WO1999021475A1 - Vorrichtung zur feststellung eines perikardergusses - Google Patents
Vorrichtung zur feststellung eines perikardergusses Download PDFInfo
- Publication number
- WO1999021475A1 WO1999021475A1 PCT/EP1998/006483 EP9806483W WO9921475A1 WO 1999021475 A1 WO1999021475 A1 WO 1999021475A1 EP 9806483 W EP9806483 W EP 9806483W WO 9921475 A1 WO9921475 A1 WO 9921475A1
- Authority
- WO
- WIPO (PCT)
- Prior art keywords
- impedance
- probes
- measuring device
- pericardial
- heart
- Prior art date
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
- A61B5/053—Measuring electrical impedance or conductance of a portion of the body
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B5/00—Measuring for diagnostic purposes; Identification of persons
- A61B5/05—Detecting, measuring or recording for diagnosis by means of electric currents or magnetic fields; Measuring using microwaves or radio waves
- A61B5/053—Measuring electrical impedance or conductance of a portion of the body
- A61B5/0538—Measuring electrical impedance or conductance of a portion of the body invasively, e.g. using a catheter
Definitions
- the invention relates to a device for determining a pericardial effusion after cardiac surgery.
- the opening of the pericardium is necessary for almost every cardiac surgery, be it heart valve replacement, bypass surgery, transplantation or implantation of a vascular prosthesis. Before this, the skin, the subcutaneous fat and the sternum must be severed. The actual procedure begins after the pericardium is opened.
- the heart-lung machine is connected in a similar manner for all operations. For this purpose, large-lumen catheters are introduced into the right atrium or the upper and lower vena cava and into the right pulmonary vein, through which the blood then circulates. After cooling the patient to a temperature between 18 ° C and 32 ° C, the operation is then carried out.
- the coronary arteries are prepared in a bypass procedure and with the Bypasses connected, the aorta or the right or left atrium is opened for heart valve replacement, during the transplant all larger vessels leading to or from the heart are severed and connected to the new heart.
- the patient is warmed up again on the cardiopulmonary machine and, if the cardiovascular conditions are sufficiently stable, separated again. After inserting several drains to drain the bleeding, the sternum is closed with wires and the skin with threads.
- the draina In order to drain this blood, which mainly collects in the pericardial sac, the draina inserted. If these drainages are blocked or if they come to rest so that not all of the blood can drain off, it accumulates in the pericardium. With further bleeding, since the pericardium is not stretchable, the bleeding compresses the heart. This compression means that the heart can no longer fill properly and therefore cannot pump enough blood through the body. This then results in a drop in blood pressure, an increase in central venous pressure, a decrease in urine output and a centralized circulation. The heart shadow is broadened in the X-ray image. This situation is known as pericardial tamponade. It is acutely life-threatening for the patient; If the pericardium is not immediately reoperated by removing the accumulated blood, this complication is fatal.
- a pericardial tamponade can only be recognized by its clinical picture.
- An x-ray of the chest with widening of the shadow of the heart is not sufficient for diagnosis alone.
- An ultrasound examination is not always reliable, since the tissue to be examined can often be poorly displayed after an operation.
- both the X-ray and the ultrasound examination are only carried out if there is a concrete suspicion. This suspicion usually arises only when the above symptoms appear. Valuable time can pass for the patient until suspicion and during the requested examinations. In the meantime, it can deteriorate to such an extent that the operation must be carried out under emergency conditions.
- the object of the invention is therefore to provide a device with which it is possible to continuously monitor the patient with regard to a developing pericardial tamponade and to alert the doctor or the nursing staff even before the clinical symptoms develop.
- the figure shows a preferred embodiment of the device according to the invention for determining a pericardial effusion in connection with the human heart.
- the device 1 consists of a measuring device 2 which is connected to a total of three wire probes 3, 4 and 5.
- the first wire probe 3 can be an ordinary pacemaker probe which is sewn to the right ventricle (7) in almost every cardiac surgical operation before the breastbone is closed and which is passed out through the skin below the breastbone.
- the pacemaker probe is usually used to stimulate the heart with the help of this probe and an external pacemaker and to be able to set the desired heart rate in the case of slow rhythm disturbances that often occur after cardiac operations.
- the wire probe 3 has a diameter of approximately 0.5 mm and has two poles.
- the other probes 4 and 5 connected to the measuring device 2 are used for anchoring in the pericardial sac (8). They can be sewn into the pericardial sac to the left and right of the heart.
- the device After the probes 3 to 5 have been fixed in the corresponding tissues, it is possible to diagnose a effusion with the device according to the invention by measuring the impedance between the different probes. If there is a pericardial effusion, the blood that has flowed in changes or serum the resistance (or impedance) between the probes. The change in the impedance between the individual measuring points is measured by the measuring device 2 and displayed on a display 6. Since measurements can be made directly between the ventricular and pericardial probes and between the pericardial probes, both the extent and the position of the effusion can be determined. The prerequisite for this is a zero or initial value for which there is no effusion.
- This initial value can easily be measured before the chest is closed, since the pericardium is sucked empty again with the help of a suction device.
- the measuring device 2 now compares the value measured immediately thereafter at any time. If the difference exceeds a certain threshold value, the measuring device 2 issues a warning; if a further threshold value is exceeded, an alarm is triggered.
- the respective threshold values must be tested accordingly and determined in the experiment. If these are collected from a correspondingly large group of patients, the device can be used on any patient without lengthy calibration. As already mentioned, only a single intraoperative zero point measurement is necessary.
- the necessary probes 3, 4 and 5, like a pacemaker probe, can be pulled through the skin and removed after use.
- the device 1 must be safe against high-frequency currents (electric knife) and can also be used during pacemaker operation; in addition, the pacemaker must not be influenced. Furthermore, it should be as small and light as possible so that the patient remains mobile. Due to the light weight of the electronic components of the impedance measuring device 2 and the probes 3, 5 used, the device according to the invention can be manufactured in a handy size and with a low weight as a device that can be easily carried by a doctor or the patient. Since the device is designed as a routine device, the consumables in particular can be disposable products that are as inexpensive as possible, as is the case, for example, with the sewable pacemaker probes used to date.
- the device according to the invention offers more security for the post-operative cardiac surgical patient, since the formation of a pericardial effusion with a dangerous tamponade can be continuously monitored and immediately ascertained.
- the size of an effusion can be measured directly. If the effusion has reached a certain size, an alarm is triggered and further diagnostics using echocardiography or other methods can be initiated immediately without further delay.
- the insertion of the probes is straightforward and easy to do by a experienced cardiac surgeon.
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- Health & Medical Sciences (AREA)
- Life Sciences & Earth Sciences (AREA)
- Biomedical Technology (AREA)
- Molecular Biology (AREA)
- Radiology & Medical Imaging (AREA)
- Biophysics (AREA)
- Pathology (AREA)
- Engineering & Computer Science (AREA)
- Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
- Heart & Thoracic Surgery (AREA)
- Medical Informatics (AREA)
- Physics & Mathematics (AREA)
- Surgery (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Measurement And Recording Of Electrical Phenomena And Electrical Characteristics Of The Living Body (AREA)
- Measuring And Recording Apparatus For Diagnosis (AREA)
Abstract
Description
Claims
Priority Applications (4)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
JP2000517643A JP3431900B2 (ja) | 1997-10-24 | 1998-10-13 | 心嚢貯留を検出するための装置 |
EP98954407A EP1024743B1 (de) | 1997-10-24 | 1998-10-13 | Vorrichtung zur feststellung eines perikardergusses |
DE59810603T DE59810603D1 (de) | 1997-10-24 | 1998-10-13 | Vorrichtung zur feststellung eines perikardergusses |
US09/529,840 US6351667B1 (en) | 1997-10-24 | 2000-10-13 | Device for detecting pericardial effusion |
Applications Claiming Priority (2)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
DE19747172.2 | 1997-10-24 | ||
DE19747172A DE19747172C2 (de) | 1997-10-24 | 1997-10-24 | Vorrichtung zur Feststellung eines Perikardergusses |
Publications (1)
Publication Number | Publication Date |
---|---|
WO1999021475A1 true WO1999021475A1 (de) | 1999-05-06 |
Family
ID=7846600
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
PCT/EP1998/006483 WO1999021475A1 (de) | 1997-10-24 | 1998-10-13 | Vorrichtung zur feststellung eines perikardergusses |
Country Status (6)
Country | Link |
---|---|
US (1) | US6351667B1 (de) |
EP (1) | EP1024743B1 (de) |
JP (1) | JP3431900B2 (de) |
DE (2) | DE19747172C2 (de) |
ES (1) | ES2212367T3 (de) |
WO (1) | WO1999021475A1 (de) |
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US11813464B2 (en) | 2020-07-31 | 2023-11-14 | Medtronic, Inc. | Cardiac conduction system evaluation |
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US4862361A (en) * | 1985-06-05 | 1989-08-29 | Massachusetts Institute Of Technology | Methods and apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis |
EP0487429A1 (de) * | 1990-11-23 | 1992-05-27 | Fred Zacouto | Einrichtung zur Verhinderung von Herzfunktionstörungen |
US5454377A (en) * | 1993-10-08 | 1995-10-03 | The Ohio State University | Method for measuring the myocardial electrical impedance spectrum |
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DE3732640C1 (de) * | 1987-09-28 | 1989-05-18 | Alt Eckhard | Medizinisches Geraet zum Ermitteln von physiologischen Funktionsparametern |
DE4100568A1 (de) * | 1991-01-11 | 1992-07-16 | Fehling Guido | Vorrichtung zur ueberwachung eines patienten auf abstossungsreaktionen eines implantierten organs |
FI106529B (fi) * | 1995-05-26 | 2001-02-28 | Instrumentarium Oy | Menetelmä potilaan hengityksen tarkkailemiseksi |
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-
1997
- 1997-10-24 DE DE19747172A patent/DE19747172C2/de not_active Expired - Fee Related
-
1998
- 1998-10-13 ES ES98954407T patent/ES2212367T3/es not_active Expired - Lifetime
- 1998-10-13 WO PCT/EP1998/006483 patent/WO1999021475A1/de active IP Right Grant
- 1998-10-13 EP EP98954407A patent/EP1024743B1/de not_active Expired - Lifetime
- 1998-10-13 JP JP2000517643A patent/JP3431900B2/ja not_active Expired - Fee Related
- 1998-10-13 DE DE59810603T patent/DE59810603D1/de not_active Expired - Lifetime
-
2000
- 2000-10-13 US US09/529,840 patent/US6351667B1/en not_active Expired - Fee Related
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US3971365A (en) * | 1973-02-12 | 1976-07-27 | Beckman Instruments, Inc. | Bioelectrical impedance measuring system |
US4862361A (en) * | 1985-06-05 | 1989-08-29 | Massachusetts Institute Of Technology | Methods and apparatus for monitoring cardiovascular regulation using heart rate power spectral analysis |
GB2213381A (en) * | 1987-12-12 | 1989-08-16 | Univ Wales Medicine | Electro-surgical apparatus with body impedance monitoring |
EP0487429A1 (de) * | 1990-11-23 | 1992-05-27 | Fred Zacouto | Einrichtung zur Verhinderung von Herzfunktionstörungen |
US5454377A (en) * | 1993-10-08 | 1995-10-03 | The Ohio State University | Method for measuring the myocardial electrical impedance spectrum |
Also Published As
Publication number | Publication date |
---|---|
JP3431900B2 (ja) | 2003-07-28 |
US6351667B1 (en) | 2002-02-26 |
DE59810603D1 (de) | 2004-02-19 |
DE19747172C2 (de) | 2000-04-13 |
JP2001520902A (ja) | 2001-11-06 |
EP1024743B1 (de) | 2004-01-14 |
DE19747172A1 (de) | 1999-05-12 |
ES2212367T3 (es) | 2004-07-16 |
EP1024743A1 (de) | 2000-08-09 |
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