We studied 246 consecutive patients, mean age 11.9 +/- 6.7 years, with primary (n = 155) or secondary (n = 91) complete repair of tetralogy of Fallot (TOF) between 1961 and 1972. Prospective follow-up was complete and ranged from 18.1 to 29.3 (mean: 20.3 +/- 4.2) years. There were 46 operative and 21 late deaths. Cumulative survival was 0.76 +/- 0.03 after 1 year, 0.72 +/- 0.03 (10 years), 0.68 +/- 0.04 (20 years) and 0.63 +/- 0.05 (25 years). After 20 years of follow-up, which was a follow-up time available for all patients, cumulative complication rates were 0.17 +/- 0.03 for documented ventricular tachycardias/fibrillation, 0.16 +/- 0.03 for right-heart failure, 0.13 +/- 0.03 for left-heart failure and 0.11 +/- 0.03 for infective endocarditis. Eighteen of the 21 late deaths were from cardiac causes: sudden (n = 9), infective endocarditis (n = 4), left-heart failure (n = 3), and right-heart failure (n = 2). The hazard for ventricular arrhythmias was inconstant and increasing with time from the initial operation. After 20 years of follow-up, the cumulative incidence of sudden death, documented ventricular tachycardia/fibrillation was 0.81 +/- 0.07. Younger age at surgery resulted in a significantly better long-term prognosis (p = 0.03) with cumulative survival rates after 20 years being 0.90 +/- 0.06 (ages 1-9 years), 0.92 +/- 0.04 (10 to 14 years), 0.83 +/- 0.09 (15 to 19 years) and 0.69 +/- 0.11 for patients being operated beyond age 20. Twenty years following TOF repair 59.2% of the late survivors were in NYHA functional class I and 36.2% in NYHA II.

We studied 246 consecutive patients, mean age 11.9 +/- 6.7 years, with primary (n = 155) or secondary (n = 91) complete repair of tetralogy of Fallot (TOF) between 1961 and 1972. Prospective follow-up was complete and ranged from 18.1 to 29.3 (mean: 20.3 +/- 4.2) years. There were 46 operative and 21 late deaths. Cumulative survival was 0.76 +/- 0.03 after 1 year, 0.72 +/- 0.03 (10 years), 0.68 +/- 0.04 (20 years) and 0.63 +/- 0.05 (25 years). After 20 years of follow-up, which was a follow-up time available for all patients, cumulative complication rates were 0.17 +/- 0.03 for documented ventricular tachycardias/fibrillation, 0.16 +/- 0.03 for right-heart failure, 0.13 +/- 0.03 for left-heart failure and 0.11 +/- 0.03 for infective endocarditis. Eighteen of the 21 late deaths were from cardiac causes: sudden (n = 9), infective endocarditis (n = 4), left-heart failure (n = 3), and right-heart failure (n = 2). The hazard for ventricular arrhythmias was inconstant and increasing with time from the initial operation. After 20 years of follow-up, the cumulative incidence of sudden death, documented ventricular tachycardia/fibrillation was 0.81 +/- 10.07. Younger age at surgery resulted in a significantly better long-term prognosis (p = 0.03) with cumulative survival rates after 20 years being 0.90 +/- 0.06 (ages 1-9 years), 0.92 +/- 0.04 (10 to 14 years), 0.83 +/- 0.09 (15 to 19 years) and 0.69 +/- 0.11 for patients being operated beyond age 20. Twenty years following TOF repair 59.2% of the late survivors were in NYHA functional class I and 36.2% in NYHA II.

The aim of the present study was to assess abnormalities of left ventricular filling by Doppler echocardiography in patients with hypertrophic obstructive cardiomyopathy and to investigate whether a myectomy, in addition to normalizing flow, also improves diastolic function. In part A of the study, 40 patients with diagnosed invasive HOCM (29 patients with a gradient at rest, 11 patients with a gradient only after provocation) were compared with 20 normal subjects. The blood flow in the left ventricular inflow tract was examined by means of Doppler echocardiography. At the same time the isovolumic relaxation (IVR) period and the mitral valve opening area (MVOA) were determined using M-mode and the two-dimensional echocardiography, respectively. In part B of the study, 17 patients were examined directly preoperatively and again postoperatively (mean 14 days). Nine patients were then examined at a later date (mean 8.6 months).(ABSTRACT TRUNCATED AT 250 WORDS)

The therapeutic effectiveness of propranolol, verapamil and surgery (transaortal subvalvular myectomy) in hypertrophic cardiomyopathy was assessed in 100 patients with hypertrophic obstructive cardiomyopathy (HOCM) and 12 patients with hypertrophic non-obstructive cardiomyopathy (HNCM) by means of exercise tests with hemodynamic measurements. The effects of propranolol were assessed in 13 HOCM patients, of verapamil in 68 HOCM patients and 12 HNCM patients, and of surgery in 31 HOCM patients after a mean of 3 to 9 months. Of the 68 verapamil-treated patients, 23 were reexamined once more after a mean of 38 months. Ten of the 31 surgically treated patients were reexamined after a mean of 52 months. In the studies performed within the first year of medical treatment or after surgery, verapamil was clinically and hemodynamically superior to propranolol, but not as effective as surgical treatment. Functional limitation according to the NYHA classification improved after propranolol in 31% of the patients, after verapamil in 41%, and after surgery in 94% of the cases. Improvements by more than one NYHA class were observed exclusively after surgical treatment. Maximal exercise capacity was, on average, not changed after propranolol, but increased after verapamil and, more substantially, after surgery. These different responses to treatment could be attributed to hemodynamic changes, especially concerning heart rate, stroke volume, cardiac output, arterio-venous oxygen difference and pulmonary artery pressure. In the case of verapamil, the beneficial hemodynamic effects occurred independently of the site of intraventricular obstruction in HOCM (subvalvular or midventricular), but seemed to be superior in HOCM as compared to HNCM. The late reexaminations, an average of 38 months after beginning verapamil treatment and 52 months after surgery, demonstrated that the initial salutary clinical and hemodynamic effects of verapamil were not maintained during long-term follow-up in the majority of patients, whereas they persisted or even intensified during long-term observation after surgery.

Despite different aetiologies, acquired aortic stenosis is a self-maintaining, slowly progressive process with good long-term prognosis. In 142 patients with mild stenosis, there was clinical progression within 10 years of the initial diagnosis in only 12% of patients. Twenty-five years after the diagnosis had been established, the severity of aortic stenosis was clinically unchanged in 38%, while 25% of patients had moderate stenosis and 35% had undergone valve replacement. Progression of moderate aortic stenosis was more rapid: the average time interval between the manifestation of moderate aortic stenosis and surgery was 13.4 years. Age at the onset of initial symptoms was related to aetiology: 39 +/- 18 years with rheumatic aortic stenoses, 48 +/- 6 years in patients with bicuspid valves who had no history of rheumatic fever, infective endocarditis or myocarditis, and 66 +/- 12 years in degenerative, calcific stenoses of tricuspid aortic valves. Patients with haemodynamically severe stenosis who had refused the recommended operation (n = 55) had an overall poor prognosis: mean survival averaged 23 +/- 5 months and the five-year probability of survival was 18 +/- 7%. All these patients died within 12 years of observation. Mean survival after the occurrence of angina pectoris was 45 +/- 13 months, after syncope 27 +/- 15 months, and after first occurrence of left heart failure 11 +/- 10 months.

Horstkotte, D.; Krayenbuhl, H. P.; Loogen, F.; Kardiol, S.; Cohn, Lawrence H. MD Author Information

Journal Article Left ventricular function during exercise before and after percutaneous transluminal coronary angioplasty using intravenous digital subtraction angiocardiography Get access J. Jehle, J. Jehle Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar F. K. Schmiel, F. K. Schmiel Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar E. Schwammenthal, E. Schwammenthal Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar P. Spiller, P. Spiller Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar F. Loogen F. Loogen Med. Klinik der Universitaät Düsseldorf, Abteilung für Kardiologie, Angiologie und PneumologieMoorenstr.5, 4000 Düsseldorf, F.R.G. Search for other works by this author on: Oxford Academic PubMed Google Scholar European Heart Journal, Volume 8, Issue suppl_G, October 1987, Pages 29–32, https://doi.org/10.1093/eurheartj/8.suppl_G.29 Published: 01 October 1987

To determine the value of Doppler echocardiography for the normal clinical use in functional diagnostics of prosthetic mitral valves, and to determine normal values for different types of prosthetic valves, 136 patients with different types of prosthetic mitral valves with the same external diameter (29 mm) were examined. For pressure half-time (t1/2) there were higher values for Starr-Edwards (SE) (n = 18) and Lillehei-Kaster (LK) prostheses (n = 10) (113 +/- 29 and 125 +/- 29 ms) than for Saint Jude-Medical (SJM) (n = 56), Björk-Shiley (BS) (n = 40) and Ionescu-Shiley valves (IS) (n = 12) (78 +/- 16, 82 +/- 17 and 93 +/- 28 ms, p less than 0.001), as well as for the orifice and for the mean diastolic gradient (delta p). The upper permissible limits of t1/2 and delta p were 104 ms and 4.1 mm Hg for SJM, and 111 and 4.8 for BS valves respectively. Day-to-day variability (n = 30) was 5.0% (0.0-14.4%, if t1/2 greater than 100 ms: 0.0-6.0%), the correlation was r = 0.97. The duration of implantation did not have any influence on prosthetic mitral valve function. These normal values and limits form a basis for the evaluation of prosthetic mitral valves in the future.

The beneficial effect of endocarditis prophylaxis was studied in 229 patients with prosthetic heart valves, in whom 287 diagnostic interventions were performed. The prevention used was similar to that recommended earlier by the American Heart Association. Prosthetic valve endocarditis was not observed in any of these patients. This result was compared with that of 304 patients with prosthetic heart valves, in whom, without any prevention, 390 similar interventions were performed during the same observation period. The incidence of prosthetic valve endocarditis occurring within 14 days after the intervention was 1 .5/100 interventions (N = 6). All patients required re-operation. One patient died peri-operatively. Two more patients developed prosthetic valve endocarditis 8 and 13 weeks, respectively, after the initial intervention. This retrospective study documents the benefit of the endocarditis prophylaxis used.