H Richter

Universitätsklinikum Freiburg, Freiburg an der Elbe, Lower Saxony, Germany

Are you H Richter?

Claim your profile

Publications (5)3.67 Total impact

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Paraplegia remains the most dreaded complication following thoracoabdominal aortic repair. We investigated the efficacy of cerebrospinal fluid drainage as a spinal cord-protecting modality. We also evaluated the correlation between the frequency of cerebrospinal fluid drainage and the Crawford classification. Spinal cord function was monitored during 20 open surgical procedures (group I) and 27 stent-graft implantations (group II). Evoked potentials and intracranial pressure were monitored in each operation. If intracranial pressure exceeded 15 mmHg, cerebrospinal fluid was drained. Cerebrospinal fluid drainage was necessary in 75 % of patients in group I (Crawford type I: 33 %, type II: 40 %, type III: 20 %, type IV: 7 %) and in 22 % of patients in group II (Crawford type I: 33 %, type II: 66 %). Evoked potential alterations correlated with an increase in intracranial pressure. Timely cerebrospinal fluid drainage reversed these changes in 72 %. Three patients remained paraplegic. Cerebrospinal fluid drainage is a valuable neuroprotective interventional tool to lower the risk of spinal cord ischemia. The combination of neurophysiological monitoring and cerebrospinal fluid drainage optimizes the prevention of paraplegia during aortic repair.
    The Thoracic and Cardiovascular Surgeon 04/2007; 55(2):73-8. · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: There are few families with the diagnosis of ascending aortic aneurysm and acute type-A aortic dissection inherited as an autosomal-dominant disorder in the absence of a known genetic syndrome. We investigated a family with 26 members in whom ascending aortic aneurysms and acute type-A aortic dissections occurred over three generations. Examinations were performed to identify family members at specific risk. Six members presented with acute type-A aortic dissections and three relatives had ascending aortic aneurysms. Clinical examinations showed no characteristics of a known genetic syndrome. Molecular genetic analysis revealed no mutations known to cause a form of autosomal-dominant inherited aortic disease. Adequate diagnostic measures are mandatory in families with ascending aortic aneurysms or type-A aortic dissections to identify or exclude family members at risk for aortic diseases. Even in the absence of identifiable mutations causing isolated aortic aneurysms or aortic dissections, we recommend standardised examinations of all first-degree relatives of affected families. An indication for prophylactic aortic root replacement should be considered for patients at risk.
    The Thoracic and Cardiovascular Surgeon 03/2007; 55(1):19-23. · 0.93 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Dural ectasia is a major diagnostic criterion for Marfan syndrome using the Ghent nosology. Our aim was to evaluate the efficacy of three different radiological methods previously proposed for the assessment of dural sac diameter in Marfan syndrome. Marfan syndrome was diagnosed in our study using the Ghent criteria, disregarding dural ectasia as a criterion. Three proposed radiological methods were applied to measure dural sac diameter, examined for 41 patients (18 patients with and 23 without Marfan syndrome) by computed tomography or magnetic resonance imaging. Using Oosterhof's method, 94% of the patients with and 44% of the patients without Marfan syndrome fulfilled the criteria of dural ectasia. According to Villeirs, dural ectasia was diagnosed in 18% of the patients with and in none of the patients without Marfan syndrome. With Ahn's method, dural ectasia was found in 72% of the patients with and in 44% of the patients without Marfan syndrome. In only two patients with Marfan syndrome was dural ectasia diagnosed by all three methods. Our results reveal overt discrepancy between the three methods of assessing dural ectasia. Considering the key role played by dural ectasia in reinforcing the diagnosis of Marfan syndrome according to the Ghent nosology, a standardized and reliable method should be sought.
    Clinical Radiology 12/2006; 61(11):971-8. · 1.82 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Zusammenfassung Hintergrund Schwere atherosklerotische Veränderungen der Aorta und anderer großer Gefäße stellen eine besondere Herausforderung für den Gefäßchirurgen dar. Das Abklemmen eines Gefäßes mittels einer herkömmlichen Gefäßklemme kann Schäden am Gefäß verursachen und atheromatöse Plaques aufbrechen, die wiederum zu arteriellen Embolien in der peripheren Strombahn führen können. Um dies zu vermeiden, haben wir ein neues Ballonokklusions (BO-)Device als Alternative zur Gefäßklemme entwickelt. Methoden Die vorliegende Studie umfasste zwei Testphasen. In der In-vitro-Phase wurde an künstlichen, flexiblen Aortenbogenmodellen, das ideale Cuffvolumen des BO-Device bestimmt. In der In-vivo-Phase wurden Untersuchungen unter physiologischen Bedingungen mit dem BO-Device an zehn Hausschweinen durchgeführt. Abschließende histologische Untersuchungen, der mit dem BO-Device geblockten Aortenwände, vervollständigten die Untersuchungen. Ergebnisse Das BO-Device absolvierte die experimentelle In-vitro-Phase problemlos und konnte kontinuierlich weiterentwickelt werden, so dass wir nach kurzer Zeit in der Lage waren, die Aorten im Tierversuch effektiv zu okkludieren. Es traten keine Komplikationen, wie intraoperative Ballonruptur, Dislokation oder Undichtigkeiten, auf. Desweiteren fanden sich keine Dissektionen oder andere Gefäßschäden bei den postoperativen histologischen Nachuntersuchungen. Schlussfolgerung Das BO-Device hat in der experimentellen In-vitro- und In-vivo-Testphase alle Anforderungen erfüllt und gezeigt, dass es dazu beitragen kann Gefäßschäden zu minimieren. Das BO-Device ist jetzt soweit um im klinischen Alltag erprobt zu werden und hat das Potential eine Alternative zur konventionellen Gefäßklemme, bei Patienten mit schwer atherosklerotisch veränderten Gefäßen, zu werden.
    Zeitschrift für Herz- Thorax- und Gefäßchirurgie 12/2005; 19(6):257-263.