Browsing by Author "Motz, R."

Background The blood pressure difference between the right arm and the legs is often used as an estimate of a possible gradient across a coarctation or recoarctation aortae. We wanted to test the reliability of this hypotheses while estimating the local stiffness of the aortae ascendens and abdominalis. Patients: We examined 50 healthy children and adolescents as well as 50 patients of a similar age after repair of an coarctation aortae. There was no relevant recoarctation on echocardiography or magnet resonance tomography. Methods: We measured in all patients the blood pressure by oscillometry three times on the right upper arm and thigh. At the same time we measured the systolic and diastolic diameter of the aorta before the branching of the truncus brachiocephalicus and the branching of the truncus coeliacus. The local stiffness was calculated, using the stiffness index beta, from the aortic diameter and the corresponding blood pressure. Results: The systolic blood pressure difference showed in healthy subjects and patients after coarctation a wide range (about 60 mm Hg). The diastolic and mean blood pressure showed a slightly smaller range. There was no signifcant difference in this respect between the two groups. The stiffness index beta was elevated after coarcectomy in the aorta ascendens compared to healthy subjects. The local stiffness of the abdominal aortae were similar in both groups and showed a similar increase with advancing age. Discussion: The blood pressure difference between the upper arm and thigh showed a wide range. Therefore Is the blood pressure difference an unreliable tool to estimate the severity of a re-coarctation. The local stiffness of the aorta ascendens was elevated after coarctation and implied at least a partial loss of the Windkessel. The local stiffness in the aorta abdominalis was normal after coarctation repair.

Background:The influence of cyanosis, and cardiac index in children with cyanotic heart disease on their growth. Patients: 37 infants with cyanotic heart disease needing a systemico-pulmonary anastomosis. Methods: Body weight, length, head circumference, body mass-index and transcutaneous oxygen-saturation were measured (mean follow-up 610 days). In 25 children cardiac index was recorded by cardiac catheter before their next operation. Results: At 9 months the percentiles had fallen from the 50th at birth to the 3rd for body weight, 10th for length, 25th for head circumference and 25th for the body mass-index. Growth-velocity normalized in the second year. Growth patterns were independent of the oxygen-saturation. Cardiac index was initially reduced but normalized during the 2nd year of life. Conclusion: Growth of infants with a systemico-pulmonary shunt was asymmetric. Growth velocity was reduced in the first year of life, and not influenced by the oxygen-saturation. A causal relationship between cardiac index and decreased growth seems possible.

Case report about a 16 year old boy after Mustard operation of transposition of the great arteries, who developed severe "diuretic resistant", congestive heart failure in longtime follow up under a antiarrhythmic therapy with verapamil. if cardiac recompensation succeeded only after termination of verapamil therapy hemodynamic and neurohumoral causes of systemic and pulmonary congestion were evaluated. Increase of systemic (by 75%) and pulmonary (by 150%) vascular resistance as well as a fall of cardiac index from 3,0 to 1,8 l/min/m(2) after verapamil therapy were invasively measured. Unchanged ejection fractions and atrial pressures are evidence, that the negative inotropic effect of verapamil seems not to be the cause of cardiac decompensation. After exclusion of neurohumoral causes, the increase of capillary filtration pressure by vasodilatation seems to be the pathophysiological cause of venous congestion in this patient.

Treatment in heart failure could be guided by additional non-clinical measures, such as neurohumoral levels. Variability in heart rate is known to reflect neurohumoral stimulation. With this in mind, we sought to assess retrospectively the variability in heart rate to guide the treatment of infants in heart failure. We analysed retrospectively the data from 20 infants with a significant left-to-right shunt. All were unsuitable for cardiac surgery or interventional therapy at the time the treatment had commenced. None of the infants improved while receiving diuretics, spironolactone, and digoxin alone, but improved after the addition of propanolol or metoprolol. None of the infants had problems during or after the subsequent operation. Parasympathetic activity reflected by parameters of variability in heart rate, such as the square root of adjacent RR-intervals, and the amount of adjacent RR-Intervals greater than 50 milliseconds, improved in nearly all infants during beta blockade. On the other hand, parameters of variability in heart rate reflecting sympathetic activity did not change. Parasympathetic activity reflected the clinical state of nearly all the infants. These parameters, therefore, seem to be a good non-clinical parameter, showing the optimal treatment for heart failure in an ambulatory setting.