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Papers by Michael Vogel

Research paper thumbnail of Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement

Heart, 2000

Objective-To define the morphological criteria of perforated atrial septal aneurysms suitable for... more Objective-To define the morphological criteria of perforated atrial septal aneurysms suitable for closure by a transcatheter device. Methods-A retrospective analysis of all consecutive patients with atrial septal aneurysm and one or more perforations presenting between May 1997 and June 1999. The aneurysms were classified as: aneurysm with persistent foramen ovale (type A); aneurysm with single atrial septal defect (type B); aneurysm with two perforations requiring more than one device for closure (type C); and aneurysm with multiple perforations (type D). Patients-Data from 50 patients aged 5-78 years (mean 43 years) were analysed; 32 had systemic thromboembolism or transient ischaemic attacks, eight presented with dyspnoea on exercise, and 10 were discovered incidentally but had significant left to right shunt and right ventricular volume overload. Results-In all 18 patients with aneurysm and persistent foramen ovale (type A), transcatheter closure was possible. In nine with aneurysm and atrial septal defect (type B), five defects were closed and four required surgery. Device closure was achieved in all 10 patients with aneurysms and two perforations (type C), but four had a residual shunt. Thirteen patients with multiple perforated aneurysms (type D) underwent surgery. Conclusions-This classification of morphology of perforations of aneurysm is clinically useful for selecting patients for treatment by transcatheter devices.

Research paper thumbnail of Comparison of sodium nitroprusside versus esmolol for the treatment of hypertension following repair of coarctation of the aorta

Interactive cardiovascular and thoracic surgery, 2003

Postoperative arterial hypertension was treated with nitroprusside or esmolol in a prospective ra... more Postoperative arterial hypertension was treated with nitroprusside or esmolol in a prospective randomized study. If treatment failed, patients were first switched over to the other study drug, and then to a combination of both. Renin, angiotensin II, epinephrine, and norepinephrine were measured before, 1, and 17 h after operation. esmolol was effective in all cases of treatment (n=6) whereas nitroprusside was ineffective in two out of seven patients (not significant), who were finally treated effectively with the combination of the study drugs. Whenever monotherapy failed, both drugs together were effective in reducing the postoperative activation of the sympathetic and renin-angiotensin systems.

Research paper thumbnail of Glucose-insulin infusion improves cardiac function during fetal tachycardia

Journal of the American College of Cardiology, 2004

The aim of this work was to study the effects of substrate deficiency and supplementation on card... more The aim of this work was to study the effects of substrate deficiency and supplementation on cardiac function during fetal tachycardia. BACKGROUND Although sustained fetal tachycardia may lead to cardiac failure and intrauterine death, neonatal tachycardia is generally better tolerated. Fetal myocardial energy production relies almost solely on glucose as substrate. We hypothesized that increased substrate availability by glucose-insulin (GI) infusion would improve fetal myocardial responses to tachycardia. METHODS We used three porcine models: 1) an isolated fetal heart model; 2) an in vivo fetal model; and 3) an in vivo closed-chest neonatal model. Each animal was randomized to control or GI treatment during tachycardia. In model 1, the controls were perfused with conventional Krebs-Henseleit solution containing a glucose concentration of 5.5 mmol/l; the GI hearts received double glucose concentration and added insulin. In models 2 and 3, the GI animals received insulin in a 20% glucose solution. All hearts were exposed to 90 min of pacing at 250 to 330 beats/min. RESULTS The isolated fetal hearts in the GI group showed no decline in dP/dt max during pacing, while the controls declined. In the in vivo fetal hearts, dP/dt max remained unchanged in the GI group and decreased significantly in the control group. Myocardial glycogen content was higher in the GI group than in controls. Functional indexes remained unchanged among both neonatal groups despite a higher glycogen content in the GI group. CONCLUSIONS Glucose-insulin infusion during fetal tachycardia has a beneficial effect on myocardial metabolism and cardiac function. These observations may have direct clinical relevance to the management of fetal arrhythmia.

Research paper thumbnail of Echocardiographic analysis of regional left ventricular wall motion in normal children and neonates

Journal of the American College of Cardiology, 1990

Research paper thumbnail of Serial analysis of regional left ventricular wall motion by two-dimensional echocardiography in patients with coronary artery enlargement after Kawasaki disease

Journal of the American College of Cardiology, 1992

Tor*nro. onrorio. Conodu Obj&ives. This study WBS designed to ~SEOES the tempwal retation between... more Tor*nro. onrorio. Conodu Obj&ives. This study WBS designed to ~SEOES the tempwal retation between early cwooary artery abnormalities and left ventricular function in Kawsaki dLwaa. *n&round. Although tate sfgntentat watt *otiw abnormalitiles may be seen in patients with Kawauki d&w who have coronary artery staoosis, the impact of early rormary artery nbmwmaJitics is uo&ar. M&d& Rwiottal letl ventricular wpll ototion was a~& by twodimuts~~lt~dkgraphy in 18 patienk with Kawasaki dii and echocsrd'ograpbtr evidelno al rorannry artery en-Inrga,,ent at 3 wpks and 3 aontbs and at eitbe~ 6 01 I2 nwnths after the onset of fever. Four patients had P prststmt kit

Research paper thumbnail of Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

Circulation, 2002

Background— We have demonstrated that myocardial acceleration during isovolumic contraction (IVA)... more Background— We have demonstrated that myocardial acceleration during isovolumic contraction (IVA) is a sensitive index of left ventricular contractile function. In this study, we assessed the utility of IVA to measure right ventricular (RV) contractile function. Methods and Results— We examined 8 pigs by using tissue Doppler imaging of the RV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (e max ), preload recruitable stroke work, and dP/dt max by conductance catheterization. Animals were paced in the right atrium at a rate of 130 beats per minute (bpm). IVA was compared with elastance during contractility modulation by esmolol and dobutamine and during preload reduction and afterload increase by transient balloon occlusion of the inferior vena cava and pulmonary artery, respectively. Data were also obtained during incremental atrial pacing from 110 to 210 bpm. Esmolol led to a decrease in IVA and dP/dt max . During dobutamine infusio...

Research paper thumbnail of Cyanotic nephropathy and use of non-ionic contrast agents during cardiac catherization in patients with cyanotic congenital heart disease

Cardiology in the Young, 2000

BackgroundChronic cyanosis with its associated rheologic changes is a known risk factor for glome... more BackgroundChronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair.MethodsWe investigated 23 cyanotic patients with an oxygen saturation of 82 (50–92)%, age 25 (5–63) years, and 13 control subjects with atrial septal defect, age 37 (20–66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluatated by selective analysis of urinary proteins and enzymes.ResultsBefore cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. ...

Research paper thumbnail of Appearance of a localized bulge in the anterior aspect of the descending aorta after balloon angioplasty of native aortic coarctation—aneurysm or reopening of the arterial duct?

Cardiology in the Young, 1993

SummaryBalloon dilation of native aortic coarctation was performed in a three-month-old boy. Angi... more SummaryBalloon dilation of native aortic coarctation was performed in a three-month-old boy. Angiography immediately after dilation revealed a localized bulge on the anterior as pect of the descending aorta interpreted initially as an aneurysm. Angiography four months later, however, failed to detect this bulge. We speculate that the early aneurysmal appearance of the anterior wall of the aorta may have been caused by factors other than a tear in the aortic adventitia.

Research paper thumbnail of Three-dimensional echocardiography can simulate intraoperative visualization of congenitally malformed hearts

The Annals of Thoracic Surgery, 1995

Background. The new technique of three-dimensional echocardiography can display the studied anato... more Background. The new technique of three-dimensional echocardiography can display the studied anatomy in any desired view plane. We sought to establish whether the reconstructions produced could provide views of the heart comparable with those obtained by the surgeon in the operating room. Methods. Ninety-four patients, aged 1 day to 19 years (mean, 4.3 years), were examined. The ultrasound probe was placed either on the chest or subcostally and acquired 80 to 100 perpendicular parallel images of the heart with electrocardiographic and respiratory gating. Any plane, in particular oblique planes, within the data set can be analyzed. Whenever possible, the arrangement as seen by the surgeon was photographed, or heart specimens with similar intracardiac lesions were cut to simulate the view of the surgeons, to validate the echocardiographic reconstructions.

Research paper thumbnail of Transthoracic three-dimensional echocardiographic reconstruction of left and right ventricles: In vitro validation and comparison with magnetic resonance imaging

American Heart Journal, 1997

Two-dimensional (2D) echocardiographic and angiographic measurements of ventricular volumes are l... more Two-dimensional (2D) echocardiographic and angiographic measurements of ventricular volumes are limited by geometric assumptions concerning cavity shape. We compared in vitro the accuracy of a three-dimensional (3D) echocardiographic system suitable for transthoracic imaging to magnetic resonance imaging (MRI) in the measurement of left and right ventricular volumes. Ventricular cast volumes from 14 excised formalin-fixed sheep hearts filled with an agarose solution were compared with data derived from 3D echocardiography and MRI. Left and right ventricular volumes from 3D echocardiographic reconstructions agreed well with actual volumes without significant underestimation or overestimation. MRI progressively underestimated left ventricular volumes as these increased and systematically underestimated right ventricu!ar volumes. Our echocardiographic system designed for 3D transthoracic imaging combines excellent measurements of left and right ventricular volumes and the computed reconstruction of tomographic slices with the full spatial resolution of the original 2D images. Thus in this in vitro model, 3D echocardiography exhibited greater accuracy than MRI. (Am Heart J 1997; 133:221-9.) Accurate determination of left and right ventricular volumes provides important pathophysiologic and prognostic information in patients with a variety of cardiac disorders. For many years, angiography has been the clinical standard for determining left ventricular volume. Recently, magnetic resonance im

Research paper thumbnail of Isovolumic Acceleration at Rest and During Exercise in Children

Journal of the American College of Cardiology, 2011

This study aimed to determine the normal variation of left ventricular (LV) isovolumic accelerati... more This study aimed to determine the normal variation of left ventricular (LV) isovolumic acceleration (IVA) in healthy children and to assess the feasibility of an entirely noninvasive method for demonstration of the LV force-frequency relationship (FFR).

Research paper thumbnail of Systemic ventricular function in patients with congenital heart disease repaired during infancy

The American Journal of Cardiology, 1980

Twenty pediatric patients who have undergone valve replacement (VR) were studied by bicycle exerc... more Twenty pediatric patients who have undergone valve replacement (VR) were studied by bicycle exercise testing. The patients underwent VR from 8 to 17 yr. of age (mean. 13 yr). Ten had mechanical VR and 10 have undergone

Research paper thumbnail of Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler-Derived Isovolumic Acceleration: Validation In An Animal Model

Circulation, 2003

Methods and Results— In study 1, we examined 6 pigs by use of tissue Doppler imaging of LV free w... more Methods and Results— In study 1, we examined 6 pigs by use of tissue Doppler imaging of LV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (E max ), and dP/dt max by conductance catheterization. Animals were paced via the right ...

Research paper thumbnail of Comparison of Results and Complications of Surgical and Amplatzer Device Closure of Atrial Septal Defects

The Journal of Thoracic …, 1999

Methods Patient selection. This study comprised all consecutive patients referred to our hospital... more Methods Patient selection. This study comprised all consecutive patients referred to our hospital during the 1-year period start-ing on May 7, 1997 (the day of the first implantation of an Amplatzer septal occluder device [AGA Medical Corporation, Golden Valley, Minn] in our institution), ...

Research paper thumbnail of Morphology of perforated atrial septal aneurysm suitable for closure by transcatheter device placement

Heart, 2000

Objective-To define the morphological criteria of perforated atrial septal aneurysms suitable for... more Objective-To define the morphological criteria of perforated atrial septal aneurysms suitable for closure by a transcatheter device. Methods-A retrospective analysis of all consecutive patients with atrial septal aneurysm and one or more perforations presenting between May 1997 and June 1999. The aneurysms were classified as: aneurysm with persistent foramen ovale (type A); aneurysm with single atrial septal defect (type B); aneurysm with two perforations requiring more than one device for closure (type C); and aneurysm with multiple perforations (type D). Patients-Data from 50 patients aged 5-78 years (mean 43 years) were analysed; 32 had systemic thromboembolism or transient ischaemic attacks, eight presented with dyspnoea on exercise, and 10 were discovered incidentally but had significant left to right shunt and right ventricular volume overload. Results-In all 18 patients with aneurysm and persistent foramen ovale (type A), transcatheter closure was possible. In nine with aneurysm and atrial septal defect (type B), five defects were closed and four required surgery. Device closure was achieved in all 10 patients with aneurysms and two perforations (type C), but four had a residual shunt. Thirteen patients with multiple perforated aneurysms (type D) underwent surgery. Conclusions-This classification of morphology of perforations of aneurysm is clinically useful for selecting patients for treatment by transcatheter devices.

Research paper thumbnail of Comparison of sodium nitroprusside versus esmolol for the treatment of hypertension following repair of coarctation of the aorta

Interactive cardiovascular and thoracic surgery, 2003

Postoperative arterial hypertension was treated with nitroprusside or esmolol in a prospective ra... more Postoperative arterial hypertension was treated with nitroprusside or esmolol in a prospective randomized study. If treatment failed, patients were first switched over to the other study drug, and then to a combination of both. Renin, angiotensin II, epinephrine, and norepinephrine were measured before, 1, and 17 h after operation. esmolol was effective in all cases of treatment (n=6) whereas nitroprusside was ineffective in two out of seven patients (not significant), who were finally treated effectively with the combination of the study drugs. Whenever monotherapy failed, both drugs together were effective in reducing the postoperative activation of the sympathetic and renin-angiotensin systems.

Research paper thumbnail of Glucose-insulin infusion improves cardiac function during fetal tachycardia

Journal of the American College of Cardiology, 2004

The aim of this work was to study the effects of substrate deficiency and supplementation on card... more The aim of this work was to study the effects of substrate deficiency and supplementation on cardiac function during fetal tachycardia. BACKGROUND Although sustained fetal tachycardia may lead to cardiac failure and intrauterine death, neonatal tachycardia is generally better tolerated. Fetal myocardial energy production relies almost solely on glucose as substrate. We hypothesized that increased substrate availability by glucose-insulin (GI) infusion would improve fetal myocardial responses to tachycardia. METHODS We used three porcine models: 1) an isolated fetal heart model; 2) an in vivo fetal model; and 3) an in vivo closed-chest neonatal model. Each animal was randomized to control or GI treatment during tachycardia. In model 1, the controls were perfused with conventional Krebs-Henseleit solution containing a glucose concentration of 5.5 mmol/l; the GI hearts received double glucose concentration and added insulin. In models 2 and 3, the GI animals received insulin in a 20% glucose solution. All hearts were exposed to 90 min of pacing at 250 to 330 beats/min. RESULTS The isolated fetal hearts in the GI group showed no decline in dP/dt max during pacing, while the controls declined. In the in vivo fetal hearts, dP/dt max remained unchanged in the GI group and decreased significantly in the control group. Myocardial glycogen content was higher in the GI group than in controls. Functional indexes remained unchanged among both neonatal groups despite a higher glycogen content in the GI group. CONCLUSIONS Glucose-insulin infusion during fetal tachycardia has a beneficial effect on myocardial metabolism and cardiac function. These observations may have direct clinical relevance to the management of fetal arrhythmia.

Research paper thumbnail of Echocardiographic analysis of regional left ventricular wall motion in normal children and neonates

Journal of the American College of Cardiology, 1990

Research paper thumbnail of Serial analysis of regional left ventricular wall motion by two-dimensional echocardiography in patients with coronary artery enlargement after Kawasaki disease

Journal of the American College of Cardiology, 1992

Tor*nro. onrorio. Conodu Obj&ives. This study WBS designed to ~SEOES the tempwal retation between... more Tor*nro. onrorio. Conodu Obj&ives. This study WBS designed to ~SEOES the tempwal retation between early cwooary artery abnormalities and left ventricular function in Kawsaki dLwaa. *n&round. Although tate sfgntentat watt *otiw abnormalitiles may be seen in patients with Kawauki d&w who have coronary artery staoosis, the impact of early rormary artery nbmwmaJitics is uo&ar. M&d& Rwiottal letl ventricular wpll ototion was a~& by twodimuts~~lt~dkgraphy in 18 patienk with Kawasaki dii and echocsrd'ograpbtr evidelno al rorannry artery en-Inrga,,ent at 3 wpks and 3 aontbs and at eitbe~ 6 01 I2 nwnths after the onset of fever. Four patients had P prststmt kit

Research paper thumbnail of Validation of Myocardial Acceleration During Isovolumic Contraction as a Novel Noninvasive Index of Right Ventricular Contractility

Circulation, 2002

Background— We have demonstrated that myocardial acceleration during isovolumic contraction (IVA)... more Background— We have demonstrated that myocardial acceleration during isovolumic contraction (IVA) is a sensitive index of left ventricular contractile function. In this study, we assessed the utility of IVA to measure right ventricular (RV) contractile function. Methods and Results— We examined 8 pigs by using tissue Doppler imaging of the RV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (e max ), preload recruitable stroke work, and dP/dt max by conductance catheterization. Animals were paced in the right atrium at a rate of 130 beats per minute (bpm). IVA was compared with elastance during contractility modulation by esmolol and dobutamine and during preload reduction and afterload increase by transient balloon occlusion of the inferior vena cava and pulmonary artery, respectively. Data were also obtained during incremental atrial pacing from 110 to 210 bpm. Esmolol led to a decrease in IVA and dP/dt max . During dobutamine infusio...

Research paper thumbnail of Cyanotic nephropathy and use of non-ionic contrast agents during cardiac catherization in patients with cyanotic congenital heart disease

Cardiology in the Young, 2000

BackgroundChronic cyanosis with its associated rheologic changes is a known risk factor for glome... more BackgroundChronic cyanosis with its associated rheologic changes is a known risk factor for glomerular nephropathy. Therefore, contrast-induced nephrotoxicity should be an important consideration for angiographers comparable to diabetics. On the other hand, progressions in diagnostic and interventional techniques have led to expanded indications and a more widespread use of x-ray contrast agents. The aim of this study was to investigate the risk of contrast-induced nephropathy in the small group of patients with cyanotic heart disease prior to surgical repair.MethodsWe investigated 23 cyanotic patients with an oxygen saturation of 82 (50–92)%, age 25 (5–63) years, and 13 control subjects with atrial septal defect, age 37 (20–66) years. Blood viscosity was measured before and after cardiac catherization. Renal damage was evaluatated by selective analysis of urinary proteins and enzymes.ResultsBefore cardiac catheterization, 48% of the cyanotic patients had a moderate glomerulopathy. ...

Research paper thumbnail of Appearance of a localized bulge in the anterior aspect of the descending aorta after balloon angioplasty of native aortic coarctation—aneurysm or reopening of the arterial duct?

Cardiology in the Young, 1993

SummaryBalloon dilation of native aortic coarctation was performed in a three-month-old boy. Angi... more SummaryBalloon dilation of native aortic coarctation was performed in a three-month-old boy. Angiography immediately after dilation revealed a localized bulge on the anterior as pect of the descending aorta interpreted initially as an aneurysm. Angiography four months later, however, failed to detect this bulge. We speculate that the early aneurysmal appearance of the anterior wall of the aorta may have been caused by factors other than a tear in the aortic adventitia.

Research paper thumbnail of Three-dimensional echocardiography can simulate intraoperative visualization of congenitally malformed hearts

The Annals of Thoracic Surgery, 1995

Background. The new technique of three-dimensional echocardiography can display the studied anato... more Background. The new technique of three-dimensional echocardiography can display the studied anatomy in any desired view plane. We sought to establish whether the reconstructions produced could provide views of the heart comparable with those obtained by the surgeon in the operating room. Methods. Ninety-four patients, aged 1 day to 19 years (mean, 4.3 years), were examined. The ultrasound probe was placed either on the chest or subcostally and acquired 80 to 100 perpendicular parallel images of the heart with electrocardiographic and respiratory gating. Any plane, in particular oblique planes, within the data set can be analyzed. Whenever possible, the arrangement as seen by the surgeon was photographed, or heart specimens with similar intracardiac lesions were cut to simulate the view of the surgeons, to validate the echocardiographic reconstructions.

Research paper thumbnail of Transthoracic three-dimensional echocardiographic reconstruction of left and right ventricles: In vitro validation and comparison with magnetic resonance imaging

American Heart Journal, 1997

Two-dimensional (2D) echocardiographic and angiographic measurements of ventricular volumes are l... more Two-dimensional (2D) echocardiographic and angiographic measurements of ventricular volumes are limited by geometric assumptions concerning cavity shape. We compared in vitro the accuracy of a three-dimensional (3D) echocardiographic system suitable for transthoracic imaging to magnetic resonance imaging (MRI) in the measurement of left and right ventricular volumes. Ventricular cast volumes from 14 excised formalin-fixed sheep hearts filled with an agarose solution were compared with data derived from 3D echocardiography and MRI. Left and right ventricular volumes from 3D echocardiographic reconstructions agreed well with actual volumes without significant underestimation or overestimation. MRI progressively underestimated left ventricular volumes as these increased and systematically underestimated right ventricu!ar volumes. Our echocardiographic system designed for 3D transthoracic imaging combines excellent measurements of left and right ventricular volumes and the computed reconstruction of tomographic slices with the full spatial resolution of the original 2D images. Thus in this in vitro model, 3D echocardiography exhibited greater accuracy than MRI. (Am Heart J 1997; 133:221-9.) Accurate determination of left and right ventricular volumes provides important pathophysiologic and prognostic information in patients with a variety of cardiac disorders. For many years, angiography has been the clinical standard for determining left ventricular volume. Recently, magnetic resonance im

Research paper thumbnail of Isovolumic Acceleration at Rest and During Exercise in Children

Journal of the American College of Cardiology, 2011

This study aimed to determine the normal variation of left ventricular (LV) isovolumic accelerati... more This study aimed to determine the normal variation of left ventricular (LV) isovolumic acceleration (IVA) in healthy children and to assess the feasibility of an entirely noninvasive method for demonstration of the LV force-frequency relationship (FFR).

Research paper thumbnail of Systemic ventricular function in patients with congenital heart disease repaired during infancy

The American Journal of Cardiology, 1980

Twenty pediatric patients who have undergone valve replacement (VR) were studied by bicycle exerc... more Twenty pediatric patients who have undergone valve replacement (VR) were studied by bicycle exercise testing. The patients underwent VR from 8 to 17 yr. of age (mean. 13 yr). Ten had mechanical VR and 10 have undergone

Research paper thumbnail of Noninvasive Assessment of Left Ventricular Force-Frequency Relationships Using Tissue Doppler-Derived Isovolumic Acceleration: Validation In An Animal Model

Circulation, 2003

Methods and Results— In study 1, we examined 6 pigs by use of tissue Doppler imaging of LV free w... more Methods and Results— In study 1, we examined 6 pigs by use of tissue Doppler imaging of LV free wall and simultaneous measurements of intraventricular pressure, volume, maximal elastance (E max ), and dP/dt max by conductance catheterization. Animals were paced via the right ...

Research paper thumbnail of Comparison of Results and Complications of Surgical and Amplatzer Device Closure of Atrial Septal Defects

The Journal of Thoracic …, 1999

Methods Patient selection. This study comprised all consecutive patients referred to our hospital... more Methods Patient selection. This study comprised all consecutive patients referred to our hospital during the 1-year period start-ing on May 7, 1997 (the day of the first implantation of an Amplatzer septal occluder device [AGA Medical Corporation, Golden Valley, Minn] in our institution), ...