[The Herz Handy--a new telemedical service concept for heart patients]. / Das Herz Handy--in neues telemedizinisches Servicekonzept für Herzpatienten.

Telemedicine is a new milestone for the health care system in the care of patients with heart disease. New technologies and the possibilities of fast data transmission have enabled this step forward. The Cardiophone offers a new telemonitoring Service Concept, which is available 24 hours a day. The patient is by the aid of the Cardiophone connected with the Medical Service Center at just the press of a button, can record and transmit an ECG and can be localized by the incorporated GPS. We report about our experiences with 363 patients over 3 years. Out of 5064 patient contacts associated with 7561 calls, 559 emergency contacts occurred. From the initial main complaints, working diagnoses were established. The final confirmed diagnoses were arrhythmias (27.8%), coronary heart disease (25.9%), psychovegetative syndrome (12.7%), backbone pain (6.2%), gastrointestinal syndrome (3.6%), others (1.8%), and exclusion diagnosis (19.9%). Ten myocardial infarctions were diagnosed, of whom 3 were confirmed; the other 7 were treated as stabile angina pectoris. Overall 823 ECG were transmitted, in average 1.6 ECGs per emergency contact. In 131 ECGs changes of the ST-segment or T-wave could be documented; 26 patients showed a pacemaker ECG. Atrial and ventricular arrhythmias as well as conduction disturbances were seen. The majority of emergency contacts (n=477, 85.3%) were successfully managed by the Service Center. In 38 emergency contacts (6.8%) admission to hospital was recommended; in 4 cases (0.7%) an ambulance was activated via the local dispatcher by the Service Center and in 29 cases (5.2%) the emergency ambulance.

The biocompound method in coronary artery bypass operations: surgical technique and 3-year patency.

BACKGROUND: Complete arterial revascularization may be unsafe in patients with a high operative risk. In patients with varicose ectatic veins, the biocompound technique, which uses unsuitable autologous veins, enables the surgeon to influence the bypass graft wall stress levels and diameter. This report summarizes the 3-year patency of 53 patients, the survival rate of 200 patients, and operative technical considerations. METHODS: Biocompound grafts were used for aortocoronary bypass in 200 patients who were considered inappropriate subjects for complete arterial revascularization and who had unsuitable saphenous veins. RESULTS: The mortality rate (30 days) of 200 patients was 3.5%. The 3-year survival rate was 88.5%. The patency rate of the left internal thoracic artery (LITA) after 3 years was 97.3%, of the native vein was 68.7%, and of the biocompound graft was 68.3%. The LITA showed a superior patency rate (p = < 0.05). CONCLUSIONS: The LITA is the first choice in coronary bypass operation. The biocompound technique is a reliable method to achieve complete revascularization in patients with a lack of suitable saphenous veins.

Measuring left ventricular function after heart transplantation via digitization of M-mode echocardiograms.

The aim of the study was to assess the usefulness of M-mode echocardiography for noninvasive diagnosis of cardiac rejection. For this purpose, 292 M-mode images of 26 heart transplant recipients were analyzed. The echocardiographic images were digitized into an image analysis system. The curves of left ventricular diameter changes were obtained and its first differential calculated. A total of 23 parameters were measured. The most important parameters were: peak velocity of systolic diameter change, peak velocity of diastolic diameter change, time to peak velocity of systolic diameter change, time to peak velocity of diastolic diameter change (TPEAK-D), isovolumetric relaxation time (IVRT), rapid filling time (RFT), shortening fraction (SF), and mean velocity of circumferential fiber shortening (MVCF). The echocardiographic parameters were compared to biopsy results. In 18 patients, 23 biopsy-proven moderate rejections occurred. When rejection occurred, IVRT decreased 23% +/- 6% (P < 0.05), SF decreased 13% +/- 14% (P<0.05), MVCF decreased 18% +/- 18% (P<0.05), and TPEAK-D increased 27% +/- 27% (P<0.05). We concluded that the analysis of digitized M-mode images can identify heart transplant rejection.