Paul H. Heintzen's research while affiliated with Christian-Albrechts-Universität zu Kiel and other places

Publications (63)

Article
In an experimental study in pigs, the function of monocuspid and bicuspid patches was compared to improve surgical reconstruction of a hypoplastic pulmonary root. Segments from glutaraldehyde-treated porcine aortic roots served as monocuspid and bicuspid patches. Their leaflets and commissures were marked with radiopaque metal clips. Marker movemen...
Article
Full-text available
Videodensitometry allows to obtain both left and right ventricular ejection fraction (EF) and aortic or pulmonary regurgitant fraction (RGF) from the wash-out curve of contrast medium. We developed this technique to digital densitometry and integrated it in the standard digital image acquisition system 'Digitron' using Siemens user's library. Sourc...
Conference Paper
On the basis of 20 years of experience the authors discuss desirable future developments of the facilities and performance of the cardiac hemodynamic-angiographic laboratory. It is proposed that three self-supporting modular subsystems be merged into an integrated system using decentralized interfaces and networks. The subsystems perform (a) hemody...
Article
Between 1978 and 1987, 39 patients aged 1 day to 15 years underwentsurgery for symptomatic left ventricular inflow obstruction. Fourdiagnostic groups were identified: cor triatriatum (6 patients),supravalvar mitral membrane (SVMM) with a normal mitral valve (7 patients),SVMM with an abnormal mitral valve (9 patients) and mitral stenosis (17patients...
Article
To assess the feasibility of quantitative central venous digital angiocardiography, right ventricular spatial orientation, size, and shape were compared with measurements based on conventional angiocardiography, both obtained during routine cardiac catheterization in 21 children with various congenital heart defects. Without systematic error, corre...
Chapter
Digital image processing techniques allow to visualize the coronary microcirculation by enhancing the capillary phase opacification of selective arteriograms. However, the spatial distribution and local extent of the myocardial perfusion is difficult to judge from only one X-ray projection. The planar technique is limited by the fact that angiograp...
Chapter
Commonly employed methods for the relief of the right ventricular outflow tract stenosis in tetralogy of Fallot are not ideal. In particular, pulmonary insufficiency cannot be prevented in most instances. For reconstruction, pulmonary and aortic allografts have been utilised (2, 5, 6, 9, 10, 14, 15, 19, 20), especially since newer methods of preser...
Chapter
Conventional angiocardiography requires a large amount of contrast medium, which is especially detrimental in infants and children. In addition, a ventricular injection is often associated with catheter-induced ventricular ectopic rhythm [1–5], precluding optimal analysis of ventricular function, necessary in the pre- and postoperative assessment....
Article
To gain information on physiologic postnatal cardiac growth in humans and to characterize the left ventricle (LV) when subjected to various types of overload during that period, angiocardiographic volume parameters in infants, children, and adolescents were analyzed. In normal subjects, the relationships between end-diastolic volume (EDV), end-syst...
Article
In 16 patients, constituting 100% of children followed for up to 7 years after two-stage anatomic correction of complete transposition of the great arteries, clinical and electrocardiographic data, as well as cardiac catheterization data in 12 patients, were analyzed. None of them has had signs or symptoms of coronary or myocardial insufficiency af...
Article
To assess postoperative arrhythmias and AV-conduction defects associated with anatomic correction of simple transposition of the great arteries, 207 standard 12-lead surface and 43 24-hour electrocardiograms of all 17 patients followed after anatomic correction for up to 6.5 years were reviewed. No dysrhythmias or AV-conduction delays definitely at...
Chapter
With increasing use of axial angiocardiography [1, 2], especially in patients with congenital heart disease, knowledge of left and right ventricular spatial orientation is of practical value. However, no systematic study exists of ventricular position during normal growth and in patients with typical congenital heart diseases. We therefore develope...
Chapter
To gain more insight into the natural history [1, 2] and right ventricular (RV) function in children with valvular pulmonary stenosis, we analyzed hemodynamic data of 18 infants and children who had two cardiac catheterizations without surgery and also quantitative angiocardiographic RV data of 38 additional patients.
Chapter
We employed image enhancement techniques [1] to determine the extent to which digital subtraction angiocardiography (DSA), after injection of small amounts of contrast medium with reduced flow into the right ventricle (RV), can provide information previously available only after large intraventricular contrast administration.
Chapter
To determine the extent to which digital subtraction angiocardiography (DSA), after injection of small amounts of contrast medium with reduced flow into the left ventricle (LV), can provide information previously available only with large intraventricular contrast administration, we employed image enhancement techniques.
Article
To evaluate the influence of the 2-stage anatomic correction of simple transposition of the great arteries on left ventricular (LV) function, pressure and angiocardiographic volume data were analyzed during resting conditions shortly before banding of the pulmonary trunk (n = 12) and before (n = 17) and after anatomic correction (n = 11), and compa...
Article
The purpose of this study was the analysis of natural history and right ventricular function of infants and children with valvular pulmonary stenosis. Available for assessment were the pressures in the right ventricle and pulmonary artery in 5 infants and 13 children obtained at two cardiac catheterizations, performed at intervals of 2 to 12 years...
Article
The surgical creation of a supravalvular pulmonary stenosis (PS) adequate to prepare the left ventricle (LV) for anatomic correction in cases of simple transposition of the great arteries (TGA) is difficult. To gain more information on the hemodynamic changes immediately following PS of various degrees, pressures (P) in the right atrium (RA), right...
Article
The purpose of this study was to determine the speed and duration of progressive pressure loading of the right ventricle to systemic pressure levels, which allows right ventricular adaptation without myocardial impairment at rest. In 8 pigs with an average weight of 22 kg progressive right ventricular pressure loading of different speeds and durati...
Article
The purpose of this work was to develop a device which allows slow progressive banding of a great artery in infants within 4 to 5 weeks. Employed was the hygroscopic casein ameroid. When brought in contact with fluids, an ameroid cylinder expands characteristically. An early phase of fast expansion proceeds gradually to a phase of slow growth. Size...
Article
To determine factors that influence the accuracy of echocardiographically estimated right ventricular volume and to improve the echocardiographic input information by applying image enhancement techniques, quantitative contrast echocardiography (4-chamber view) and biplane angiocardiography were performed in 23 children during routine diagnostic ca...
Chapter
Angiocardiographic methods for quantitative analysis of the dynamic geometry of the heart are described. 3D spatial ‘reconstruction’ of the left or right ventricle from their traced and digitized contours after contrast injection allow the generation of simplified, but clinically useful 3D models of the ventricles which form the basis for left and...
Chapter
Für die quantitative Beurteilung krankhafter Befunde sollte der bei Kindern in der Regel wachstumsabhängige Normalwert des untersuchten Parameters bekannt sein. Für die M-mode-Echokardiographie sind zahlreiche Untersuchungen zur Wachstumsabhängigkeit verschiedener Parameter veröffentlicht worden (Lange, L. et al. 1983). Mit Hilfe der zweidimensiona...
Chapter
Presently the complete three-dimensional (3-D) reconstruction of the beating heart is only feasable with high-resolution, volumetric scanning devices [1,2], which in the present state of development are more suited for fundamental investigations than for routine clinical diagnostic purposes. However, projection images from a conventional biplane an...
Article
In 12 open-chest pigs, mean weight 18 kg, simultaneous beat-to-beat measurements of pressure in the right and left atria and right and left ventricles, and of pressure and flow in the pulmonary artery, were performed before, during and after the injection of 0.8 ml/kg with 10 to 15 ml/s of diatrizoate, ioxaglate and iopamidol as well as mannitol, n...
Article
Angiocardiography is of considerable value in the dimensional analysis of the right ventricular (RV) cavity, but conventional angiocardiography requires large amounts of contrast medium. In this study digital subtraction angiocardiography was applied to biplane RV projections of 25 children with congenital heart disease after direct injection of a...
Article
A computer-assisted method of estimating left ventricular muscle volume and its clinical application in 193 children and young adults is described. Wall thickness was measured at the lower half of the left cardiac border in the angiographic posteroanterior projection of the left ventricle, where only three points are marked when the left ventricula...
Article
Correction of right ventricular outflow tract obstruction remains a challenge to cardiovascular surgeons. In order to relieve this obstruction and at the same time prevent or minimize pulmonary insufficiency, we inserted a cusp-bearing transannular patch (monocusp) in 14 patients. To test this objective, we restudied 13 of these patients 0.5 to 4 m...
Article
Systolic and diastolic diameters of the right and left pulmonary arteries (RPAD, LPAD), descending thoracic aorta (DTAD), right ventricular infundibulum (RVID), and pulmonary and aortic valve roots at the proximal, commissural and distal levels were estimated from angiocardiograms in 24 infants, children, and adolescents without heart disease, and...
Article
The purpose of this investigation was to validate in vivo the accuracy of videoangiocardiographic right ventricular volume determination. Thus the stroke volume of the right ventricle as difference of enddiastolic and endsystolic volume was determined simultaneously (n=70) by videoangiocardiography and with an electromagnetic flowmeter in 7 open-ch...
Article
On the basis of angiographic projections, left (n = 43) and right (n = 56) ventricular volume data were obtained in patients with tetralogy of Fallot before and after surgical repair. The postoperative patients were divided into 3 groups according to the degree of an additional volume load secondary to a residual ventricular septal defect or pulmon...
Article
Volume parameters of 63 left (LV) and 50 right ventricles (RV) were calculated from bi-plane angiocardiograms of infants, children and adolescents. Seventeen of the LV were from patients who were normal or had only minor abnormalities, 26 were from patients with atrial septal defect and left-to-right shunt less than 170% and 20 were from patients w...
Article
A survey of the evolution of roentgen-video-computer techniques is given which was initiated by the development of videodensitometry by Wood and his associates. Following fundamental studies of the usefulness and limitations of x-ray equipment for quantitative measurements and the applicability of the Lambert-Beers law to x-ray absorption, videoden...
Article
Volume parameters of 63 left (LV) and 50 right ventricles (RV) were calculated from bi-plane angiocardiograms of infants, children and adolescents. Seventeen of the LV were from patients who were normal or had only minor abnormalities, 26 were from patients with atrial septal defect and left-to-right shunt less than 170% and 20 were from patients w...
Article
Between 1976 and 1981, 27 patients with complete transposition of the great arteries, ranging from one month to 2 1/2 years, underwent two-stage anatomic correction and 7 patients first-stage operation only. There were three early deaths after the first-stage and five after the second-stage operation and no late deaths. In seven patients the result...
Article
With a newly developed software package left ventricular orientation, shape and function were evaluated in 273 children. In normal people, the ratio muscle volume/enddiastolic ventricular volume is constant, being a good parameter to judge left ventricular function. The spatial axis (aortic valve-apex) characterizes the orientation of the left vent...
Article
On the basis of 22 life-like human casts (the method is described in the first paper of this series) the influence of (a) spatial orientation, (b) cardiac-phase and (c) biplane (BP) and single-plane (SP) methods of volume calculation on the accuracy of right ventricular (RV) angiocardiographic volume determination was quantitated. The best results...
Article
A method is described to produce life-like left and right ventricular casts of 22 human hearts and to store their surface coordinates on magnetic tape for the analysis of ventricular shape and of angiocardiographic volume determination methods. According to their shape, experienced cardiologists divided these casts into diastolic, systolic and inte...
Article
This paper describes a hardware-software system for handling the two main groups of cardiological data: a) physiological variables such as voltages, pressures, etc., and b) morphological data, derived from x-ray images or angiocardiograms, such as dimensions, areas, or volumes. We will concentrate in particular on some aspects of automated image pr...
Article
For routine application of videometry to angiocardiograms, an easy to use program, COMED (Contours Manipulation and Editing), was developed for processing and documenting data blocks stored on magnetic tape. The interactive FORTRAN program has the following features: It compiles a comprehensive listing of all relevant data pertaining to the contour...
Article
Afin de déterminer les facteurs influencant l'exactitude des paramètres du volume du ventricule droit, obtenus par l'échocardiographie et pour améliorer les relevés donnes en appliquant des méthodes de rehaussement d'image, on a effectué une échocardiographie quantitative de contraste et une angiocardiographie biplane pendant l'examinât ion de rout...
Article
Full-text available
L'angiocardiographie est du valeur considérable pour analyser la dimension de la cavite du ventricule droit et gauche,mais les méthodes conventionelles nécessitent une quantité élevée du produit de contraste. Dans cet étude nous avons applique la soustraction numérique au projection biplane du ventricule droit et gauche, apres l'injection ventricul...

Citations

... In these two-dimensional images there does not exist a oneto-one relation between a selected myocardial region of interest (ROI) and one particular coronary segment perfusing that area due to overprojection of myocardial regions in front of and behind the selected region of interest perfused by other arterial segments. For some time, our group as well as Onnasch et al. have been studying the possibilities of three-dimensional reconstruction of the myocardial perfusion from two orthogonal projections to overcome these problems of superimposition [8,9]. Our approaches to this complex problem will be discussed in this paper. ...
... Angiographic volumes were calculated using cardiac phase and projection specific correction factors obtained from cast studies of subpulmonary right ventricles [27]. Whether these correction factors are appropriate for the variably abnormally shaped ventricles of operated HLHS patients in this study is questionable. ...
... [29]. Other investigators also showed that LVG overestimated the volume of a human heart cast [30] . This evidence suggests that underestimated LV volumes that have been ascribed to QGS may, in fact, be largely due to overestimation of true ventricular volumes by LVG. ...
... complication. 1, 2 PA stenosis might impact right ventricular (RV) hemodynamics, as well as RV geometry and function. 3,4 However, even in the absence of a significant PA stenosis, RV hypertrophy and RV relaxation abnormalities have been observed and were related to increased peak flow in the pulmonary trunk after the Lecompte maneuver. 5 Other studies have shown that left ventricular (LV) functional changes are also present in TGA patients after ASO. ...
... Lange et al. (26) reported the incidence of arrhythmias in 17 patients after anatomic correction of transposition of the great arteries; they found no arrhythmias attributable to anatomic correction. The low incidence of important arrhythmias and the absence of late arrhythmia-related death in our series so far are important facts that will need to be considered in the management of patients with transposition of the great arteries. ...
... So that, although the slope of the end-diastolic pressurevolume relation increased significantly, there was probably no change in the position of the true non-linear/exponential fit of the end-diastolic pressure -volume relation. Lange et al. too reported no significant increase in end-diastolic volume and pressure in the right ventricle immediately after acute pulmonary artery banding in pigs, indicating that there was probably no alteration to the passive diastolic compliance of the right ventricle after acute moderate pressure loading [38]. The mechanisms that cause abnormalities in diastolic function can be divided into factors intrinsic to the myocardium itself and factors that are extrinsic to the myocardium [39]. ...
... Dilatation of the pulmonary root in the aortic position and development of neoaortic regurgitation (AR) are well-known in the long-term follow-up after AsO. Occurrence of AR was observed early in the AsO experience and reported in 30% to 55% of the patients with a two-stage intervention in whom AsO was preceded by PA banding 41,42 . Later, when primary repair or rapid two-stage operation was the rule, AR prevalence decreased and ranged between 5% and 22% [43][44][45] . ...
... Contrast opacification is indicated in the 10-15% of cases with inadequate definition of RV endocardial borders or in cases where the RV is significantly dilated [33]. The use of intravenous echocardiographic contrast may indirectly improve the visualization of the RV and the alignment of the imaging by preventing off axis scanning, hence bolstering the accuracy of certain measures of the RV such as wall thickness and volumes [34,35]. Additionally, the use of intravenous echocardiographic contrast can improve visualization of defects such as degree of dysplasia, intracavitary thrombus and masses, or small apical aneurysms, which may be difficult to visualize on standard 2D imaging (see Fig. 3) [36]. ...
... Yacoub et al. [114] devised a two-stage approach for an ASO in older patients with TGA IVS that included a preparatory pulmonary artery banding together with a systemic-to-pulmonary shunt for left ventricular training, followed by an ASO several months later. However, this policy did not become widely adopted for frequent, intractable, postoperative, left ventricular dysfunction, probably because of the advanced age at pulmonary banding [115,116]. In 1989, Jonas et al. [117] introduced the so-called rapid two-stage ASO, showing that left ventricular hypertrophy is elicited as early as 1-2 weeks after the imposition of a pressure load in younger patients beyond neonatal age. ...
... The ameroid ring constrictor (ARC) is a device that has historically been used in research to create in vivo models of gradual arterial/venous occlusion, in order to replicate chronic ischaemic disease. [1][2][3] In Veterinary medicine, it is almost exclusively known to be used clinically to obtain gradual occlusion of single congenital portosystemic shunts in small animals. [4][5][6] An ARC's manufacturing process involves combining rennet casein, a by-product of cheese manufacture, with water. ...