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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The effect of chronic hypoxia (barochamber, 8 h per day, 5 days a week, stepwise up to 7000 m) on some cardiac functional and metabolic parameters was compared in rats acclimatized either from the 4th day or the 12th week of postnatal life. Pulmonary hypertension and right ventricular enlargement were found in both age group. Whereas in young hypoxic animals the weight of the right ventricle increased linearly with the right ventricular pressure, in adult high altitude exposed rats this relation could not be proved. High altitude induced significant increase of concentration of collagenous proteins: in adult animals increased collagen III only, in young also collagen I. The changes of the energy metabolism were similar in both age groups: activity of enzymes of the lactate metabolism and glucose phosphorylation increased; on the other hand, catabolism of fatty acids decreased. Chronic hypoxemia significantly influenced also the myocardial metabolism in children with congenital heart disease; the aerobic capacity was decreased both in the atrial and ventricular tissue; atrial changes were even more pronounced. The type of changes was, however, different from the rat heart.
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PMID:The effect of chronic hypoxia on the developing cardiopulmonary system. 252 33

31 patients undergoing diagnostic cardiac catheterization for suspected congenital heart disease and 30 normal subjects were examined by pulsed Doppler echocardiography. Spectrum analysis of the shape of flow velocity curve and instantaneous flow velocities of the pulmonary artery during systolic period was made and their ratio calculated. The results showed that there was a remarkable difference between the flow velocity curve of pulmonary hypertension (PH) and that of normal pulmonary pressure. Combining with the characteristics of pulmonary arterial hemodynamics, a preliminary exploration was made on the mechanism of flow velocity curve changes. A ratio of flow velocities--PV% was proposed. The sensitivity and specificity for diagnosing PH with PV% were 94% and 100% respectively. There was a high correlation between PV% and pulmonary artery systolic pressure (r = -0.84) or pulmonary artery mean pressure (r = -0.82). It is concluded that PV% may eliminate many factors that influence the pulmonary artery hemodynamics and is a reliable, practical qualitative and quantitative index for diagnosing PH noninvasively.
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PMID:[Diagnosis of pulmonary hypertension by pulsed Doppler echocardiography--comparison with cardiac catheterization]. 259 27

Since January 1987, 16 prepubertal children have undergone heart (13) or heart-lung (3) transplantation. Immunosuppression included cyclosporine and azathioprine and excluded steroids except in case of rejection. The indications for heart transplantation were hypoplastic left heart syndrome (4 infants, mean age = 2 months), congenital heart disease (4 patients, mean age = 5.7 years) and cardiomyopathy (5 patients, mean age = 2.8 years). There were 4 early deaths (acute graft failure in 2, pulmonary hypertension in 1, infection in 1) and 1 late death (heart failure at 3 months). The 8 survivors had a mean follow-up of 12 months (range 1-19 months). Late complications were minimal. There were 4 episodes of rejection in 2 patients. There was no infection, normal somatic growth and no systemic hypertension. Renal function remained within normal limits although mild-to-moderate tubulointerstitial lesions were found in 4 renal biopsies. Three children (9-11 years old) underwent heart-lung transplantation. The early postoperative course was difficult with 6 episodes of rejection and 5 infections. One patient died at 3 months from infectious complications. One child has a complete rehabilitation 8 months posttransplantation. The last patient is clinically well at 7 months but has a residual tracheal stenosis. The long-term fate of these children, and particularly the long-term effects of cyclosporine therapy are unknown. Heart and heart-lung transplantation remain under investigation but may be reasonable approaches for infants and children with end-stage cardiac and/or pulmonary disease.
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PMID:Heart- and heart-lung transplantation in children. 262 81

The hemodynamic effects of nifedipine in 15 patients with pulmonary hypertension (PH) secondary to congenital heart disease (CHD) were evaluated. The basal hemodynamic parameters were obtained before medication. The parameters were also obtained 60 minutes and 2 months after taking nifedipine. After treatment, PAPs were decreased 18% and 15% (P less than 0.01), PAPd 21% and 24% (P less than 0.01), PAPm both 19% (P less than 0.01), respectively. TPR were reduced 33% and 30% (P less than 0.01). SAP decreased slightly after 60 minutes. HR, CO and CI remained unchanged. Of the 10 patients suffering from hyperkinetic PH, 8 patients underwent closure of defects after treatment of nifedipine. The above results suggest that nifedipine is effective for patients with PH secondary to CHD. It acted as an antihypertensive agent in patients with CDH associated with hyperkinetic PH before operation.
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PMID:[Therapeutic effects of nifedipine in pulmonary hypertension secondary to congenital heart disease]. 262 74

When cardiovascular disease in women is considered, the cardiovascular physiology and diseases related to pregnancy are clearly unique, particularly to young women. Toxemia and its associated hypertension are the major cardiovascular disorders arising during and secondary to pregnancy and may well increase in prevalence as women undertake childbearing at older ages. Although its pathophysiology is unknown and its outcome may be grave to both mother and child, toxemia is preventable, treatable, and curable. This is unlike the three other forms of heart disease occurring in pregnancy discussed here. Aortic dissection, pulmonary hypertension, and peripartum cardiomyopathy are not preventable and are unpredictable, difficult to treat, and incurable. These latter disorders carry on indefinitely for the duration of the patient's life and seriously limit future options, including those for more pregnancies. Among the disorders of the heart in pregnancy, toxemia and peripartum cardiomyopathy are the subjects of especially active investigation at present. Major advances in understanding these disorders could minimize cardiovascular risk to the pregnant woman.
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PMID:Heart disease arising during or secondary to pregnancy. 264 40

Diseases of the central pulmonary arteries are difficult to diagnose. Echographic imaging of the pulmonary arteries can best be done using the suprasternal and transesophageal approach. In pulmonary arterial hypertension, the central pulmonary arteries increase in size, a fact that is used echographically to diagnose pulmonary hypertension. Even when there is volume overload (e.g. in congenital heart disease with a left-to-right shunt), characteristic changes of the pulmonary vessels are observed. Thromboemboli within the pulmonary arteries or thrombotic occlusion and a malignant process, which can lead to an obstruction or compression of the central pulmonary arteries, could be seen with echographic imaging techniques.
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PMID:[Echocardiographic diagnosis of pathologic processes of the central pulmonary vessels]. 266 42

During the past decades, the incidence of pregnant women with heart disease in Denmark has decreased from 0.9% to 0.3%. Heart disease in connection with pregnancy still remains the commonest non-obstetric cause of death. Previously, rheumatic valvular heart disease constituted the majority of all forms of heart disease in pregnant women. At present, congenital heart disease constitutes at least 80% of the maternal heart disease. Progress in heart surgery has had the result that increasingly more complicated forms of cardiac deformities can be corrected so that more survive to adult life. The range of cardiac deformities has therefore increased in recent accounts concerning pregnant women with heart disease. Ventricular septum defect, atrial septum defect and persistent ductus arteriosus still constitute approximately 50% of the forms of heart disease in pregnant women. In Denmark, the incidence of congenital heart disease is approximately 0.6% but between 2.5% and 4.2% of infants of women with congenital heart disease also have heart disease. In counselling about the risks in pregnancy, the NYHA scale provides a good guideline. Alle conditions with pulmonary hypertension are contraindications for pregnancy. The greatest risk for death occurs early in the puerperium. Guidelines for control and treatment of pregnant women with heart disease are presented. It is concluded, that pregnant women with heart disease should be assessed and be followed up in centres with the necessary cardiac, obstetric and anaesthesiologic expertise.
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PMID:[Pregnancy in women with congenital heart disease]. 268 83

Disorders of the heart frequently cause pulmonary dysfunction because of the close structural and functional association of the heart and lungs. The pulmonary vasculature is very commonly affected by cardiac pathology. The pulmonary vasculature is normally a low-pressure, low-resistance circuit with high compliance and tremendous vascular reserve. Although resting vascular tone is low, there are many identified mediators of pulmonary arterial tone that may help mediate pulmonary blood flow. Alveolar hypoxia is clearly a stimulus for increasing pulmonary vascular resistance although factors that mediate the response to hypoxia are not fully understood. Patients with left-to-right shunting due to congenital heart disease because of elevations in pulmonary artery flow and pressure tend to develop progressive anatomic changes in the pulmonary vasculature. This leads to an increase in pulmonary vascular resistance, irreversible pulmonary hypertension, right heart failure, reversal of shunt flow, and Eisenmenger's syndrome. The degree of anatomic vascular damage due to left-to-right shunting can be graded histologically. Lesser grades of damage are reversible with corrective surgery, whereas more severe grades show no improvement or progression with operation. Chronic left-sided congestive heart failure seen in rheumatic mitral stenosis can cause secondary changes in the pulmonary vasculature. Pulmonary hypertension and increased pulmonary vascular resistance can increase reflexly and form a "second stenosis" that further limits cardiac output. Unlike congenital heart disease, severe grades of pulmonary arterial damage are not seen in left heart failure from mitral stenosis or other causes, and consequently with surgical correction pulmonary hypertension reverses. Pulmonary function testing is adversely affected by congestive heart failure. Both restrictive (stiff lungs) and obstructive (cardiac asthma) defects are observed in congestive heart failure. DLCO is abnormally decreased. With treatment of heart failure these defects reverse. Both elevated systemic and pulmonary venous pressures affect fluid filtration in the pleural space and cause pleural fluid accumulation. The fluid is transudative with low protein, low lactate dehydrogenase, and low cell counts. Transudative effusions from heart failure resolve with treatment. With large effusions and cardiomegaly, pulmonary dysfunction results because of atelectasis from compression and space-occupying effects of the heart and pleural fluid. Following myocardial infarction, cardiac surgery, or other cardiac trauma, the postcardiac injury syndrome can result. The syndrome is characterized by exudative pleural and pericardial effusions along with pulmonary infiltrates, fever, chest pain, leukocytosis, and an elevated ESR. The syndrome must be diagnosed by exclusion of bacterial pneumonia, pulmonary emboli, and congestive heart failure. Treatment is with nonsteroidal anti-inflammatory agents or systemic co
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PMID:Pulmonary and pleural complications of cardiac disease. 268 66

From February 1985 through June 1987, 50 newborn infants in whom maximal ventilator therapy failed (80% predicted mortality) were treated with extracorporeal membrane oxygenation (ECMO) according to the following inclusion criteria: arterial oxygen tension less than 50 torr (alveolar-arterial oxygen gradient greater than 630 torr) for 2 hours or arterial oxygen tension less than 60 torr (alveolar-arterial oxygen gradient greater than 620 torr) for 8 hours. Criteria for exclusion from ECMO therapy included birth weight less than 2000 gm, gestational age less than 35 weeks, presence of intracranial hemorrhage, presence of other major congenital anomalies including cyanotic heart disease, and high levels of ventilatory support for more than 7 days. Mean birth weight was 3.28 +/- 0.56 kg, mean gestational age was 39.6 +/- 1.7 weeks, and mean age at the start of ECMO was 48.6 +/- 36.9 hours. Meconium aspiration, usually associated with persistent pulmonary hypertension, was the most common cause of pulmonary failure (62%). Mean pre-ECMO arterial oxygen tension during maximal ventilatory and pharmacologic support was 34.5 +/- 14.5 torr. Mean ventilatory support immediately before the institution of ECMO was as follows: peak inspiratory pressure 46.8 +/- 9.9 cm H2O, positive end-expiratory pressure 4.6 +/- 1.6 cm H2O, and intermittent mandatory ventilation rate 101.0 +/- 22.7 breaths/min with all patients receiving an inspired oxygen fraction of 1.0. Lung management to prevent pulmonary atelectasis during ECMO consisted of moderate levels of positive end-expiratory pressure (mean 10.3 +/- 2.6 cm H2O, range 8 to 14 in 94% of patients. Other mean ventilator parameters during ECMO were as follows: peak inspiratory pressure 22.8 +/- 1.6 cm H2O, intermittent mandatory ventilation rate 11.8 +/- 2.9, and inspired oxygen fraction 0.21. The overall long-term patient survival rate was 90%. Mean values for arterial blood gases and ventilator settings immediately after the discontinuation of ECMO were as follows: oxygen tension 78.4 +/- 22.1 torr, pH 7.39 +/- 0.10, carbon dioxide tension 37.4 +/- 10.7 torr, peak inspiratory pressure 25.2 +/- 3.9 cm H2O, positive end-expiratory pressure 5.6 +/- 1.2 cm H2O, and intermittent mandatory ventilation rate 41.3 +/- 12.6 with an inspired oxygen fraction of 0.42 +/- 0.17. Despite slightly higher levels of ventilator support (peak inspiratory pressure 46.8 versus 45.0 cm H2O, not significant) mean pre-ECMO oxygen tension was significantly lower than that reported from the National ECMO Registry (34.5 versus 42.0 torr, p less than 0.01).(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Extracorporeal membrane oxygenation for neonatal respiratory failure. A report of 50 cases. 270 62

661 consecutive children below the age of 14 years underwent open and closed heart surgery at the Saudi Heart Centre during a 4-year period for congenital cardiopathies of simple and complex nature with an average mortality rate of 10.5%. Congenital cardiopathies in Saudi Arabia differ from those seen in the Western world by the relative frequency of cyanotic heart disease, the presence of multiple complex congenital anomalies together, the advanced pulmonary hypertension, a rather aggressive nature of the cardiac diseases, and late referral of the children who often suffer also from congestive heart failure, reduced general condition and a malnutritional state.
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PMID:Congenital cardiopathies in Arab children. 274 98


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