F W Hehrlein's research while affiliated with Justus-Liebig-Universität Gießen and other places

Publications (212)

Article
Pre-clinical and clinical testing of artificial heart-valves has not been standardized. Therefore different centers have been using individual procedures. As a consequence, the results from different laboratories on different valves can be compared only after certain assumptions. In order to compare different valves under identical conditions, a pu...
Article
A general lack of standardization of the pre-clinical testing of artificial valves leads to an actual comparison of different prosthetic models at the time of a first clinical trial, frequently with contradictory results. Therefore, a pulse duplicator was developed in order to compare different valves of comparable size under identical standardized...
Article
Biopsies from hypertrophied left ventricles were obtained intraoperatively from patients undergoing valve replacement for aortic valve disease. The tissue was immediately fixed in glutaraldehyde and, after appropriate preparation, examined by light and electron microscopy. Morphologic characterization was carried out with respect to 1. qualitative...
Article
Stress evaluation was carried out in 26 patients approximately 7 months after aortic valve replacement with Björk-Shiley valves (13 patients) and St. Jude medical valves (13 patients). During isoproterenol infusion (0.3 micrograms/kg/min), cardiac output increased by a factor of 1.5 and aortic valve area decreased by 50% for both valve groups, whil...
Article
A report is given on 16 surgically treated cases of aneurysms of the ascending aorta with aortic valve insufficiency in necrosis of the median or mucoid degeneration, the so-called annulo-aortic ectasia. 11 patients showed good results of treatment after total correction of the condition. Bleeding to death and cardiac failure are the main causes of...
Article
Die Erkennung und Behandlung von Verletzungen großer Gefäße beim polytraumatisierten Patienten hat absolute Priorität. Die Wiederherstellung der Durchblutung innerhalb der tolerablen Ischämiezeit ist Voraussetzung für das Überleben der Patienten bzw. der betroffenen Organe oder der Extremitäten. Der erstbehandelnde Arzt muß über ausreichende Kenntn...
Article
Diagnosis and treatment of vascular injuries in patients with polytrauma is of primary importance. Restoration of blood flow during the time limit of tolerable ischemia is fundamental for the survival of the patient, and the injured organs or extremities. To achieve this, the first treating physician must have sufficient knowledge of diagnosing and...
Chapter
In vivo testing of artificial valves is complicated by the lack of standardisation of technique in different laboratories. Furthermore a continuing variation of the most important parameters, i.e. flow and heart rate, makes it a difficult task to evaluate the hemodynamic qualities of different valves from single measurements in different patients....
Chapter
The application of the intraaortic balloon counter pulsation (IABP) has become a standard therapy in patients with cardiogenic shock or in cases of low cardiac output postoperatively. Experimental results to show a reduction of the infarct size due to the IABP are contradictory (6, 9–12). The aim of this study is to find out if an acute evolving my...
Chapter
In a 55-Year-old patient with mitral insufficiency (stad. II–III NYHA), additional atypical syncopal attacks are registered. The echocardiogram shows multiple signals of a tumor behind the anterior leaflet during systole of the atrium. In the cine-angiogram, a pediculate tumor moving toward the valve orifice can be detected. Resection of the tumor...
Article
During open-heart surgery, myocardial biopsies were taken from 31 patients undergoing aortic valve replacement on total cardiopulmonary bypass. The first needle biopsy was taken before the induction of cardiac arrest (Kirsch cardioplegia), the second at the end of global ischemia, and the third during the reperfusion period. The tissue was investig...
Article
Between December 1970 and June 1978, 833 patients were operated upon for isolated mitral valve replacement (MVR: 361 patients), isolated aortic valve replacement (AVR: 345 patients) and aortic plus mitral valve replacement (DVR: 127 patients) by use of the Björk-Shiley valve. Operative mortality for the entire series was 15%. The five year survival...
Article
In our experience hemodialysis proved to be unsatisfactory in the treatment of acute renal failure after cardiovascular surgical intervention because of its negative influence on the often critical hemodynamic situation of the patients. In 21 cases we performed a continuous peritoneal dialysis (CPD) for 1 to 29 (mean 9.2) days by using a Tenckhoff...
Article
Since February 1978, seventy-nine St. Jude medical prostheses have been implanted in seventy-two patients with an overall mortality of 8.5%. Clinical, hemodynamic and hematological findings are presented. Twenty-two patients have been catheterized postoperatively, and findings are presented. In vitro comparisons have made between the St. Jude and o...
Article
Light and electron microscopic morphometry was carried out on myocardial tissue samples of 79 patients with coronary artery disease. Transmural biopsies of the myocardium perfused by the left anterior descending branch (LAD) were obtained during coronary bypass operation or aneurysmectomy. LAD-stenosis was measured and regional LAD wallmotion was d...
Article
The specific characteristics of the SJM prosthesis are based on a new design in which there are two centrally hinged leaflets. Preclinical in vitro studies showed a favorable hemodynamic profile, causing minimal disturbance of the central flow. Therefore, starting in February, 1978, our department undertook a large-scale clinical trial of the SJM v...
Article
Three transvenous pacemaker electrodes are presented which can be positional with a corkscrew-or a pincer mechanism. This type of fixation reduces early failure of the leads due to displacement from the right ventricular apex and also allows transvenous placement of an atrial leads. By this way permanent atrial pacing in patients with sick sinus sy...
Article
Contraction and relaxation of the canine myocardium were examined during normothermic ischemia in an isolated heart model. Decrease in the development of tension depends on the duration of ischemia. Deficient functional recovery was observed after ischemic periods extending beyond 30 minutes, in spite of reperfusion periods of over 1 hour. A decrea...
Article
Starting in February 1978 52 St. Jude Medical Prostheses have been implanted in 47 patients (age 13--73 years) in aortic, mitral and tricuspid positions. Perioperative death occurred in 3 cases. Post mortem examination of these patients showed unimpaired valvular function. There were no other complications in an accumulated total valve time of appr...
Article
From December 1970 to June 1978, 833 patients were operated upon for isolated mitral valve replacement (MVR: n = 361), isolated aortic valve replacement (AVR: n = 345), and aortic plus mitral valve replacement (DVR: n = 127) by the use of the Bjork-Shiley tilting disc valve. Operative mortality for the entire series was 15%. A comparison of operati...
Article
Report of the case of a 12 years old boy, who because of acquired mitral valve insufficiency (grades II--III), after an illness of virus-carditis, became, in the first instance, a Bjoerk-Shiley-Ventil M27 prosthetic valvular replacement, and after 3 months, in one sitting, correction of a paravalvular leakage and prosthetic valvular replacement of...
Article
Several causes of restricted graft flow in a series of 99 patients could be identified by intraoperative measurements of aorta-coronary graft flow and poststenotic pressure. Mechanical stenosis as well as functional restriction of graft flow caused by competition between vein and native artery flow were noted in cases with a mildly stenotic artery...
Article
The influence of controlled ischemia on myocardial ultrastructure was investigated in isolated, metabolically supported canine hearts. Recovery of functionally normal tissue as indicated by the reversibility of morphological alterations was observed up to 60 minutes of anoxia. It was shown that prolonged reperfusion of the empty beating heart suppo...
Article
Left ventricular end-diastolic properties were evaluated with cineangiography and pressure measurements before and 6 months after aortic valve replacement with a Björk-Shiley prosthesis in 10 patients with aortic stenosis, 7 patients with mixed aortic valve disease and 7 patients with aortic insufficiency. Mean left atrial pressure, left ventricula...
Chapter
Intra-operative basal graft flow measurements are of predictive val­ue in determining the fate of aorto-coronary artery vein bypass grafts. In patients with a graft flow less than 20 ml/min at the time of operation an early closure rate of 50%-l00% was established [1-3]. Because different factors may be involved in graft closure occurring in the pe...
Article
In an isolated dog heart preparation the influence of normothermic ischemic arrest and recovery of the ventricular function during the period of post-ischemic reperfusion were investigated. If ischemic arrest has caused a depression of ventricular function, the functional recovery of the myocardium cannot be improved significantly by a prolonged re...
Article
Hemodynamic studies were performed in 6 normal individuals, 8 patients with severe obstruction (more than 85% stenosis) of the left anterior descending coronary artery (LAD), 10 patients with patent LAD grafts and 4 patients with stenosed or occluded LAD grafts. All patients were suffering from stable angina before operation. Monoplane ventriculogr...
Article
Hämodynamische Studien wurden an 6 normalen Individuen, 8 Patienten mit hochgradiger Obstruktion des Ramus descendens anterior der linken Koronararterie (LAD), 10 Patienten mit offenem aortokoronarem Bypass zum LAD und 4 Patienten mit stenosiertem oder verschlossenem aortokoronarem Bypass zum LAD, durchgeführt. Alle Patienten hatten vor Operation e...
Article
Am Modell des isolierten Hundeherzens wurden der Einfluß einer induzierten, normothermen Ischämie auf die diastolischen und systolischen Wandeigenschaften des linken Ventrikels sowie die Rückbildung dieser Beeinträchtigung der Ventrikelfunktion in der Reperfusionsphase untersucht. Ist es durch die Ischämie zu einer deutlichen Einschränkung der Vent...
Article
Coronary hemodynamics were studied intraoperatively in 65 patients undergoing aortocoronary bypass grafting. Poststenotic coronary pressure and graft flow hyperemia were measured. Patients without coronary collateral vessels on arteriography (class A) were compared with patients with collateral vessels (class B). Patients in class A were grouped ac...
Article
Left ventricular angiographic studies were performed before and 6 months after aortic valve replacement with a Björk-Shiley prosthesis in 21 patients, 5 with aortic stenosis, 8 with mixed aortic valve lesions and 8 with aortic insufficiency. The degree of myocardial fibrosis and myocardial ultrastructural changes were evaluated from transmural need...
Article
This study evaluates the tolerance to ischemia during induced cardiac arrest in patients undergoing aortic valve replacement. In all patients cardiac standstill was of 45 minutes duration. Biopsies for electron microscopic study were taken from the left ventricle before induction of arrest, at the end of the ischemic period and 20 minutes after cor...
Article
In 29 patients with coronary artery disease the functional significance of coronary collaterals was studied during surgery for aortocoronary bypass grafting. Poststenotic coronary pressure and postocclusion graft flow hyperemia were measured in 34 vessels receiving a coronary bypass graft. The vessels were divided into groups according to the angio...
Article
Stumpfe Herzverletzungen treten im Gefolge von Thoraxtraumen weit häufiger auf als allgemein angenommen. Wegen bestehender Begleitverletzungen ist ihre Diagnostik oft sehr erschwert. Während leichtere Traumen auch ohne Therapie völlig ausheilen, können schwerere Formen wegen eines Hämoperikards oder wegen akuter Herzinsuffizienz (z. B. bei traumati...
Chapter
Bei 68 Patienten mit einer Signifikaten LAD-Stenose wurden der Grad dieser Stenose (CAS), die Vorderwandbeweglichkeit des linken Ventrikels (AWM), der mittl. Transplantatfluß (BF) und die reaktive Hyperämie (RH %) gemessen. Patienten mit einem Blutfluß im Transplantat von unter 40 ml/Min. wurden mit solchen vergli¬chen, die einen Transplantatfluß v...
Chapter
In a previous study [3] ultrastructural changes occurring in human myocardial tissue during ischemia and during reperfusion after ischemia were investigated in order to evaluate the tolerable duration of induced cardiac arrest during open-heart surgery. It was concluded that 45 min of ischemia resulted in a moderate degree of myocardial damage and...
Article
Regional myocardial blood flow reserve was studied in 18 dogs with chronic coronary artery occlusion before and after aortocoronary bypass grafting. Changes in collateral resistance due to progressive coronary narrowing were determined in the same animal using the tracer microspheres technique. Preexisting collateral vessels had a resistance of 8,4...
Article
The effect of an aortocoronary bypass graft on coronary hemodynamics was studied experimentally in dogs and during surgery for aortocoronary bypass grafting in man. In the experimental part of this study it was shown that coronary dilatory reserve is unaffected between 0 and 50% coronary narrowing. In the presence of more severe stenosis the dilato...
Article
Die regionale Myokarddurchblutungsreserve wurde an 18 Hunden mit chronischem Koronarverschluß vor und nach aorto-koronarem Venen-bypass gemessen. Änderungen des Kollateralwiderstandes als Folge der progressiven Koronareinengung wurden mit der Tracer Microspheres-Technik bestimmt. Der vor Stenose bestehende Kollateralwiderstand betrug 8,49 Widerstan...
Article
Die Wirkung eines aorto-koronaren Venenbypass auf die koronare Hämodynamik wurde experimentell bei Hunden und intraoperativ bei Patienten untersucht. Experimentell wurde gezeigt, daß bei einer Koronararterienstenose zwischen 0 und 50% die koronare Dilatationsreserve nicht beeinträchtigt wurde. Bei höhergradiger Stenose nimmt die Dilatationsreserve...
Article
Needle biopsies taken from human hearts during cardiac surgery were investigated with the electron microscope. Cardiac tissue obtained before induction of ischemia was compared with tissue removed at the end of the ischemic period during total cardiopulmonary bypass with mild cardiac hypothermia and elective cardiac arrest (cardioplegia) and with t...
Article
A report on surgical treatment of 40 patients, 39 with left ventricular aneurysm and 1 with double aneurysm in rupture stage, is presented. The general hospital lethality lies at 7.5%. The highest mortality is noted in patients with additional aortic-coronary bypass procedures. Prognosis after surgical treatment is generally more favourable than th...
Article
During the last 20 years 156 patients underwent a direct and indirect aortic-isthmus-plastic. Early complications occurred in 7.6%. 5 patients developed an aneurysm in the area of isthmus-plastic. The mortality rare was 4.5%. There was no evidence of recurrent coarctation in a group of children and in adult patients. The indirect aortic-isthmus-pla...
Article
Since April 1975 we used 50 bovine arterial heterografts for reconstructive surgery after chronic arterial occlusions or for the production of AV-shunts needed for chronic dialysis. In none of the cases incompatibility was seen. The early results (with a follow-up period of 6-10 months) after femoro-popliteal bypass were excellent, as far as a good...
Article
Seit April 1975 kamen 50 bovine Arterientransplantate zur Behandlung chronischer Arterienverschlüsse oder zur Herstellung von AV-Fisteln bei chronischer Dialysebehandlung zur Anwendung. Unverträglichkeitsreaktionen wurden nicht beobachtet. Die Frühergebnisse (Beobachtungszeitraum 6-10 Monate) nach Gefäßrekonstruktionen im femoro-poplitealen Bereich...
Article
Während der letzten 20 Jahre wurden bei 156 Patienten eine direkte und indirekte Aortenisthmusplastik durchgeführt. Frühkomplikationen traten in 7,6% auf. Bei 5 Patienten (3,8%) entwickelte sich als Spätkomplikation ein Aneurysma im Bereich der Isthmusplastik. Die Gesamtletalität betrug 4,5%. Kontrolluntersuchungen ergaben keinen Anhalt für funktio...
Article
From October 1973 to May 1975 cardiae surgery with extracorporal circulation using Acupuncture as Analgesia was performed in 131 patients in the surgical clinic of the University of Giessen. Acupuncture is performed by electric-stimulation of 8 points at the lower legs, the neck and ears with 90 V and 5--6 Htz. All patients are intubated; controlle...
Article
The first clinical results of 100 patients, operated since November 1973 using ECC and acupuncture anesthesia are reported. The method of combined chinese and european procedures of analgesia is described. Advantages and problems of the new method are discussed.
Article
100 offene herzchirurgische Eingriffe wurden bisher nach dem neuen Verfahren der Akupunktur-Analgesie durchgeführt. Nach Beschreibung des kombinierten Verfahrens von chinesischer Akupunktur mit der herkömmlichen Intubation und Narkoseeinleitung werden die ersten klinischen Ergebnisse dargelegt. Der wesentliche Vorteil der Methode liegt in einer 80%...
Article
Peak isovolumetric left ventricular pressure and dp/dtmax before and after norepinephrine (N.E.) infusion and cross-clamping of the aorta was identical in normal dogs and in dogs with chronic coronary artery occlusion (C.C.O.) before and after aortocoronary bypass. In normal dogs, coronary reserve was 7.9 and 7.4 times control for the subendocardiu...
Article
5 patients with primary infective endocarditis developed acute cardiac failure because of aortic valve insufficiency. 2 patients were in the active and 3 patients in the inactive stage of infective endocarditis. In 4 patients an aortic and in 1 patient an aortic and mitral valve replacement was performed. The early mortality rate (death within 30 d...
Article
In unterschiedlichen Zeitabständen nach einer infektiösen Endokarditis wurde wegen eines Klappenvitiums bei therapieresistenter Herzinsuffizienz ein akuter Klappenersatz durchgeführt: Bei 4 Patienten ein Aorten- und bei 1 Patienten ein Aorten- und Mitralklappenersatz. 4 von 5 Patienten verließen beschwerdefrei die Klinik. Der präoperative Zeitpunkt...
Article
From October 1973 to February 1975 cardiac surgery with extracorporal circulation using Acupuncture as analgesia was performed in 88 patients in the surgical clinic of the University of Giessen. Acupuncture is performed by electric-stimulation of 8 points at the lower legs, the neck and ears with 90 V and 5-6 Hz. All patients are intubated; control...
Article
1. The humoral immunosystem is impaired in those cases of catabolic metabolism in which quantitative and qualitative insufficient alimentation is expected after operation. 2. We showed that after cardiac surgery with extracorporal circulation as well as after other operations a reasonably balanced parenteral nutrition composed of carbohydrates and...
Article
Vom Oktober 1973 bis Februar 1975 wurden an der Chirurgischen Universitätsklinik Gießen 88 offene Herzoperationen unter Akupunktur-Analgesie nach folgender Methode durchgeführt: Elektrostimulation von 8 Nadeln, die an den Armen, Hals und Ohren implantiert werden, mit asym. Wechselspannungsimpulsen, 90 VSS und 5 Hz. Frequenz. Alle Patienten werden i...
Article
1. Das humorale Immunsystem wird durch katabole Stoffwechselsituationen beeinträchtigt, mit denen unter quantitativ und qualitativ ungenügender Ernährung bei Operierten zu rechnen ist. 2. Nach Herzoperationen in extrakorporaler Zirkulation konnte ebenso wie nach anderen Eingriffen gezeigt werden, daß durch eine zweckmäßig zusammengesetzte parentera...
Article
Cardiac biopsies were taken from the hearts of 40 patients undergoing open heart surgery for acquired and congenital disease. Tissue samples were taken prior to aortic cross-clamping, at the end of the ischemic period, and 20 minutes after reperfusion. Cardiac arrest was induced with Kirsch's cardioplegic solution at mild hypothermia (28-30 degrees...
Article
During cardiopulmonary bypass surgery without coronary perfusion, most myocardial cells show ischemic lesions of the mitochondria but all other cell organelles remain unchanged. Ischemic damage to the myocardial cells caused by cardiopulmonary bypass surgery for a period of 47 minutes is reversible, since, after 20 minutes of reperfusion of the hea...
Article
Investigations in myocardial ultrastructure before, during and after coronary bypass with induced cardiac arrest have shown significant changes of ultrastructure, especially in the mitochondria. Ischemic damage to the myocardium caused by cardiac arrest for a period of 60 min is fully reversible after a short reperfusion of the heart. Based on the...
Article
Elektronenmikroskopische Untersuchungen des Myokards vor, während und nach Anwendung der extrakorporalen Zirkulation mit kardioplegischem Herzstillstand haben gezeigt, daß es zu deutlichen ischämiebedingten ultrastrukturellen Veränderungen insbesondere an den Mitochondrien kommt. Die während einer Ischämiedauer von maximal 60 Minuten zu beobachtend...
Article
Summary The new Omnicor pacer system (Cordis) permits a change of rate and of output current at any time, before or after implantation. Since October 1973, in the Surgical Clinic of the University of Giessen we have implanted 110 Omnicor pacemakers. In all patients the output of the pacers could be distinctly reduced. Since June 1973 we have been c...
Article
Initial clinical experiences with the Omnicor System for programmable permanent pacing in 18 patients (16 with epicardial electrodes and 2 with pervenous ones) are reported. The functional mode of the R wave synchronous and R wave inhibited pacers, as well as of the programmer, is described. The expected improvement in longevity for the pacemaker i...