-
[show abstract]
[hide abstract]
ABSTRACT: Hintergund. Der Begriff akzelerierter ventrikulärer Rhythmus (AVR) beschreibt eine tachykarde Rhythmusstörung ventrikulären Ursprungs
mit mindestens 3 aufeinander folgenden Schlägen, deren Frequenz nicht schneller als 10(–20)% der zugrunde liegenden Sinusfrequenz
ist.Die Frequenz des ventrikulären Rhythmus schwankt altersabhängig zwischen 70/min und 170/min.Typischerweise kommt es unter
körperlicher bzw.psychischer Belastung mit dem Anstieg der Sinusfrequenz zum Sistieren des ventrikulären Rhythmus.Die myokardiale
Kontraktilität ist bei dieser Rhythmusstörung im Kindesalter normal.
Fallbericht. Wir berichten über einen Fall mit akzeleriertem ventrikulärem Rhythmus bei einem 14-jährigen Mädchen.
Diskussion. Der akzelerierte ventrikuläre Rhythmus (AVR) kommt im Kindesalter sehr selten vor, bisher wurden weniger als 60 Fälle jenseits
der Neugeborenenperiode beschrieben.Der Verlauf dieser Rhythmusstörung ist gutartig, eine Therapie ist nicht notwendig.Die
Kenntnis dieser Rhythmusstörung ist jedoch wichtig, da sie von anderen, potenziell gefährlichen Tachykardien abgegrenzt werden
muss.
Background. Accelerated ventricular rhythm is characterized by a ventricular rate no more than 10(–20)% faster than the prevailing sinus
rhythm.Rate of ventricular rhythm varies between 70–170/min depending on age.Striking feature of this rhythm disturbance is
that on physical and emotional exertion with increase of sinus rate disappearence of ventricular rhythm is observed. The ventricular
function in children with accelerated ventricular rhythm is normal.
Case report. We report on a 14 year old girl with accelerated ventricular rhythm.
Discussion. Accelerated ventricular rhythm (AVR) is unusual in childhood.So far there are reports on less than 60 cases beyond the neonatal
period.The course of this rhythm disturbance in children is benign, therapeutic treatment is not necessary.The most important
reason for diagnosing AVR is to avoid unnecessary treatment and to differentiate this disorder from malign tachycardias.
Monatsschrift Kinderheilkunde 04/2012; 151(2):214-217. · 0.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: In einer prospektiven Studie wurde der klinische Stellenwert der auf automatischer Konturerkennung beruhenden Methode der
„Akustischen Quantifizierung“ (AQ) untersucht. Dazu wurden echokardiographisch linksventrikuläre Volumina und Ejektionsfraktion
on-line bestimmt und mit den entsprechenden konventionell (manuell) off-line ermittelten Daten verglichen. 107 Säuglinge,
Kinder und Jugendliche zwischen 0,1 und 18 Jahren wurden in die Studie einbezogen. Sowohl für AQ als auch für die manuelle
off-line-Bestimmung wurde im apikalen Vierkammerblick untersucht. Die linksventrikulären Volumina wurden monoplan mit der
„Method of discs“ (SIMPSON-Regel) bestimmt. Obwohl niedriger bestimmt, korrelierten die mit der AQ-Methode ermittelten enddiastolischen
Volumina mit den manuell bestimmten Volumina (r=0,99). Die mit den beiden Methoden ermittelten endsystolischen Volumina (ESV)
des linken Ventrikels wiesen ebenfalls eine gute Korrelation (r=0,98) auf, wobei das mit AQ bestimmte ESV etwas niedriger
war. Die mittlere Ejektionsfraktion wurde mit 61,1±6,8% durch AQ und mit 61,5±5,9% manuell bestimmt; lineare Regressionen
erbrachten eine gute Korrelation: y=0,77 x±14,1; r=0,89; p<0,001. Die Bestimmung linksventrikulärer Volumina und der aus
den Volumina abgeleiteten Ejektionsfraktion durch AQ führt zu Ergebnissen, die mit den manuell bestimmten Parametern durchaus
vergleichbar sind. Allerdings führt die AQ-Methode zu einer gewissen Unterschätzung. Die für die Datenacquisition erforderliche
Zeit ist bei beiden Methoden nahezu gleich. AQ stellt sich auch für die Pädiatrie als eine prinzipiell funktionierende Methode
bei der real-time-Bestimmung linksventrikulärer Volumina dar.
Accurate and efficient echocardiographic on-line determination of left ventricular volume would be advantageous in the care
of children with congenital heart disease and children with hemodynamic instability. The prospective study was performed to
evaluate the clinical usefulness of the on-line automatic border detection system (acoustic quantification: AQ) for determination
of left ventricular volumes and ejection fraction in comparison to the conventional off-line method (manual tracing). 107
patients were enrolled in the study. The ages ranged from 0.1 to 18.8 years (mean 8.3±5.6). All patients were studied in the
apical four-chamber plane for acoustic quantification (AQ) and manual tracing as well. Left ventricular volumes were determined
using the mono-plane Simpson‘s rule. Left ventricular end-diastolic volumes obtained by AQ correlated well but were slightly
underestimated compared to those determined by manual tracing (r=0.99). Left ventricular endsystolic volumes by AQ correlated
well but were also slighly underestimated compared to those obtained by manual tracing (r=0.98). Mean ejection fraction was
61.1±6.8% by AQ compared with 61.5±5.9% by manual tracing. Linear regression analysis demonstrated good correlation: y=0.77x
+14.1, r=0.89; p<0.001. Measurement of left ventricular volumes and ejection fraction by AQ using automatic border detection
compares well with measurements done by manual tracing. However, AQ tends to underestimate to some degree. The time necessary
for acquisition of data was similar in both methods. AQ seems to be a promising method for real-time estimation of left ventricular
volume, even in children.
Schlüsselwörter Echokardiographie–akustische Quantifizierung–linksventrikuläre Volumina–EjektionsfraktionKey words Echocardiography–acoustic quantification–left ventricular volume–ejection fraction
Zeitschrift für Kardiologie 04/2012; 89(10):906-913. · 0.97 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Accurate and efficient echocardiographic on-line determination of left ventricular volume would be advantageous in the care of children with congenital heart disease and children with hemodynamic instability. The prospective study was performed to evaluate the clinical usefulness of the on-line automatic border detection system (acoustic quantification: AQ) for determination of left ventricular volumes and ejection fraction in comparison to the conventional off-line method (manual tracing). 107 patients were enrolled in the study. The ages ranged from 0.1 to 18.8 years (mean 8.3 +/- 5.6). All patients were studied in the apical four-chamber plane for acoustic quantification (AQ) and manual tracing as well. Left ventricular volumes were determined using the mono-plane Simpson's rule. Left ventricular end-diastolic volumes obtained by AQ correlated well but were slightly underestimated compared to those determined by manual tracing (r = 0.99). Left ventricular endsystolic volumes by AQ correlated well but were also slightly underestimated compared to those obtained by manual tracing (r = 0.98). Mean ejection fraction was 61.1 +/- 6.8% by AQ compared with 61.5 +/- 5.9% by manual tracing. Linear regression analysis demonstrated good correlation: y = 0.77x + 14.1, r = 0.89; p < 0.001. Measurement of left ventricular volumes and ejection fraction by AQ using automatic border detection compares well with measurements done by manual tracing. However, AQ tends to underestimate to some degree. The time necessary for acquisition of data was similar in both methods. AQ seems to be a promising method for real-time estimation of left ventricular volume, even in children.
Zeitschrift für Kardiologie 11/2000; 89(10):906-13. · 0.97 Impact Factor
-
Journal of Inherited Metabolic Disease 08/2000; 23(5):514-6. · 3.58 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Beim aortorechtsventrikulären Tunnel handelt es sich um eine ausgesprochen seltene kardiale Fehlbildung. Wir berichten über
einen Patienten, bei dem ein solcher aorto-rechtsventrikulärer Tunnel im Alter von 15 Monaten erfolgreich korrigiert wurde.
Diagnostisch wegweisend ist das systolisch-diastolische Herzgeräusch mit Punctum maximum über dem 3. bis 4. ICR links parasternal.
Echokardiographie und Angiokardiographie sichern die Diagnose.
Diskussion: Eine Korrekturoperation sollte bei diesen Fehlbildungen möglichst frühzeitig angestrebt werden. Der interventionelle Verschluß
im Herzkatheterlabor könnte in geeigneten Fällen eine Alternative zur operativen Korrektur sein.
The authors report about a rare case of aortico-right ventricular tunnel. This defect was successfully corrected in a 15-months-old
infant. A characteristic continuous murmur was heard over the 3th/4th intercostal space at the left sternal border. Two-dimensional
echocardiography and angiography confirmed the diagnosis. If possible, an early corrective operation should be attempted for
this defect.
Discussion: In certain cases interventional closure might be considered.
Monatsschrift Kinderheilkunde 04/1999; 147(1):19-21. · 0.27 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The faulty origin of the left coronary artery from the pulmonary artery is with an incidence of 1:300,000 newborns a very rare heart defect. We report a case of a pregnancy with two intrauterine blood transfusions in the 30th and 32nd week of gestation because of Rh-incompatibility and fetal anaemia. Dopplersonographic and echocardiographic parameters were normal. In the 32nd week of gestation delivery was induced (birth weight 2240 g, cord pH value 7.35, Apgar-score 8/9/9). Under a therapy with respiration, blood exchange transfusion and cardiotonic drugs the newborn died in the second week. The autopsy showed a general immaturity, a haemosiderosis of spleen, liver and lungs, a marked cellular jaundice and signs of a multi-organ-failure. The sinus of the pulmonary valve was the origin of the left coronary artery. In case of a seriously impaired pumping action and after exclusion of other heart defects the Bland-White-Garland-Syndrome (BWGS) has to be considered. Although a prenatal diagnosis of BWGS is with high resolution-ultrasound possible, the early postnatal diagnosis seems to be more relevant.
Zentralblatt für Gynäkologie 02/1997; 119(6):286-9.
-
[show abstract]
[hide abstract]
ABSTRACT: The attitude of medical professionals towards natural infant feeding is decisive in the support of mothers who want to breastfeed. The atmosphere in a "Baby-Friendly Hospital" is determined by the creation of conditions for breastfeeding on demand and for early, undisturbed mother-child contact. At the University Women's Hospital in Leipzig the development of good breastfeeding management was supported by the employment of a "breastfeeding nurse" and enhanced by continuing education for physicians, nurses and midwives in lactation and breastfeeding. In this way comprehensive, uniform information as well as practical guidance important for breastfeeding success were ensured for pregnant and young mothers.
Zentralblatt für Gynäkologie 02/1997; 119 Suppl 1:41-6.
-
Kinderkrankenschwester: Organ der Sektion Kinderkrankenpflege / Deutsche Gesellschaft fur Sozialpadiatrie und Deutsche Gesellschaft fur Kinderheilkunde 03/1996; 15(2):58-61.
-
[show abstract]
[hide abstract]
ABSTRACT: 7 premature infants with progressive posthaemorrhagic hydrocephalus were treated by means of external ventricular drainage (birth weight: 1050 gms, gestational age: 27.7 wks). All infants were generally unwell and were ventilated. The progression of hydrocephalus was well controlled during the drainage period in each patient. We believe external ventricular drainage is an effective form of therapy in premature infants with posthaemorrhagic hydrocephalus until the time of insertion of a ventriculo-peritoneal shunt.
Kinderärztliche Praxis 06/1993; 61(3):112-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Report about experiences with developing a perinatal center step by step an the University of Leipzig, primarily directed to improve the results of premature labour, then expanded by intensive diagnostics and treatment and uniform documentation of all risk pregnancies. Perinatal and neonatal mortality decreases following this management.
Zentralblatt für Gynäkologie 02/1991; 113(22):1251-5.
-
[show abstract]
[hide abstract]
ABSTRACT: Early detection of fetal malformations has become possible owing to the availability of highly advanced ultrasound systems. Majority of malformations, 30 per cent, has been recordable from urinary system. This system is early of access for the examiner, so that even sophisticated diagnosis of malformation is possible. High accuracy diagnosis has been increasingly helpful in forecasting pregnancy prognosis. Hence, with adequate perinatological management, it will be possible to influence on perinatal morbidity and mortality positively. 70 fetuses with malformations of kidneys and to urinary system have been observed in the context of this study. An assessment was made of diagnostic efficiency, postpartum development and long-range prognosis. Recommendations are derived from the above mentioned findings for perinatological approach in cases of diagnosed malformations of kidneys and the other urinary system.
Zentralblatt für Gynäkologie 02/1989; 111(10):669-77.
-
[show abstract]
[hide abstract]
ABSTRACT: In prenatal diagnosis besides radiographic methods there is a growing trend towards the use of invasive diagnostic techniques. These techniques have proved to be suitable for early detection of genetically determined conditions, diseases, and malformations of different origin. Invasive examination techniques were applied to 1.104 cases of prenatal diagnosis at Humboldt-University, Berlin, School of Medicine (Charité), Department of Gynaecology and Obstetrics, from January 1st, 1985, up to September 30th, 1987. In this paper importance and possible applications of these methods have been reported.
Zentralblatt für Gynäkologie 02/1988; 110(14):857-63.
-
[show abstract]
[hide abstract]
ABSTRACT: Prenatal diagnosis of fetal diseases and malformations, using invasive techniques is outlined in this paper. The value of amniofetography under present conditions is discussed together with the use of drugs both isolated and in conjunction with fill-up of the amniotic cavity. Indications for puncture of fluid-filled body cavities, with reference being made to patients looked after at the Humboldt-University Berlin, School of Medicine (Charité), Department of Gynaecology and Obstetrics, from 1985 up to 1987, are reported, too.
Zentralblatt für Gynäkologie 02/1988; 110(14):864-71.
-
[show abstract]
[hide abstract]
ABSTRACT: Intra-uterine exchange transfusion was performed on a patient in the 30th week of gestational age for Morbus haemolyticus fetalis. The indication for intra-uterine intervention resulted from spectrophotometric investigation of amniotic fluid which had revealed Zone III according to Liley as well as incipient hydropic development and development of ascites. The pregnancy had to be terminated for pathological CTG, four days after therapy. Postnatal neonatological intensive therapy included two exchange transfusions, before the child was dismissed in clinically intact condition.
Zentralblatt für Gynäkologie 02/1988; 110(1):54-9.
-
Zeitschrift für ärztliche Fortbildung 02/1987; 81(21):1107-11.
-
[show abstract]
[hide abstract]
ABSTRACT: Within the last years Doppler sonographic studies in high risk pregnancies had been included into obstetrical management strategies. Especially the high fetal risk in cases with severe intrauterine perfusion disturbances with signs of hemodynamic centralization--the brain sparing effect--had been established. In 11 premature newborns with prenatal sonographic recorded vasodilatation of cerebral vessels as a sign of hemodynamic centralization flow velocity waveforms of the anterior cerebral artery as well as left cardiac functional parameters (LVET, PEP) were measured at the 1st, 2nd, 3rd, 5th and 6th day of life. For the evaluation of the peripheral circulation the perfusion of the superior mesenteric artery was recorded by Doppler ultrasound. Additionally, the blood pressure, heart rate, pH and acid base status was considered. We used 25 premature newborns of corresponding gestational age and normal prenatal Doppler sonographic findings as a control group. In the group with prenatal brain sparing effect we could demonstrate a remarkable increase of the pulsatility index as a result of extreme diminished diastolic blood flow velocity. 5 newborns showed signs of reverse diastolic flow. The difference to the control group was highly significant. Perfusion measurements in the superior mesenteric artery demonstrated corresponding results at the first day of life with significant increased PI and diminished diastolic flow velocities. Our results demonstrate the great importance of prenatal diagnosis for the understanding of postnatal disturbances. The birth is not the endpoint of fetal hemodynamic centralization and the compensational mechanism is still continuing. Despite a well adapted cardiac function, normal hemodynamic situation and balanced metabolic findings remarkable changes of the impedance of the cerebral vessels are evident. Especially for the very immature newborns this may lead to the risk of leasions of the germinal matrix with following hemorrhage or ischaemic injury.
Zeitschrift für Geburtshilfe und Neonatologie 201(6):263-9.
-
[show abstract]
[hide abstract]
ABSTRACT: The importance of measurement of blood flow in the fetal and uteroplacental circulations for the assessment of fetal wellbeing has been undisputed since some years. The present study is designed to prove if any relationship exists between severe hemodynamic disturbance in fetal as well as uteroplacental vessels and the occurrence of postnatal impairment of intestinal motility. The progress of 130 children, born in the University Women's Hospital Leipzig between 1991-1993 and with birth weights below 1500 g, has been analyzed. Doppler ultrasound examinations for detection of impairment in fetal and uteroplacental circulation were performed in all cases during pregnancy. A severe impairment of blood flow in the above mentioned circulations was defined by the presence of pathological pulsatility or resistance indices in both fetal and uteroplacental vessels as well as absent end diastolic flow in the umbilical artery and signs of centralization in the fetus. A severe hemodynamic impairment was found in 27 children and 26 of these were classified as severe hypotrophic after birth. The progress of these children was compared with this of other hypotrophic and euthrophic premature babies who had not revealed hemodynamic abnormalities. The incidence of disturbed postnatal intestinal motility (delayed meconium excretion, abdominal distention, retrograde peristalsis, subileus) was significantly higher in hypotrophic neonates with hemodynamic abnormalities in the course of pregnancy. Four of these newborns underwent surgery and surgical findings did not correlate with enterocolitis. The resumption of oral food intake for neonates who had hemodynamic impairments during pregnancy was delayed compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)
Zeitschrift für Geburtshilfe und Neonatologie 199(5):190-4.
-
[show abstract]
[hide abstract]
ABSTRACT: Hemodynamic impairements play an important role in the development of cerebral lesions. These changes may be detected by dopplersonographic flow measurements in cerebral arteries. For that reason it is necessary to establish normal values in relation to cardiac function and intestinal perfusion.
62 neonates with uncomplicated postnatal adaptation were investigated by dopplersonographic measurements of ant. cerebral artery (ACA) at the 1st, 2nd, 3rd and 5th day of life. Relations to left ventricular ejection time (LVET) and systemic blood pressure were described. An index of parameters from ACA and sup. mesenteric artery was determined.
We demonstrated a significant increase of flow velocities and a decrease of pulsatility index in relation to increased gestational and postnatal age. There was a positive correlation between LVET and systemic blood pressure to peak flow velocities and a negative correlation to pulsatility index. The index of the parameters from ACA to sup. mesenteric artery was not depended on gestational age. The index of the flow velocities of both arteries increased from first to fifth day of life, whereas the index of the pulsatility index decreased.
With these results it is possible to evaluate cerebral hemodynamic changes by dopplersonographic measurements in relation to gestational and postnatal age and under consideration of cardiac function and mesenteric perfusion.
Zeitschrift für Geburtshilfe und Neonatologie 203(6):234-40.
