Peter Zartner | Friedrich-Alexander-Universität Erlangen-Nürnberg (original) (raw)
Papers by Peter Zartner
Mikrofiche-Ausg.: 2 Mikrofiches : 24x. Berlin, Freie Univ., Diss., 1995.
The Thoracic and Cardiovascular Surgeon, 2015
P . b . b . 0 2 Z 0 3 1 1 0 5 M , V e r l a g s p o s t a m t : 3 0 0 2 P u r k e r s d o r f , E... more P . b . b . 0 2 Z 0 3 1 1 0 5 M , V e r l a g s p o s t a m t : 3 0 0 2 P u r k e r s d o r f , E r s c h e i n u n g s o r t : 3 0 0 3 G a b l i t z Indexed in EMBASE/Excerpta Medica/Scopus www.kup.at/kardiologie Member of the ESC-Editors' Club Member of the Offizielles Organ des Österreichischen Herzfonds
Zeitschrift für Kardiologie, 2003
Two patients, both 16 years old, presented because of chest pain after extended sports activity. ... more Two patients, both 16 years old, presented because of chest pain after extended sports activity. The thoracal X-ray showed trapped air in the mediastinum especially around the cervical vessels in one patient. In the thoracal X-ray of the other patient a vertical lucent streak along the left side of the heart, showing the pleura as a fine opaque line, was found. Both developed subcutaneous emphysema after a few hours, which led to the diagnosis spontaneous pneumomediastinum. The chest pain resolved under analgetic medication, and after resorption of the subcutaneous emphysema both patients recovered completely. The main differential diagnosis of the spontaneous pneumomediastinum is besides pericarditis and myocarditis, the spontaneous esophageal perforation (also called Boerhaave syndrome), with the high morbidity, it has to be ruled out consequently.
Zeitschrift für Kardiologie, 2002
Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 ... more Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 years, underwent catheter closure between 6/1995 and 6/2001. One hundred and forty-one had an ischemic stroke, 99 a transient ischemic attack (TIA) or prolonged reversible ischemic neurologic deficit, 5 peripheral arterial embolism, 4 suffered from decompression sickness after diving and 2 had transient global amnesia. Fifty-nine of them had multiple events in spite of antiplatelet or anticoagulant therapy. The patients received five different devices: 13 Rashkind Occluders, 20 Amplatzer septal Occluders, 109 Amplatzer PFO-Occluders, 73 CardioSEAL and 36 STAR-Flex devices. Time of fluoroscopy was 8.3 +/- 4.5 min. In three patients a device embolized and had to be removed from the groin vessels. We saw five inguinal or retroperitoneal venous hematomas with the need for operation in one patient. One early and one late perforation of the left atrium caused by a guide wire and a left-atrial ...
Heart (British Cardiac Society), 2002
To evaluate the reasons for repeat intervention in patients treated with balloon expandable stent... more To evaluate the reasons for repeat intervention in patients treated with balloon expandable stents for pulmonary artery stenoses, with particular analysis of the time intervals between interventions. A retrospective observational study. A single paediatric cardiology centre. 38 patients, mean age 6.9 years, range 6 days to 34 years (one adult patient); mean weight 19.7 kg, range 2.5-75 kg. Implantation of balloon expandable stents in 46 cases of main pulmonary artery stenosis, right pulmonary artery stenosis, left pulmonary artery stenosis, or right ventricle to pulmonary artery conduits. Adaptation of stent diameter to patient growth; development of pulmonary arteries; pressure gradient in the right ventricle. 56 stents were implanted in 46 lesions. During a mean follow up time of 2.2 years, 40 repeat dilatations were performed on 28 of 42 reinvestigated stents. A second repeat dilatation was performed on eight stents, and a third on four stents. The mean time period between implan...
Heart (British Cardiac Society), 2000
Objective-To determine the reasons for delay in calling for help during acute myocardial infarcti... more Objective-To determine the reasons for delay in calling for help during acute myocardial infarction and the reasons for choice of first medical contact. Design-Review of routine medical records and one to one semi-structured interviews. Setting-Community survey in city of Glasgow, north of the river Clyde. Patients-228 men and 85 women aged between 25 and 65 years, respectively, who survived acute myocardial infarction between October 1994 and December 1996. Results-Only 25% of the subjects made a call for help within one hour of the onset of coronary symptoms; in 40% the delay was greater than four hours. Symptoms were not recognised as coronary in origin in the majority of cases. In all cases where delay was more than one hour the main reasons for the delay were thinking that symptoms would go away or that they were not serious. Requesting the attendance of a general practitioner was the first course of action in the majority of cases (55%); the main reason given was that the patient believed this should always be the first course of action. Reluctance to call the emergency services reflected the belief that the symptoms were not serious enough to warrant an ambulance. Conclusions-Strategies to reduce patient delay times in this deprived urban population must focus on educating the public on the recognition and diversity of coronary symptoms and the benefits of presenting promptly to hospital by way of the emergency ambulance service. (Heart 2000;84:137-141)
Heart (British Cardiac Society), 1999
Three patients with Emery Dreifuss muscular dystrophy are reported. Emery Dreifuss muscular dystr... more Three patients with Emery Dreifuss muscular dystrophy are reported. Emery Dreifuss muscular dystrophy is an X linked muscular dystrophy, in which locomotor involvement is characteristically mild and slowly progressive. The eVect on the heart becomes apparent in the teenage years and is characterised by cardiac conduction defects and infiltration of the myocardium by fibrous and adipose tissue. It first aVects the atria, which results in atrial paralysis; treatment with ventricular pacing is usually needed. Female carriers can develop heart problems and are at risk of sudden death. Relatives of aVected patients should be oVered screening with electrocardiography and echocardiography. (Heart 1999;82:105-108)
Zeitschrift für Kardiologie
After modified Fontan operations various communications between the systemic and pulmonary venous... more After modified Fontan operations various communications between the systemic and pulmonary venous returns may cause persistent or increasing postoperative cyanosis. Interventional closure of these right-to-left shunts may be necessary to eliminate hypoxemia and to reduce the risk of paradoxical embolic complications. Eighteen patients with a mean age of 5.6 +/- 4.1 (2.5-17.5) years underwent interventional closure of a right-to-left shunt 17.4 +/- 15.8 (3-60) months after a modified Fontan operation. After test balloon occlusion fenestrations were closed in 13 patients using an Amplatzer Septal occluder (n = 7), a Rashkind PDA occluder (n = 3), a CardioSeal umbrella (n = 1) and detachable coils (n = 2). Residual leaks at the suture lines between the interatrial patch and the right atrial wall were closed using detachable coils and a Rashkind PDA occluder in 2 and 1 patients, respectively. In 3 patients intracardiac venous collateral channels were closed by means of detachable coils....
The Thoracic and Cardiovascular Surgeon, 2014
Background Restrictive atrial septal defect (ASD) is described as risk factor for Norwood procedu... more Background Restrictive atrial septal defect (ASD) is described as risk factor for Norwood procedure because of elevated pulmonary resistance. We hypothesized that it invariably could not cause pulmonary hypertension, unless it was combined with mitral valve or aortic valve atresia. We investigated how restrictive ASD influenced survival of patients with hypoplastic left heart syndrome (HLHS) who underwent Norwood operation. Patients and Methods A total of 118 HLHS patients who underwent surgery between January 2005 and December 2012 were grouped into three groups. Group 1 included 31 patients with restrictive ASD combined with mitral or aortic atresia; Group 2 composed of 12 patients with restrictive ASD and mitral and aortic stenosis; Group 3 (n = 75) had no ASD restriction. Survival was determined for each group. Multivariate analysis was conducted to test risk factors for mortality. Results Mean follow-up was 26.3 ± 24.1 months. Survival was 78.7% ± 4.2% at 30-month interval and onward after Norwood procedure for the whole cohort; it was 43.8% ± 10.0%, 91.7% ± 8.0%, and 77.3% ± 5.0% for Group 1, 2, and 3, respectively. The difference was significant between Group 1 and Group 2 and 3: p < 0.001. Survival was similar for Group 2 and Group 3: p = 0.45. Combination of restrictive ASD and mitral or aortic atresia was found to be the sole risk factor for early and late mortality (odds ratio: 3.5, 95% confidence interval: 1.8-7.1, p < 0.001). Conclusion Restrictive ASD only affects survival of HLHS patients following Norwood procedure if it is associated with mitral or aortic atresia.
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2005
Pediatric Cardiology, 2013
Improved results have evolved from the modified Norwood procedure (NP). This study compares the i... more Improved results have evolved from the modified Norwood procedure (NP). This study compares the incidence of interventions after NP with the Sano (n = 37) and modified Blalock-Taussig (BT n = 70) shunt. Incidence, location, interval of interventions, and weight were retrospectively analysed for 107 neonates undergoing NP during the period from October 2002 to December 2009. Forty-six (43.0 %) patients underwent interventions, mostly for dilatation of the aortic arch ([DAA] n = 26 [24.3 %]; Sano n = 10, BT n = 16, p = 0.6), dilatation of the shunt ([DS] n = 15 [14.0 %]; Sano n = 11, BT n = 4; p = 0.002), or closure of aortopulmonary collaterals ([APC] n = 15 [14.0 %]; Sano n = 3, BT n = 12; p = 0.08). Mean interval after NP and body weight at DAA, DS, and APC were 72.4 ± 18.9, 108.5 ± 15.8, and 110.7 ± 17.8 days and 4.5 ± 1.3, 4.9 ± 1.9, 5.3 ± 1.2 kg, respectively. The interventions were not associated with mortality but with a greater rate of complications (9 of 46 [21.4 %]) compared with the rate after diagnostic catheterization (0 of 45, p = 0.03). Complications included closure of the femoral or subclavian artery (n = 5), cerebral embolic or bleeding events (n = 4), cardiopulmonary resuscitation (n = 3), and temporary heart block (n = 2). Actuarial survival was similar from the postoperative month 8 onward at 78.6 ± 4.9 % (95 % confidence interval [CI] 67.0-86.5 %) for Sano and 78.4 ± 6.8 % (95 % CI 61.4-88.6 %) for BT (p = 0.95). Interventions after NP were common irrespective of shunt type. However, a significantly greater rate of shunt interventions was noted in the Sano group. In particular, interventions addressing the aortic arch and the shunt were related with a significant rate of complications.
Klinische Pädiatrie, 2007
A male patient with bicuspid aortic valve and mild mitral valve prolapse was seen since birth at ... more A male patient with bicuspid aortic valve and mild mitral valve prolapse was seen since birth at regular intervals. At the age of 19 years the trans-aortic gradient was 15 mm Hg with a mild aortic regurgitation and left ventricular end-diastolic diameter (LVEDD) was 38 mm. Left ventricular (LV) contractility was normal and ergometry revealed excellent exercise tolerance.
Journal of Interventional Cardiology, 2013
The small vessel size of infants and children makes interventional treatment of impaired coronary... more The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions. Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7-65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step-by-step closure of the right ventricular to the CA connections. No procedure-related deaths occurred. Congenital and post-procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long-term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail-out strategies should be planned in all coronary interventions.
Mikrofiche-Ausg.: 2 Mikrofiches : 24x. Berlin, Freie Univ., Diss., 1995.
The Thoracic and Cardiovascular Surgeon, 2015
P . b . b . 0 2 Z 0 3 1 1 0 5 M , V e r l a g s p o s t a m t : 3 0 0 2 P u r k e r s d o r f , E... more P . b . b . 0 2 Z 0 3 1 1 0 5 M , V e r l a g s p o s t a m t : 3 0 0 2 P u r k e r s d o r f , E r s c h e i n u n g s o r t : 3 0 0 3 G a b l i t z Indexed in EMBASE/Excerpta Medica/Scopus www.kup.at/kardiologie Member of the ESC-Editors' Club Member of the Offizielles Organ des Österreichischen Herzfonds
Zeitschrift für Kardiologie, 2003
Two patients, both 16 years old, presented because of chest pain after extended sports activity. ... more Two patients, both 16 years old, presented because of chest pain after extended sports activity. The thoracal X-ray showed trapped air in the mediastinum especially around the cervical vessels in one patient. In the thoracal X-ray of the other patient a vertical lucent streak along the left side of the heart, showing the pleura as a fine opaque line, was found. Both developed subcutaneous emphysema after a few hours, which led to the diagnosis spontaneous pneumomediastinum. The chest pain resolved under analgetic medication, and after resorption of the subcutaneous emphysema both patients recovered completely. The main differential diagnosis of the spontaneous pneumomediastinum is besides pericarditis and myocarditis, the spontaneous esophageal perforation (also called Boerhaave syndrome), with the high morbidity, it has to be ruled out consequently.
Zeitschrift für Kardiologie, 2002
Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 ... more Two hundred and fifty-one patients with a persistent foramen ovale (PFO), mean age 43.3 +/- 12.4 years, underwent catheter closure between 6/1995 and 6/2001. One hundred and forty-one had an ischemic stroke, 99 a transient ischemic attack (TIA) or prolonged reversible ischemic neurologic deficit, 5 peripheral arterial embolism, 4 suffered from decompression sickness after diving and 2 had transient global amnesia. Fifty-nine of them had multiple events in spite of antiplatelet or anticoagulant therapy. The patients received five different devices: 13 Rashkind Occluders, 20 Amplatzer septal Occluders, 109 Amplatzer PFO-Occluders, 73 CardioSEAL and 36 STAR-Flex devices. Time of fluoroscopy was 8.3 +/- 4.5 min. In three patients a device embolized and had to be removed from the groin vessels. We saw five inguinal or retroperitoneal venous hematomas with the need for operation in one patient. One early and one late perforation of the left atrium caused by a guide wire and a left-atrial ...
Heart (British Cardiac Society), 2002
To evaluate the reasons for repeat intervention in patients treated with balloon expandable stent... more To evaluate the reasons for repeat intervention in patients treated with balloon expandable stents for pulmonary artery stenoses, with particular analysis of the time intervals between interventions. A retrospective observational study. A single paediatric cardiology centre. 38 patients, mean age 6.9 years, range 6 days to 34 years (one adult patient); mean weight 19.7 kg, range 2.5-75 kg. Implantation of balloon expandable stents in 46 cases of main pulmonary artery stenosis, right pulmonary artery stenosis, left pulmonary artery stenosis, or right ventricle to pulmonary artery conduits. Adaptation of stent diameter to patient growth; development of pulmonary arteries; pressure gradient in the right ventricle. 56 stents were implanted in 46 lesions. During a mean follow up time of 2.2 years, 40 repeat dilatations were performed on 28 of 42 reinvestigated stents. A second repeat dilatation was performed on eight stents, and a third on four stents. The mean time period between implan...
Heart (British Cardiac Society), 2000
Objective-To determine the reasons for delay in calling for help during acute myocardial infarcti... more Objective-To determine the reasons for delay in calling for help during acute myocardial infarction and the reasons for choice of first medical contact. Design-Review of routine medical records and one to one semi-structured interviews. Setting-Community survey in city of Glasgow, north of the river Clyde. Patients-228 men and 85 women aged between 25 and 65 years, respectively, who survived acute myocardial infarction between October 1994 and December 1996. Results-Only 25% of the subjects made a call for help within one hour of the onset of coronary symptoms; in 40% the delay was greater than four hours. Symptoms were not recognised as coronary in origin in the majority of cases. In all cases where delay was more than one hour the main reasons for the delay were thinking that symptoms would go away or that they were not serious. Requesting the attendance of a general practitioner was the first course of action in the majority of cases (55%); the main reason given was that the patient believed this should always be the first course of action. Reluctance to call the emergency services reflected the belief that the symptoms were not serious enough to warrant an ambulance. Conclusions-Strategies to reduce patient delay times in this deprived urban population must focus on educating the public on the recognition and diversity of coronary symptoms and the benefits of presenting promptly to hospital by way of the emergency ambulance service. (Heart 2000;84:137-141)
Heart (British Cardiac Society), 1999
Three patients with Emery Dreifuss muscular dystrophy are reported. Emery Dreifuss muscular dystr... more Three patients with Emery Dreifuss muscular dystrophy are reported. Emery Dreifuss muscular dystrophy is an X linked muscular dystrophy, in which locomotor involvement is characteristically mild and slowly progressive. The eVect on the heart becomes apparent in the teenage years and is characterised by cardiac conduction defects and infiltration of the myocardium by fibrous and adipose tissue. It first aVects the atria, which results in atrial paralysis; treatment with ventricular pacing is usually needed. Female carriers can develop heart problems and are at risk of sudden death. Relatives of aVected patients should be oVered screening with electrocardiography and echocardiography. (Heart 1999;82:105-108)
Zeitschrift für Kardiologie
After modified Fontan operations various communications between the systemic and pulmonary venous... more After modified Fontan operations various communications between the systemic and pulmonary venous returns may cause persistent or increasing postoperative cyanosis. Interventional closure of these right-to-left shunts may be necessary to eliminate hypoxemia and to reduce the risk of paradoxical embolic complications. Eighteen patients with a mean age of 5.6 +/- 4.1 (2.5-17.5) years underwent interventional closure of a right-to-left shunt 17.4 +/- 15.8 (3-60) months after a modified Fontan operation. After test balloon occlusion fenestrations were closed in 13 patients using an Amplatzer Septal occluder (n = 7), a Rashkind PDA occluder (n = 3), a CardioSeal umbrella (n = 1) and detachable coils (n = 2). Residual leaks at the suture lines between the interatrial patch and the right atrial wall were closed using detachable coils and a Rashkind PDA occluder in 2 and 1 patients, respectively. In 3 patients intracardiac venous collateral channels were closed by means of detachable coils....
The Thoracic and Cardiovascular Surgeon, 2014
Background Restrictive atrial septal defect (ASD) is described as risk factor for Norwood procedu... more Background Restrictive atrial septal defect (ASD) is described as risk factor for Norwood procedure because of elevated pulmonary resistance. We hypothesized that it invariably could not cause pulmonary hypertension, unless it was combined with mitral valve or aortic valve atresia. We investigated how restrictive ASD influenced survival of patients with hypoplastic left heart syndrome (HLHS) who underwent Norwood operation. Patients and Methods A total of 118 HLHS patients who underwent surgery between January 2005 and December 2012 were grouped into three groups. Group 1 included 31 patients with restrictive ASD combined with mitral or aortic atresia; Group 2 composed of 12 patients with restrictive ASD and mitral and aortic stenosis; Group 3 (n = 75) had no ASD restriction. Survival was determined for each group. Multivariate analysis was conducted to test risk factors for mortality. Results Mean follow-up was 26.3 ± 24.1 months. Survival was 78.7% ± 4.2% at 30-month interval and onward after Norwood procedure for the whole cohort; it was 43.8% ± 10.0%, 91.7% ± 8.0%, and 77.3% ± 5.0% for Group 1, 2, and 3, respectively. The difference was significant between Group 1 and Group 2 and 3: p < 0.001. Survival was similar for Group 2 and Group 3: p = 0.45. Combination of restrictive ASD and mitral or aortic atresia was found to be the sole risk factor for early and late mortality (odds ratio: 3.5, 95% confidence interval: 1.8-7.1, p < 0.001). Conclusion Restrictive ASD only affects survival of HLHS patients following Norwood procedure if it is associated with mitral or aortic atresia.
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2013
The Thoracic and Cardiovascular Surgeon, 2005
Pediatric Cardiology, 2013
Improved results have evolved from the modified Norwood procedure (NP). This study compares the i... more Improved results have evolved from the modified Norwood procedure (NP). This study compares the incidence of interventions after NP with the Sano (n = 37) and modified Blalock-Taussig (BT n = 70) shunt. Incidence, location, interval of interventions, and weight were retrospectively analysed for 107 neonates undergoing NP during the period from October 2002 to December 2009. Forty-six (43.0 %) patients underwent interventions, mostly for dilatation of the aortic arch ([DAA] n = 26 [24.3 %]; Sano n = 10, BT n = 16, p = 0.6), dilatation of the shunt ([DS] n = 15 [14.0 %]; Sano n = 11, BT n = 4; p = 0.002), or closure of aortopulmonary collaterals ([APC] n = 15 [14.0 %]; Sano n = 3, BT n = 12; p = 0.08). Mean interval after NP and body weight at DAA, DS, and APC were 72.4 ± 18.9, 108.5 ± 15.8, and 110.7 ± 17.8 days and 4.5 ± 1.3, 4.9 ± 1.9, 5.3 ± 1.2 kg, respectively. The interventions were not associated with mortality but with a greater rate of complications (9 of 46 [21.4 %]) compared with the rate after diagnostic catheterization (0 of 45, p = 0.03). Complications included closure of the femoral or subclavian artery (n = 5), cerebral embolic or bleeding events (n = 4), cardiopulmonary resuscitation (n = 3), and temporary heart block (n = 2). Actuarial survival was similar from the postoperative month 8 onward at 78.6 ± 4.9 % (95 % confidence interval [CI] 67.0-86.5 %) for Sano and 78.4 ± 6.8 % (95 % CI 61.4-88.6 %) for BT (p = 0.95). Interventions after NP were common irrespective of shunt type. However, a significantly greater rate of shunt interventions was noted in the Sano group. In particular, interventions addressing the aortic arch and the shunt were related with a significant rate of complications.
Klinische Pädiatrie, 2007
A male patient with bicuspid aortic valve and mild mitral valve prolapse was seen since birth at ... more A male patient with bicuspid aortic valve and mild mitral valve prolapse was seen since birth at regular intervals. At the age of 19 years the trans-aortic gradient was 15 mm Hg with a mild aortic regurgitation and left ventricular end-diastolic diameter (LVEDD) was 38 mm. Left ventricular (LV) contractility was normal and ergometry revealed excellent exercise tolerance.
Journal of Interventional Cardiology, 2013
The small vessel size of infants and children makes interventional treatment of impaired coronary... more The small vessel size of infants and children makes interventional treatment of impaired coronary perfusion, such as stenoses, complete occlusions, and fistulae, demanding. Materials and techniques appropriate for this young age group have to demonstrate their ability to effectively treat these lesions. Between 2004 and 2011, 14 patients with an age of 9 days to 25 years (median 4.6 years) and a bodyweight of 1.7-65 kg (median 14 kg) underwent coronary intervention. In 3 cases, emergency revascularization of the left coronary artery (CA) was performed successfully, followed by stent implantation in 1 patient. Embolization of coronary arterial fistulae with coils and vascular plugs was effective in 10 patients. An antegrade, retrograde or combined approach to achieve the most distal device placement preserved all side branches. One infant with pulmonary atresia and an intact ventricular septum was prepared for biventricular repair by step-by-step closure of the right ventricular to the CA connections. No procedure-related deaths occurred. Congenital and post-procedural coronary obstructive lesions can be considered for effective treatment with balloon dilation at any age as a salvage procedure. In coronaries impaired by external compression, stent implantation can restore perfusion, but long-term results are missing. Interventional closure of coronary fistulae has shown improvement of coronary arterial perfusion. The latter techniques can be used to close right ventricular to CA connections in patients with pulmonary atresia to prepare for biventricular repair, but bail-out strategies should be planned in all coronary interventions.