S Fröhner

Herz- und Gefäß-Klinik, Neustadt, Bavaria, Germany

Are you S Fröhner?

Claim your profile

Publications (38)25.74 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: A 64-year-old male reported worsening dyspnea four months after right-sided pneumonectomy, due to lung cancer. Platypneu-or-thodeoxie syndrome was suspected due to a decrease in oxygen-saturation while the patient was in upright position. The shift of the right hemidiaphragm and liver caused compression of the right atrium and a shunt over a persistent foramen ovale. The right-to-left shunt was proven during right heart catheter. Interventional closure of the shunt resulted in immediate improvement of arterial oxygenation and a decrease in dyspnea.
    Der Internist 08/2011; 52(8):1002-5. · 0.33 Impact Factor
  • Acta Anaesthesiologica Scandinavica 07/2011; 55(6):765. · 2.36 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The appropriate approach for aortic coarctation associated with other cardiac diseases necessitating surgery is still controversial. The aim of this study was to evaluate the results after simultaneous surgery performed via median sternotomy and consisting of extra-anatomical ascending-to-descending aortic bypass and various other cardiac procedures. Between January 1999 and February 2009, 13 consecutive patients with aortic coarctation coexistent with other cardiac diseases necessitating surgery underwent simultaneous surgery via median sternotomy. An extra-anatomical ascending-to-descending aortic bypass for coarctation repair was performed in all patients accompanied by various cardiac procedures (5 aortic root and valve replacement; 2 aortic valve replacement; 2 coronary artery bypass grafting; 2 mitral valve repair; 1 aortic valve replacement and coronary artery bypass grafting; 1 mitral and tricuspid valve repair). There were 3 women and 10 men with a mean age of 52 years (range 25-69). Two patients had recurrent or residual coarctation 37 and 46 years after previous surgical repair, respectively. Early mortality was 0 and there was only 1 late death during the follow-up of up to 11 years. New York Heart Association (NYHA) functional class improved on average from 2.4 to 1.2. At the last follow-up, blood pressure measured at the upper and lower extremities showed no gradient in any patient, indicating a durable function of the extra-anatomical bypass. Only 3 patients were on reduced antihypertensive therapy; 8 patients were on the same medication and 1 patient required increased medication therapy compared with the medication prior to surgery. Ascending-to-descending bypass can be performed via median sternotomy simultaneously with various cardiac procedures without considerable extension of the procedure. The operative and long-term results are excellent, and this approach can be recommended as the procedure of choice in patients with aortic coarctation and additional cardiac diseases necessitating surgery.
    The Thoracic and Cardiovascular Surgeon 04/2011; 60(3):210-4. · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: To describe the imaging signs of idiopathic osteonecrosis of the scaphoid (Preiser's disease) and to differentiate the findings from scaphoid nonunion. 10 patients (4 men, 6 women, mean age 36.9 years) with radial-sided wrist pain were identified to suffer from primary osteonecrosis of the scaphoid. Imaging methods included radiograms in all cases, CT imaging in 9 cases, and contrast-enhanced MRI in 7 cases. In CT and MRI, images were also acquired in the sagittal-oblique plane for depicting the scaphoids in the entire longitudinal extension. Follow-up examinations were performed in 5 patients, two of them underwent surgery with pedicled bone grafts. In all patients, both osteosclerosis and lesions of the bone marrow were most intensive at the proximal scaphoid pole. A three-layered architecture was found. The zone of osteonecrosis was located most proximally, followed by a zone of repair in the middle, and the zone of viable bone marrow in the distal part of the scaphoid. In contrast to scaphoid nonunion, pathological fractures were exclusively located within the zone of osteonecrosis in 8 cases. Applying morphologic criteria, three stages of Preiser's disease were discernible. The initial stage (proximal osteosclerosis, but unaltered shape of the scaphoid), the advanced stage (pathologic fractures, volume loss of the proximal pole), and the final stage (osteonecrosis of the entire scaphoid). Pathoanatomy of Preiser's disease and the differentiation into three zones of bone marrow viability can be explained with the retrograde blood supply of the scaphoid. In its natural course, three different stages can be depicted with the initial stage seen only in MRI.
    European journal of radiology 02/2011; 77(2):228-34. · 2.65 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Ein 64-jähriger Mann stellte sich mit schwerer Luftnot 4Monate nach rechtsseitiger Pneumektomie bei Bronchialkarzinom vor. Die lageabhängige Sauerstoffdeoxygenierung wies differenzialdiagnostisch auf einen Rechts-Links-Shunt hin. Durch die Verschiebung von Zwerchfell und Leber nach Pneumektomie kam es zur Einengung des rechten Vorhofs und zu einem Shunt über ein wiedereröffnetes Foramen ovale. Die Rechtsherzkatheteruntersuchung sicherte die Diagnose des Rechts-Links-Shunts über ein funktionell wiedereröffnetes Foramen ovale. Nach interventionellem Verschluss des Foramen ovale kam es zur sofortigen Normalisierung der Sauerstoffsättigung und Besserung der Beschwerden. A 64-year-old male reported worsening dyspnea four months after right-sided pneumonectomy, due to lung cancer. Platypneu-orthodeoxie syndrome was suspected due to a decrease in oxygen-saturation while the patient was in upright position. The shift of the right hemidiaphragm and liver caused compression of the right atrium and a shunt over a persistent foramen ovale. The right-to-left shunt was proven during right heart catheter. Interventional closure of the shunt resulted in immediate improvement of arterial oxygenation and a decrease in dyspnea. SchlüsselwörterHypoxämie–Pneumektomie–Vorhofseptumverschluss–Rechts-links-Shunt–Platypnoe-Orthodeoxie-Syndrom KeywordsHypoxemia–Pneumonectomy–Atrial shunt closure–Right-to-left shunt–Platypnoe-orthodeoxia syndrome
    Der Internist 01/2011; 52(8):1002-1005. · 0.33 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We describe the case of a 65-year-old female patient who underwent aortic valve reconstruction for aortic valve stenosis. During the operation, repair of a left ventricular laceration produced by a left ventricular vent was necessary. BioGlue® (CryoLife, Atlanta, GA, USA) and pledgeted sutures were used for repair. Pericardial effusion with signs of cardiac tamponade developed five months later. The patient was treated successfully by the removal of all foreign material and part of the BioGlue®. Microbiological findings were sterile. Histology showed a chronic granulomatous inflammatory response suggesting a foreign material reaction to BioGlue® as the cause of the effusion. Though all visible material was removed, the risk of pericardial effusion still persists as part of the BioGlue® remained within the ventricular wall.
    The Thoracic and Cardiovascular Surgeon 12/2010; 58(8):489-91. · 0.93 Impact Factor
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2010; 182.
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2009; 181.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83 ms per heart-phase. In this study, the clinical performance of this new method is evaluated. In fifty patients (33 male, 17 female; age 50 +/- 13 years) with suspected coronary heart disease, CT angiography (slice thickness 0.75 mm, contrast-agent 60-80 ml iomeprol) was performed with a Somatom Definition scanner. Based on the coronary 15-segment-model of the AHA, scores for image quality and lumen reduction were established to enable the observer, to give recommendations for further therapy. Out of 750 possible AHA-segments, 655 were depicted (87.3%). 591 segments (90.2%) were assessed without any limitation of quality, 49 (7.5%) segments showed moderate, and 15 (2.3%) segments severe limitation in image quality. 508 (77.6%) segments were without pathological findings, 92 (14.0%) segments had minimal atherosclerotic lesions, 42 (6.4%) segments suffered from stenoses with lumen reduction less than 70%, and 13 (2.0%) showed significant stenoses of more than 70%. In 31 patients (62%), coronary heart disease was ruled out by CT angiography without any need for further non-invasive or invasive diagnostics. 8 patients (16%) underwent stress-testing for ischemia. In 11 (22%) patients coronary angiography was recommended, and DSCT findings were confirmed in 10 cases. Only one LCx stenosis was overestimated in DSCT. Contrast-enhanced DSCT is a powerful tool in diagnosis of coronary heart disease. 98% of coronary segments could be assessed in diagnostic quality, and at least 90% of haemodynamically significant coronary stenoses were detected.
    Rontgenpraxis 02/2008; 56(5):155-63.
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2008; 180.
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2008; 180.
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2008; 180.
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dual-source-CT-technology (DSCT) improves temporal resolution of cardiac computed tomography to 83ms per heart-phase. In this study, the clinical performance of this new method is evaluated.
    Rontgenpraxis 01/2008; 56(5):155-163.
  • Rofo-fortschritte Auf Dem Gebiet Der Rontgenstrahlen Und Der Bildgebenden Verfahren - ROFO-FORTSCHR RONTGENSTRAHL. 01/2007; 179.
  • Thoracic and Cardiovascular Surgeon - THORAC CARDIOVASC SURG. 01/2007; 55.
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: This review addresses the pathoanatomical basics as well as the clinical and radiological presentation of instability patterns of the wrist. Carpal instability mostly follows an injury; however, other diseases, like CPPD arthropathy, can be associated. Instability occurs either if the carpus is unable to sustain physiologic loads ("dyskinetics") or suffers from abnormal motion of its bones during movement ("dyskinematics"). In the classification of carpal instability, dissociative subcategories (located within proximal carpal row) are differentiated from non-dissociative subcategories (present between the carpal rows) and combined patterns. It is essential to note that the unstable wrist initially does not cause relevant signs in standard radiograms, therefore being "occult" for the radiologic assessment. This paper emphasizes the high utility of kinematographic studies, contrast-enhanced magnetic resonance imaging (MRI) and MR arthrography for detecting these predynamic and dynamic instability stages. Later in the natural history of carpal instability, static malalignment of the wrist and osteoarthritis will develop, both being associated with significant morbidity and disability. To prevent individual and socio-economic implications, the hand surgeon or orthopedist, as well as the radiologist, is challenged for early and precise diagnosis.
    European Radiology 11/2006; 16(10):2161-78. · 4.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The partial tear of the scapholunate ligament (pre-dynamic stage of SLD) as well as the complete tear (dynamic stage) does not lead to carpal malalignment. However, if the completely ruptured ligament is accompanied by lesions of the extrinsic ligaments, both the scaphoid and the lunate are malaligned already at rest (static stage of SLD). Later, osteoarthritis will develop, beginning in the radioscaphoid compartment, progressing to the midcarpal joint, and ending in a carpal collapse (osteoarthrotic stage of SLD). Dynamic SLD is detectable only in stress views and in cinematography. The high utility of MRI for directly visualizing the injured ligament is emphasized: reparation tissue is focally enhanced at the rupture site by intravenously applied contrast agent; the individual segments of the scapholunate ligament can be visualized in direct MR arthrography, therefore allowing differentiation of partial and complete ligamentous tears.
    Der Radiologe 09/2006; 46(8):654-63. · 0.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Scaphoid fractures, which involve approximately two-thirds of all wrist injuries, are often not detected during initial radiographic examination. By using high-resolution CT and dedicated MRI, it is possible to recognize scaphoid fractures soon at the first diagnostic approach and to assess fragment stability. CT imaging provides all the relevant information of the fracture extent and of the fracture healing in the follow-up. MRI is most sensitive in the detection of scaphoid fractures; however, fracture signs must be differentiated from those of a bone bruise. Both the initially overseen scaphoid fracture and the unsuccessful healing can lead to the natural history of scaphoid nonunion. In the injured scaphoid, CT imaging is essential for depicting the osseous morphology, whereas contrast-enhanced MRI is crucial for assessing the viability of the proximal fragment.
    Der Radiologe 09/2006; 46(8):664, 666-76. · 0.47 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: We present a 63-year-old patient with aortic valve stenosis, ascending aorta aneurysm, aortic coarctation as well as atherosclerotic, elongated, and stenosed aortic arch. Surgical treatment consisted of a complete ascending aorta replacement with a valved composite graft and complete replacement of the aortic arch including the isthmus, and was performed simultaneously through median sternotomy.
    The Thoracic and Cardiovascular Surgeon 07/2006; 54(4):276-8. · 0.93 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The purpose of this study was to include the pedal vasculature into the coverage of peripheral multistation magnetic resonance angiography (3DceMRA). A total of 216 patients suffering from peripheral vascular disease were examined with a modified hybrid dual-bolus technique. The cruropedal arteries were acquired first with two sagittal slabs and time-resolved 3D sequences. Then the aortofemoral vessels were visualized using the bolus-chase technique and a second contrast injection. Interventional procedures were performed in 104 patients, and in 69 of those, the cruropedal vessels were also examined with digital subtraction angiography (iaDSA). Using 3DceMRA, the cruropedal arteries were displayed with both excellent and good quality in 95% (205/216 cases), and without any venous overlay in 94% (203/216 cases). The aortofemoral vessels were not jeopardized by the first contrast injection. With iaDSA as the standard of reference, observed sensitivity of 3DceMRA was found in ranges from 80% (29%, 99%) to 100% (86%, 100%) for assessing significant stenoses, and observed specificity ranged between 93% [80%, 98%] and 100% (82%, 100%). In conclusion, hybrid dual-bolus 3DceMRA significantly reduces the limitations of standard single-bolus 3DceMRA in anatomic coverage and temporal resolution of the cruropedal arteries, thus providing high-quality images of the entire peripheral vasculature.
    European Radiology 01/2006; 15(12):2513-24. · 4.34 Impact Factor