komplikationen erfolgte die Antagonisierung des Heparins mit Protamin . Hierauf kam es zwar rasch zur gewuenschten Haemostase , die Patientin klagte jedoch bald ueber Symptome eines Akutverschlusses der rechten A. femoralis . Aufgrund des unzureichenden Lyseergebnisses erfolgte die Verlegung in die Gefaesschirurgie . Das gesamte Angio-SealTM-System ( Anker einschliesslich Kollagen ) lag intravasal ." ], "offsets": [ [ 0, 1507 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870077.ger.abstr-passage-0", "type": "abstract", "text": [ "Neben der bekannten Wirkung von organischen Nitraten auf Venen fuehrt die Gabe von Nitraten auch zu einer Dilatation von arteriellen Leitungsgefaessen . Die maximale Dilatationsfaehigkeit und die Schwellendosis sind bisher nicht ausreichend untersucht worden . Wir pruefen deshalb bei 28 Patienten mit V. a. koronare Herzkrankheit ( mittleres Alter : 58 +/- 2 Jahre ) den Diameter der A. radialis vor und nach intravenoesen Nitroglycerinfusionen in steigenden Konzentrationen ( 0,015 ; 0,05 ; 0,15 ; 0,5 und 1,5 µg/kg/min) ueber jeweils 7 min mittels eines hochaufloesenden Praezisionsultraschallgeraetes ." ], "offsets": [ [ 0, 606 ] ] } ]

[ { "id": "ZfuerKardiologie.80870077.ger.abstr-s1-t1", "type": "umlsterm", "text": [ "Nitraten" ], "offsets": [ [ 44, 52 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0028125" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s1-t2", "type": "umlsterm", "text": [ "Venen" ], "offsets": [ [ 57, 62 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0042449" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s1-t3", "type": "umlsterm", "text": [ "Nitraten" ], "offsets": [ [ 83, 91 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0028125" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s1-t4", "type": "umlsterm", "text": [ "Dilatation" ], "offsets": [ [ 106, 116 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0012356" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t1", "type": "umlsterm", "text": [ "Patienten" ], "offsets": [ [ 288, 297 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0030705" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t2", "type": "umlsterm", "text": [ "Herzkrankheit" ], "offsets": [ [ 317, 330 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0018799" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t3", "type": "umlsterm", "text": [ "Nitroglycerinfusionen" ], "offsets": [ [ 424, 445 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0017887" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t4", "type": "umlsterm", "text": [ "Konzentrationen" ], "offsets": [ [ 460, 475 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0086045" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t5", "type": "umlsterm", "text": [ "Praezisionsultraschallgeraetes" ], "offsets": [ [ 574, 604 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0022023" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t6", "type": "umlsterm", "text": [ "Praezisionsultraschallgeraetes" ], "offsets": [ [ 574, 604 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0041621" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t7", "type": "umlsterm", "text": [ "Praezisionsultraschallgeraetes" ], "offsets": [ [ 574, 604 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0699733" } ] }, { "id": "ZfuerKardiologie.80870077.ger.abstr-s3-t8", "type": "umlsterm", "text": [ "koronare Herzkrankheit" ], "offsets": [ [ 308, 330 ] ], "normalized": [ { "db_name": "UMLS", "db_id": "C0010068" } ] } ]

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[ { "id": "ZfuerKardiologie.80870084.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einem Teil der Patienten mit nichtischaemischer Herzinsuffizienz werden entzuendliche Veraenderungen im Herzmuskelgewebe beobachtet , die fuer die Entwicklung einer Herzinsuffizienz ursaechlich oder pathogenetisch von Bedeutung sein koennen . Das interzellulaere und das vaskulaere Adhaesionsmolekuel-1 ( ICAM-1,VCAM-1) stellen Membranproteine mit Rezeptorfunktion aus der Immunglobulin-Superfamilie dar , die als Marker fuer eine ablaufende Entzuendungsreaktion bei verschiedenen entzuendlichen Erkrankungen gelten . Ziel der vorliegenden Studie war es , das Vorkommen von zirkulierenden Formen von ICAM-1 und VCAM-1 bei 71 Patienten mit nichtischaemisch bedingter Herzinsuffizienz ( 47 M/24 F , mittl . Alter : 55 +/- 11 Jahre ) in Abhaengigkeit von haemodynamischen und myokardbioptischen Befunden zu untersuchen . Methode : Serumkonzentrationen von cICAM-1 und cVCAM-1 wurden mittels ELISA-Kits bestimmt . Die Einteilung des Schweregrades der Herzinsuffizienz erfolgte nach der NYHA-Klassifikation und nach haemodynamischen Parametern ( Pulmonalarterienmitteldruck , linksventrikulaere Ejektionsfraktion ) . Die Erfassung entzuendlicher Veraenderungen im Herzmuskelgewebe erfolgte histologisch und immunhistologisch ( mittlere T-Lymphozyten > = 7,0 mm2, Expression der HLA-Antigene der Klasse I und II ) an rechtsventrikulaer entnommenen Myokardbiopsien . Als Kontrollen galten 16 altersentsprechende Patienten mit global normaler LV-Funktion ( 8 M/8 F , mittl . Alter 55 +/- 6 Jahre , mittlere Ejektionsfraktion 76 +/- 3% ) ohne entzuendliche Veraenderungen in der Myokardbiopsie ( mittlere T-Lymphozyten 3,5 Zellen/mm2, geringe HLA-Expression ) . Ergebnisse : Die mittleren Serumkonzentrationen fuer cICAM-1 und cVCAM-1 waren bei Patienten mit nichtischaemisch bedingter Herzinsuffizienz ( 372 +/- 107 ng/ml und 949 +/- 439 ng/ml ) hoeher als mit Kontrollkollektiv ( 264 +/- 37 und 710 +/- 164 ng/ml ) ( p 0,05 ) . Haemodynamisch schwach positiv korrelierte der mittlere Pulmonalarteriendruck und invers die linksventrikulaere Ejektionsfrakation mit beiden loeslichen Formen der Adhaesionsmolekuele ( fuer cICAM-1; Pearson's r : 0,24 und -0 , 33 ; fuer cVCAM-1: Pearson's r : 0,28 und -0 , 26 , p 0,05 ) Myokardbioptisch wiesen 38% der Patienten ( n = 16 ) mit erhoehten Konzentrationen von cICAM-1 ( > = 337 ng/ml ) und 41% ( n = 7 ) mit erhoehten Serumspiegeln fuer cVCAM-1 ( > = 1038 ng/ml ) erhoehte T-Lymphozyten ( im Mittel : 7 bis 22 Zellen/mm 2 ) und eine verstaerkte Expression der Histokompatibilitaetsantigene der Klasse I/II im Herzmuskelgewebe auf ( p 0,05 ) . Bei mehr als 9,3 T-Lymphozyten pro mm2 im Myokard ( n = 7 ) waren signifikant hoehere Serumkonzentrationen fuer cICAM-1 ( 447 +/- 146 ng/ml , p 0,05 gegenueber Kontrollen ) und fuer cVCAM-1 ( 1577 +/- 688 ng/ml , p 0,001 ) zu messen . Beide Adhaesionsmolekuele korrelierten signifikant mit der mittleren Anzahl von T-Lymphozyten im Herzmuskelgewebe ( Pearson's r : 0,31-0,37, p 0,05 ) . Zusammenfassung und Schlussfolgerung : Die vorliegende Studie zeigt , dass bei Patienten mit nichischaemisch bedingter Herzinsuffizienz haeufig erhoehte Serumkonzentrationen von cVCAM-1 und cICAM-1 nachweisbar sind . Diese korrelieren mit haemodynamischen Zeichen der Herzinsuffizienz und sind bei Patienten mit entzuendlichen Infiltraten im Herzmuskelgewebe bsonders deutlich erhoeht . Dies deutet auf einen Zusammenhang zwischen Herzinsuffizienz und entzuendlichen Veraenderungen im Myokard hin ." ], "offsets": [ [ 0, 3469 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870094.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einem 52jaehrigen Patienten wurde wegen seit mehr als einer halben Stunde anhaltender thorakaler Schmerzen mit ST-Hebungen von > 1 mV in den Ableitungen V INF 1-3 eine Fibrinolysetherapie mit 100 mg rt-PA eingeleitet . Als es nach 90 Minuten weder zur Remission der Beschwerden noch Rueckgang der ST-Strecken-Hebungen kam , wurde eine Koronarangiographie durchgefuehrt . Es zeigten sich unauffaellige Koronargefaesse bei hypertropher Kardiomyopathie . Vier Stunden spaeter wurde aufgrund erneuter thorakaler Schmerzen eine weitere Roentgenaufnahme des Thorax angefertigt . Nun zeigte sich gegenueber der ersten Thoraxaufnahme bei Ankunft im Krankenhaus ein deutlich erweitertes Mediastinum mit neu aufgetretenem Pleuraerguss . Dieser Befund war Anlass fuer eine Spiral-Computertomographie des Thorax , die das Vorliegen einer Dissektion der thorakalen Aorta mit Auspraegung eines Mediastinalhaematoms zeigte . Bei sinkendem Haematokrit wurde daraufhin der sofortige prothetische Ersatz der Aorta descendens durchgefuehrt . Eine Literaturanalyse lieferte 34 Faelle von Fibrinolyse-Therapie bei verkannter Aortendissektion mit einer Mortalitaet von 64% ; ST-Hebungen bei Aortendissektion treten nach Analyse der internationalen Literatur in 4% der Faelle auf , die Praevalenz der koronaren Herzerkrankung bei Patienten mit Aortendissektion liegt bei 13% . Vor dem Hintergrund dieser Daten werden Strategien zur Vermeidung einer Fehldiagnose und Behandlung dissezierender Aortenaneurysmen als Myokardinfarkt diskutiert ." ], "offsets": [ [ 0, 1521 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870100.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir berichten ueber einen bei der Erstuntersuchung 30jaehrigen Patienten mit progressiver kardiomyopathischer Lentiginose . Dieses Syndrom mit der Kombination einer Lentiginose mit hypertropher Kardiomyopathie und Kleinwuchs wurde erstmals 1972 von Polani und Moynahan von den bis dahin bekannten Syndromen mit Lentiginose und kardialen Manifestationen , dem kardiokutanen Syndrom sowie dem LEOPARD-Syndrom abgegrenzt . Alle Merkmale des Syndroms konnten bei unseren Patienten gefunden werden , wobei wir nur eine niedriggradige , rechtsventrikulaer betonte , hypertrophe Kardiomyopathie fanden ." ], "offsets": [ [ 0, 596 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870111.ger.abstr-passage-0", "type": "abstract", "text": [ "Das fetale Magnetokardiogramm ( fMKG ) misst das vom fetalen Herzen erzeugte magnetische Feld . Im Gegensatz zum fetalen EKG gelingt mit fMKG die nichtinvasive Registrierung des PQRST-Erregungsablaufes . So kann die Dauer der fetalen Herzzeitintervalle in verschiedenen Schwangerschaftsstadien bestimmt werden . Unsere Arbeitsgruppe fuehrte 104 magnetokardiographische Messungen bei 53 Patientinnen ab der 10. Schwangerschaftswoche ( SSW ) durch 1-10 Messungen ( pro Patientin ) Das fMKG wurde mit einem 37-Kanal-Messsystem in einer magnetisch abgeschirmten Kammer registriert , wobei der Messkopf beruehrungsfrei 2-3 cm ueber dem muetterlichen Abdomen positioniert wurde ( Abtastfrequenz 1024 Hz , Bandbreite 1-200 Hz ) . Die Registrierung fetaler Herzaktionen gelang mit einem standardisierten Messprotokoll ab der 20. /21 . SSW . In Einzelfaellen liessen sich bereits in der 16. SSW Herzaktionen ableiten . Mit zunehmendem fetalem Wachstum verlaengerte sich die Dauer der Herzzeitintervalle . Im Beobachtungszeitraum verlaengerte sich die P-Welle im Mittel von 31 auf 49 ms ( p 0,05 ) , das PQ-Intervall von 95 auf 107 ms ( n.s. ) , der QRS-Komplex von 36 auf 52 ms ( p 0,01 ) . Die Hoehe der Amplituden des fMKG nahm mit zunehmendem Gestationsalter zu ." ], "offsets": [ [ 0, 1257 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870119.ger.abstr-passage-0", "type": "abstract", "text": [ "Die atemkontrollierte NMR-Angiographie ist eine neue Abbildungstechnik in der Kernspintomographie , die es erlaubt , einen dreidimensionalen Bilddatensatz des Herzens zu akquirieren und hieraus einzelne Koronararterien zu rekonstruieren . In dieser Studie sollte die Beurteilbarkeit von signifikanten Koronararterienstenosen ( > = 50% ) mittels atemkontrollierter NMR-Angiographie untersucht werden ." ], "offsets": [ [ 0, 400 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870128.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Herzfrequenzvariabilitaet ( HRV ) ist als wichtiger Risikomarker bei Patienten mit ueberlebtem Myokardinfrakt etabliert . In juengster Zeit ist die Analyse der HRV - insbesondere des Parameters SDNN - aus Kurzzeit-EKG-Registrierungen als Alternative zur Langzeit-EKG-Analyse vorgeschlagen worden . In der vorliegenden Untersuchung wird erstmals SDNN der Kurzzeitmessung mit der aus dem Langzeit-EKG bestimmten SDNN hinsichtlich der Risikoabschaetzung nach Myokardinfarkt , verglichen . Bei 60 Patienten wurde zum Zeitpunkt der Hospitalentlassung eine SDNN im Langzeit-EKG von 93 +/- 30 ms gemessen , verglichen mit 39 +/- 18 ms in der Kurzzeitmessung . Patienten mit prospektiv definiertem klinischem Endpunkt unterschieden sich von denen mit unauffaelligem Postinfarkt-Verlauf signifikant hinsichtlich Alter , LVEF , mittlerem RR-Intervall sowohl in der Langzeit- ( 753 +/- 153 vs 921 +/- 132 ms ) als auch in der Kurzzeit-Messung ( 783 +/- 153 vs 914 +/- 163 ms ) und der aus dem Langzeit-EKG ermittelten Standardabweichung der NN-Intervalle ( SDNN ; 71 +/- 27 vs 97 +/- 29 ms ; : p 0,001 ) . Hingegen war die aus Kurzzeitmessung ermittelte SDNN nicht in der Lage , Patienten mit und ohne Endpunkt zu separieren ( 35 +/- 22 vs 41 +/- 19 ms ; p = NS ) . Somit eignet sich eine Kurzzeit-Registrierung der SDNN im Zeitbereich nicht hinsichtlich der Risikostratifizierung von Postinfarktpatienten . Die HRV-Analyse sollte - auch unter Beruecksichtigung zirkadianer Schwankungen - aus dem Langzeit-EKG durchgefuehrt werden , wenn sie zur Risikostratifikation verwendet werden soll ." ], "offsets": [ [ 0, 1583 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870134.ger.abstr-passage-0", "type": "abstract", "text": [ "Patienten mit paroxysmaler supraventrikulaerer Tachykardie ( SVT ) haben oftmals eine Polyurie nach Terminierung der Tachykardie . Juengere Untersuchungen weisen darauf hin , dass beim Menschen das renale Peptid Urodilatin ( ANP ( 95-126 ) ) - und nicht Plasma-ANP ( ANP ( 99-126 ) ) - der an Natriurese und Diurese beteiligten Mediator aus der Familie natriuretischer Peptide ist ." ], "offsets": [ [ 0, 382 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870139.ger.abstr-passage-0", "type": "abstract", "text": [ "Herzkatheteruntersuchungen sind haeufige Ursachen fuer arterielle Thrombosen im Kindesalter . Zur Therapie wird heutzutage neben der Heparintherapie vor allem die medikamentoese Fibrinolyse eingesetzt . Den chirurgischen Therapieformen kommt im Kindesalter eine nur untergeordnete Bedeutung zu . Wir berichten ueber einen 19 Monate alten Patienten mit Fallotscher Tetralogie , bei dem nach einer interventionellen Herzkatheteruntersuchung mit arteriellem , retogradem Zugang eine Thrombose der Arteria femoralis auftrat . Zur Therapie fuehrten wir eine transvenoese , transkardiale antegrade intraluminale Ballonangioplastie durch . Wir nutzten hierzu die Verbindung von rechtem und linkem Herzen ueber einen Ventrikelseptumdefekt . Die Untersuchung verlief komplikationslos , die dopplersonographische Kontrolle zeigt nach 4 Monaten keinerlei Re- oder Reststenose ." ], "offsets": [ [ 0, 866 ] ] } ]

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[]

[]

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[ { "id": "ZfuerKardiologie.80870161.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Spektrum der diagnostischen Optionen bei Patienten mit Marfan-Syndrom ( MFS ) hat sich im letzten Jahrzehnt durch den Einsatz moderner bildgebender Verfahren , wie der Kernspintomographie ( , MRT ) , der Computertomographie ( CT ) und der transoesophagealen Echokardiographie ( TEE ) , massgeblich erweitert . Neue diagnostische Ansaetze zielen auf die nichtinvasive Charakterisierung der Aortenwandstruktur sowie auf In-vitro-Immunfluoreszenz-Untersuchungen an Haut- oder Aortengewebe . Fibroblastenkulturen und gel-ektrophoretische Untersuchungen von radioaktiv markiertem Fibrillin . Von besonderem Interesse sind molekulargenetische Untersuchungen auf cDNA/DNA-Ebene . Erkenntnisse und Erfahrungen mit modernen Diagnosemodalitaeten fuehrten zu veraenderten diagnostischen Kriterien im Rahmen der neuen Genter Nosologie ; neue diagnostische Befunde bei MFS sowie die Wertigkeit einzelner etablierter und experimenteller diagnostischer Verfahren zur Evaluation kardiovaskulaerer Manifestationen werden im Folgenden unter besonderer Beruecksichtigung der diagnostischen Leistungsfaehigkeit der einzelnen Methoden beim MFS dargestellt ." ], "offsets": [ [ 0, 1140 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870173.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei optimalem Management kann die Lebenserwartung von Patienten mit Marfan-Syndrom von durchschnittlich 32 Jahren auf > 60 Jahren angehoben werden . Wichtige Pfeiler der kardiologischen Betreuung stellen hierbei die Aufklaerung ueber eine der Erkrankung angepasste Lebensweise , regelmaessige kardiologische Kontrolluntersuchungen und eine Endokarditisprophylaxe dar . Die Entscheidung ueber den prophylaktischen Einsatz von Betablockern ist im Einzelfall ebenso schwierig wie die Wahl des geeigneten Zeitpunktes fuer eine elektive chirurgische Massnahme an der Aorta und die Wahl des chirurgischen Verfahrens , unter Beruecksichtigung der speziellen Gegebenheiten bei Kindern , Schwangeren , in Abhaengigkeit vom Alter und bei bereits voroperierten Patienten . Durch den Dialog zwischen Literatur und eigenen Daten soll ein moeglichst differenziertes therapeutisches Vorgehen ermoeglicht werden , unter Beruecksichtigung klassischer Ansaetze und mit Ausblick auf eine moegliche Kausaltherapie in der Zukunft ." ], "offsets": [ [ 0, 1010 ] ] } ]

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[]

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[ { "id": "ZfuerKardiologie.80870185.ger.abstr-passage-0", "type": "abstract", "text": [ "Der interventionelle Verschluss eines Vorhofseptumdefekts gelingt nur bei , hinsichtlich der Lage und der Groesse des Defekts , gut selektionierten Patienten . Alle Verschlusssysteme haben jedoch ihre speziellen Probleme , das optimale Device scheint bisher noch nicht gefunden zu sein . Seit Ende 1996 steht jedoch der von der Bauart vollstaendig neue Amplatzer Septal Occuder ( ASO ) fuer den ASD-Verschluss , im Rahmen einer internationalen Multicenterstudie , zur Verfuegung . Der ASO ist ein selbstexpandierendes und -zentrierendes Doppelschirmchen aus Nitinoldrahtgeflecht , bei dem beide Schirmanteile mit einem zentralen Stent , dessen Durchmesser der Defektgroesse entspricht , verbunden sind . In beide Schirme und den Stentanteil sind Polyesterflicken eingenaeht , die den Verschluss des Loches beguenstigen . Nach invasiver Groessenmessung des Defekts wird der passende Doppelschirm ausgewaehlt und ueber eine lange 7- oder 8-French-Schleuse, von femoralvenoes ueber den ASD , in den linken Vorhof geschoben . Im linken Vorhof werden der distale Anteil und der zentrale Stentanteil entfaltet und durch Zurueckziehen das Loch verschlossen , so dass der Stent den ASD vollstaendig auskleidet . Danach wird der proximale Anteil entwickelt und der Doppelschirm freigesetzt . Eine Repositionierung des Schirms ist jederzeit problemlos durch Zurueckziehen in die Schleuse moeglich . Innerhalb von 4 Monaten gelang bei 29 von 31 Patienten ( Alter Median 12,1 Jahre , Gewicht Median 45,0 kg ) der vollstaendige Verschluss des ASD mit mittlerem Durchmesser von 11,0 mm ( 6-20 mm ) ohne Komplikationen , bei einer mittleren Durchleuchtungszeit von 8,3 min ( 2,9-21,5 min ) und Katheterverweildauer von 104,9 min . Qp : Qs lag im Mittel bei 1,5 ( 0,9-2,2). Waehrend einer Beobachtungszeit von im Mittel 2,4 Monaten zeigte sich bei allen Patienten ein sicherer Sitz das ASO ohne Restshunt , Arrythmien , thrombembolische Komplikationen und ohne Beeintraechtigung der AV-Klappen-Funktion ." ], "offsets": [ [ 0, 1988 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870202.ger.abstr-passage-0", "type": "abstract", "text": [ "Problem : Vorhofflimmern geht mit einer signifikanten Morbiditaet und Mortalitaet einher . Das erhoehte Thrombembolierisiko erfordert eine dauerhafte Antikoagulation , die fehlende Vorhofkontraktion verschlechtert die haemodynamische Situation . Die vorliegende Studie untersucht die Ergebnisse einer chirurgischen Therapie des chronischen Vorhofflimmerns mittels der \" Cox/Maze-III-Operation \" , die waehrend Mitralklappen- , ASD-II-Operationen und einer Thrombektomie aus dem linken Vorhof ( LA ) durchgefuehrt wurde . Patienten und Methoden : Von 2/95 bis 5/97 wurde bei 16 Patienten im Alter zwischen 50 und 72 Jahren ( Mittel 59 Jahre ) waehrend einer Herzoperation die chirurgische Therapie des chronischen Vorhofflimmerns mittels Cox/Maze-III-Operation \" \" durchgefuehrt . 13 Patienten erhielten eine Mitralklappenoperation ( Ersatz n = 10 , Rekonstruktion n = 3 ) . Bei weiteren drei Patienten wurde eine Mitralklappenrekonstruktion mit ASD-II-Verschluss , ein ASD-II-Verschluss oder eine Thrombektomie aus dem LA durchgefuehrt . Die praeoperative Dauer des chronischen Vorhofflimmerns lag zwischen 2 und 12 Jahren ( Mittel 5,0 Jahre ) . Die Patienten wurden praeoperativ sowie 3 , 6 , 12 und 24 Monate nach der Operation mittels transoesophagealer Echokardiographie ( TEE EKG , Langzeit-EKG und Belastungsergometrie ) , nachuntersucht . Ergebnisse : In der fruehen postoperativen Phase ( 7 die ) befanden sich alle Patienten im Sinusrhythmus oder Vorhofpacing . Intermittierend bestand bei 8 Patienten Vorhofflimmern . Waehrend des Nachbeobachtungszeitraums von 1 bis 27 Monaten ( Mittel 14 Monate ) hatten 15 Patienten einen stabilen Sinusrhythmus ( 94% ) . Ein Patient erhielt 2 Monate postoperativ , wegen Sinusbradykardie , einen Schrittmacher ( 6% ) . Postoperativ zeigten die Patienten im TEE bei synchronen atrioventrikulaeren Kontraktionen eine Verbesserung der praeoperativen Haemodynamik . In der Ergometrie fanden sich 6 Monate postoperativ niedrigere Frequenzanstiege , 12 Monate postoperativ jedoch Sinusrhythmus mit adaequaten , belastungsabhaengigen Frequenzanstiegen . Schlussfolgerung : Die chirurgische Therapie des chronischen Vorhofflimmerns mittels der \" Cox/Maze-III-Operation \" ist in der Kombination mit anderen Herzoperationen ohne erhoehtes peri- bzw. postoperatives Risiko durchfuehrbar und kann als effektive chirurgische Therapie des chronischen , medikamentoes therapiefraktaeren Vorhofflimmerns angesehen werden . Postoperativ kommt es zu einer deutlichen Verbesserung der Haemodynamik durch Entstehen von Sinusrhythmus mit synchronen atrioventrikulaeren Kontraktionen ." ], "offsets": [ [ 0, 2610 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870209.ger.abstr-passage-0", "type": "abstract", "text": [ "Von Juni 1988 bis Dezember 1996 wurden am Kinderherzzentrum Giessen 36 Patienten , im Alter von weniger als einem Jahr , einer Herztransplantation zugefuehrt . Zugrundeliegende Diagnosen waren ein hypoplastisches Linksherzsyndrom ( n = 26 Endokardfibroelastose ( ) , n = 4 Kardiomyopathie ( ) , n = 3 ) und komplexe Vitien ( n = 3 ) . Die mittlere Wartezeit von Transplantation betrug 52 Tage , das Verhaeltnis der Koerpergewichte von Spender zu Empfaenger lag im Mittel bei 1,8 . Sieben Patienten ( 19% ) verstarben nach Transplantation , ueberwiegend innerhalb des ersten Monats nach der Transplantation . Die kumulative Ueberlebenswahrscheinlichkeit liegt im Geamtkollektiv bei 79% . Der Einfluss zunehmender Erfahrung zeigt sich beim Vergleich der Patienten mit Transplantationen von 1988 bis 1993 ( n ? 15 ) und von 1994 bis 1996 ( n = 21 ) . Waehrend im ersten Zeitraum lediglich 50% ueberlebten , betrug die Ueberlebensrate der spaeter transplantierten Kinder 92% , die 1-Jahres-Ueberlebensrate lag bei 100% . Bei 20 Patienten traten insgesamt 31 Abstossungsepisoden auf , wobei 2 Saeuglinge verstarben . 71% aller Abstossungen traten innerhalb des ersten Monats nach der Transplantation auf . Die Nierenfunktion ist ein Jahr nach der Transplantation nur maessiggradig eingeschraenkt ohne Tendenz zur Verschlechterung . Die somatische Entwicklung verlaeuft bei nahezu allen Kindern perzentilengerecht . Die Lebensqualitaet der Patienten nach der Transplantation ist ausgezeichnet . Alle Patienten leben ohne Einschraenkungen zu Hause . Bei zwei Patienten liegt allerdings ein neurologisches Defizit vor . Bislang gibt es im Gesamtkollektiv keine Anzeichen fuer eine Transplantatvaskulopathie oder eine maligne Erkrankung . Eine Herztransplantation stellt nach diesen Ergebnissen eine ueberdenkenswerte Alternative in der Behandlung sehr komplexer Vitien und Kardiomyopathien im Neugeborenen- und Saeuglingsalter dar ." ], "offsets": [ [ 0, 1924 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870218.ger.abstr-passage-0", "type": "abstract", "text": [ "Die Diagnostik kardialer Raumforderungen stellt hohe Anforderungen an die verwendeten bildgebenden Verfahren . Sie sollten bei raeumlicher und zeitlicher Aufloesung , breiter Verfuegbarkeit , kurzer Untersuchungsdauer und niedrigen Kosten nichtinvasiv ueber die Dignitaet , den Ursprung , die raeumliche Ausdehnung und moegliche funktionelle Auswirkungen Auskunft geben . Die transthorakale Echokardiographie ist aufgrund ihrer ubiquitaeren Verbreitung , geringen Kosten und meist guten Bildqualitaet das Untersuchungsverfahren der Wahl . Transoesophageale Echokardiographie Computertomographie und Magnetresonanztomographie , sind ergaenzende Verfahren , die dann zum Einsatz kommen , wenn klinisch relevante Details transthorakal echokardiographisch nicht zu klaeren sind . Die Magnetresonanztomographie liefert Bilder mit einer hohen Aufloesung in jeder beliebigen Schnittebene ueber ein sehr grosses Gesichtsfeld ohne Strahlenbelastung . Peri- und intrakardiale Tumore sowie intrakardiale Thromben werden detailliert dargestellt , und in der Mehrzahl der Faelle lassen sich die eingangs aufgefuehrten Fragen beantworten . Obwohl eine Gewebedifferenzierung moeglich ist , laesst sich keine histologische Genauigkeit erzielen . Artefakte bei Patienten mit ausgepraegten Arrhythmen oder Dyspnoe sind Nachteile des Verfahrens , die fuer diese Patientengruppen die Computertomographie geeigneter machen ." ], "offsets": [ [ 0, 1403 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870227.ger.abstr-passage-0", "type": "abstract", "text": [ "Die erfolgreiche Radiofrequenz-Katheterablation tachykarder Rhythmusstoerungen setzt eine genaue Lokalisation des arrhythmogenen Substrats waehrend der elekrophysiologischen Untersuchung voraus . Mit Hilfe der elektromagnetischen Technologie des neuen Mappingsystems CARTO ist die dreidimensionale farbcodierte elektroanatomische Darstellung der Aktivierungssequenz moeglich . Mapping der sinutrialen Aktivierung des rechten Vorhofs bei 11 Patienten lieferte erste klinische Erfahrungen mit diesem neuen System . Die physiologische Aktivierungssequenz liess sich bei allen Patienten komplikationslos dreidimensional darstellen und der Sinusknoten als physiologischer Aktivitaetsfokus mit interindividueller Variabilitaet lediglich in der Sagittalebene lokalisieren . Das nichtfluoroskopische Mappingsystem erlaubt eine Visualisierung der elektrischen Aktivitaet und kann dadurch die Lokalisierung des arrhythmogenen Substrats waehrend Tachykardie vor erfolgreicher Ablation erleichtern ." ], "offsets": [ [ 0, 987 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870233.ger.abstr-passage-0", "type": "abstract", "text": [ "Bei einem 70jaehrigen Patienten mit koronarer Dreigefaesserkrankung und Zustand nach ACB-Operation 1989 zeigte die diagnostische Kerzkatheteruntersuchung eine filiforme Ostiumstenose des Lambda-Bypasses ( R. circumflexus und R. marginalis ) sowie eine filiforme Stenose des RIVA-Bypasses unmittelbar vor der peripheren Anastomose . Der ACD-Bypass war verschlossen . Waehrend die Stenose des Lambda-Bypasses problemlos mit gutem Primaerresultat mit einem Stent versorgt werden kann , kommt es beim Versuch , die filiforme Stenose des RIVA-ACB zu dilatieren bzw. einen Stent zu implantieren , zu der seltenen vital bedrohlichen Bypass-Perforation mit einer sich rasch entwickelnden Herzbeutel-Tamponade . Wegen sofortigem Blutdruckabfall mit schwerster Schmerzsymptomatik wird sofort ein Autoperfusionskatheter im Bereich der Perforationsstelle positioniert , worauf sich die haemodynamische Situation stabilisiert . Ein Abdichten durch mehrfaches Aufblasen und Ablassen des Perfusionsballons war nicht moeglich , so dass dieser entfaltet im Gefaess belassen wird . Dennoch kommt es im weiteren Verlauf zu einer Herzbeuteltamponade . Der abgekapselte Perikarderguss wird an atypischer Stelle ( intercostal ) erfolgreich punktiert . Ueber einen Perikard-Pigtail-Katheter werden in der naechsten Stunde ca. sieben Liter Blut entnommen und retransfundiert . Da der kardiologisch interventionelle Weg zwar die Situation stabilisiert , das Problem des Abdichtens der Perforationsstelle jedoch nicht loesen kann , faellt die Entscheidung zur Operation . Mittels linksthorakaler Thoraktomie werden saemtliche Blutkoagel ausgeraeumt , trotz sorgfaeltigster Inspektion kann jedoch keine Blutungsquelle ausfindig gemacht werden . Somit muss von einem Spontanverschluss der Perforationsstelle durch Thrombusbildung ausgegangen werden . Eine Kontrollangiographie eine Woche spaeter zeigte ein gutes Resultat sowohl am Lambda-Bypass als auch am Venen-Bypass auf den RIVA ohne Extravasat oder Nachweis der ehemaligen Perforationsstelle . Der Patient konnte in beschwerdefreiem Zustand nach Hause entlassen werden ." ], "offsets": [ [ 0, 2098 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870249.ger.abstr-passage-0", "type": "abstract", "text": [ "Diagnostische und interventionelle Herzkatheteruntersuchungen bei peripherer arterieller Verschlusserkrankung erfordern oft , wegen des Ausmasses der Arteriosklerose der Beckengefaesse , alternative Zugangswege zur Judkinsmethode . Vielfach angewandt wird dabei die perkutane Punktion der Arteria brachialis . Problematisch ist bei diesem Verfahren eine hohe Rate von Gefaessokklusionen , so dass es das Ziel dieser prospektiven Untersuchung war , durch die Duplexsonographie Gefaessparameter als Risiken dieser Komplikation zu erkennen . In 20 Monaten wurde dazu unter 8000 konsekutiven Patienten ein Kollektiv von 34 Patienten mit ueberwiegender Mehretagensklerose und erhoehtem Risikoprofil ( Diabetes mellitus , Hypertonie , Nikotinabusus etc. ) identifiziert , bei denen eine Koronarangiographie nach Judkins wegen peripherer Arteriopathie nicht durchfuehrbar war . Vergleichend wurden 53 Normalpersonen untersucht . Im Punktionsbereich der Arteria brachialis erfolgte dazu duplexsonographisch die Darstellung des Gefaessverlaufs und der Lumendiameter ." ], "offsets": [ [ 0, 1058 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870267.ger.abstr-passage-0", "type": "abstract", "text": [ "Einfuehrung : Die praeklinische Diagnostik von Patienten mit akutem Koronarsyndrom stuetzt sich primaer auf die Anamnese und die klinische Symptomatik , Parameter mit unbefriedigender Sensitivitaet und Spezifitaet . 1994 wurde ein Schnelltest zum qualitativen Nachweis von kardialem Troponin T entwickelt . Mit der vorliegenden Arbeit sollte dessen Eignung zur praeklinischen Diagnostik bei dem o.g. Krankheitsbild evaluiert werden . Methodik : In die Studie wurden 145 notaerztlich versorgte Patienten mit akuten ischaemieverdaechtigen Thoraxschmerzen eingeschlossen . Waehrend der ersten Studienphase ( 73 Patienten ) wurde der Test anhand der praeklinisch entnommenen Blutproben unter standardisierten Bedingungen in der Klinik durchgefuehrt , waehrend der zweiten Phase ( 72 Patienten ) dagegen noch am Notfallort . Ergebnisse : Waehrend der Test in Phase 1 stets korrekt durchgefuehrt wurde , traf dies nur fuer 68 ( 94,4% ) der Patienten in Phase 2 zu . Insgesamt wiesen 17 von 145 Patienten ( 11,7% ) einen positiven Schnelltest auf . In allen Faellen wurde die vom Hersteller angegebene Nachweisgrenze von 0,3 ng/ml eingehalten . Bei 37 Patienten ( mediane Beschwerdedauer : 150 min ) bestand ein akuter Myokardinfarkt . Die Kenngroessen diagnostische Sensitivitaet , Spezifitaet , positiver und negativer praediktiver Wert betrugen 35,1% 69,3% , 76,5% und 81,3% . , Patienten mit positivem Testresultat wiesen gegenueber negativ getesteten Patienten eine deutlich hoehere Hospitalletalitaet auf ( 35,3% vs. 6,3% , p 0,001 ) . Schlussfolgerungen : Der Schnelltest weist Troponin T in Konzentrationen von > =0 , 3 ng/ml zuverlaessig nach . Die strikte Beachtung der Herstellervorgaben reduziert die Wahrscheinlichkeit von fehlerhaften Testinterpretationen , schliesst diese jedoch nicht aus . Bei kurzer Anamnesedauer ist der Test nicht mit hinreichender Sicherheit zum Infarktausschluss geeignet . Patienten mit positivem Testergebnis weisen eine schlechte Prognose auf ." ], "offsets": [ [ 0, 1979 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870276.ger.abstr-passage-0", "type": "abstract", "text": [ "Das Entstehen eines paravalvulaeren Abszesses im Verlauf einer akuten Endokarditis zeigt ein fortgeschrittenes Erkrankungssstadium an , in dem , unabhaengig von sonstigen Befunden , eine chirurgische Intervention im floriden Stadium der Erkrankung erwogen werden sollte , da eine alleinige Antibiotikatherapie in den meisten Faellen nicht zur Ausheilung fuehrt . Nach Angaben aus der Literatur ist jedoch das operative Risiko bei der Endokarditis mit Abszessen deutlich erhoeht , ebenfalls haeufiger sind postoperative Komplikationen wie Rezidivendokarditis und paravalvulaeres Leck . In der folgenden prospektiven Studie wurde untersucht , ob sich die Prognose dieser Erkrankung durch radikales chirurgisches Vorgehen und eine aggressive postoperative Antibiotikatherapie verbessern laesst ." ], "offsets": [ [ 0, 792 ] ] } ]

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[ { "id": "ZfuerKardiologie.80870288.ger.abstr-passage-0", "type": "abstract", "text": [ "Wir berichten ueber zwei Patientinnen mit Ullrich-Turner-Syndrom bei denen mit Hilfe der Farbdopplersonographie eine partielle Lungenvenenfehleinmuendung diagnostiziert wurde . In der Literatur wurde die Kombination einer Fehleinmuendung von einer oder mehreren Lungenvenen und einem Ullrich-Turner-Syndrom mehrfach beschrieben . Bei den bisher publizierten Fallberichten wurde die Diagnose jedoch angiographisch im Rahmen einer Herzkatheteruntersuchung gestellt , die wegen zusaetzlich vorliegender kardiovaskulaerer Fehlbildungen durchgefuehrt wurde . Unsere hier beschriebenen Patientinnen zeigen , dass eine partielle Lungenvenenfehleinmuendung im Neugeborenen- und Saeuglingsalter nichtinvasiv mit der transthorakalen Echokardiographie und Farbdopplersonographie einfach diagnostiziert werden kann , sofern an die Moeglichkeit einer solchen Anomalie gedacht wird ." ], "offsets": [ [ 0, 869 ] ] } ]

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