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

Between 1979 and 1988, 656 patients were operated upon for abdominal aortic aneurysm. Elective operation was performed in 287 patients (44%) and acute operation in 369 patients. A ruptured aneurysm was found in 218 patients (33%). Patients with arteriosclerotic heart disease, hypertension, impaired renal function or chronic pulmonary disease showed an increased perioperative mortality. Development of postoperative cardiac and renal complications could not be related to previous cardiac or renal diseases. The major postoperative complications were renal failure in 81 patients (12%), pulmonary insufficiency in 77 patients (11%) and cardiac complications in 96 patients (13%). Failure of one or more organs occurred in 153 patients (23%) and the mortality rate for patients with multiorgan failure was 68%. Complications leading to reoperation occurred in 93 patients (14%). The perioperative mortality was 18.8%. The mortality for elective cases was 4.8%, for symptomatic cases 17.2% and 37% for ruptured aneurysms. The five-year survival rate was 48% for ruptured aneurysms, 70% for symptomatic cases and 75% for elective cases. After six months the life expectancy in these three groups of patients were identical and comparable to the expected survival for a sex and age matched control population.
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PMID:Surgery for abdominal aortic aneurysms. A survey of 656 patients. 193 27

The purpose of this study was to assess the clinical utility of pulsed Doppler echocardiography in the determination of shunt flow magnitude in adults with an atrial septal defect. Therefore, in 24 unselected, consecutive adult patients with an ostium-secundum type atrial septal defect, and in 16 patients without heart disease, Doppler echocardiography was performed to measure blood flow in the right and left ventricular outflow tract. In eight patients with an atrial septal defect, pulmonary flow measurement was impossible because of pulmonary insufficiency or poor visualization of the pulmonary annulus. The ratio between the pulmonary (Qp) and systemic blood flow (Qs) was between 0.83 and 1.13 in the control group and between 1.31 and 4.46 in patients with an atrial septal defect. In the control group the correlation between Qs and Qp was r = 0.96 (SEE = 0.417 l/min, y = 1.05x - 0.21). The correlation between Qp/Qs, determined by oximetry and pulsed Doppler echocardiography in patients with an atrial septal defect, was significant (r = 0.82, SEE = 0.54). Systematic differences between invasive and non-invasive shunt calculations did not occur. Thus, pulsed Doppler echocardiography is clinically useful in the determination of shunt flow magnitude in about two thirds of adult patients with an atrial septal defect and provides precise information for the decision for conservative or operative treatment.
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PMID:[Clinical value of Doppler echocardiography in the determination of shunt size in atrial septal defect of adult patients]. 342 1

Despite the very good results published by B. Barrat Boyes and A. castaneda with early correction of Tetralogy of Fallot in the first year of life, the authors prefer palliative surgery for this group. They have operated upon 47 infants less than one year of age, 15 of them being less than 2 weeks of age. The overall mortality is 4%, the only two deaths being in the neonate group, which is usually a very small group in the published series with early correction. Since all the children with S.P. Shunt performed for Tetralogy of Fallot can wait 2 to 4 years before complete correction, and since the mortality of corrective surgery at 4 years of age is almost nil, the authors think that the two stages approach give as good results than one stage surgery, despite the possibility of neurological complications which may occur between operations. They argue that with early correction, surgeons are obliged to put more transannular patches which result in more pulmonary insufficiency cases, and that the mortality in this age group is still very high in some publications. They have also compared the percentage of low cardiac output syndrome after correction and found that children with a previous S-P shunt have smoother post-operative course. Finally they think that it is possible to obtain a global mortality around 7% for the 2 stages approach and that this kind of surgery is technically easier than early correction and must be very useful for the majority of cardiac centers interested in congenital heart disease.
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PMID:[Surgery of tetralogy of Fallot in the first year of life (author's transl)]. 615 96

Two hundred and ten morbidly obese patients underwent a standardized gastric bypass procedure between February 1980 and November 1983. We conclude, based on 100% follow-up, that the operation is safe (operative mortality--1%, significant complications--10%) and effective (reoperation rate--4%). Only one patient failed to lose more than 25% of preoperative weight. The operation produced a mean weight loss in the group from 289 pounds (202-505) before surgery to 176 pounds (118-308) at 18 months after surgery. Stated as "per cent of ideal weight," patients lost from a preoperative mean of 214% (153-350) to 130% (88-189) at 18 months. Maximum weight loss was reached by 18 months after the procedure and was maintained during 36 months of observation in over 95% of patients. When patients were divided into four groups according to preoperative weight, weight loss occurred at a roughly similar rate, but heavier patients, although they lost more weight, plateaued at a higher weight than patients originally less obese. Striking and objective benefits were seen in patients with diabetes, hypertension, heart disease, and pulmonary insufficiency.
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PMID:The Greenville gastric bypass. Progress report at 3 years. 672 5

Treatment of congenital diaphragmatic hernia (CDH) has undergone a revolutionary change in philosophy, from previous urgent repair to the present practice of stabilization and delayed repair. However, when extracorporeal membrane oxygenation (ECMO) is required, many people believe that the risk of postoperative pulmonary hypertension (PPHN) mandates hernia repair while on ECMO. This report details the experience in two ECMO centers with stabilization, ECMO if required, and CDH repair post-ECMO. All CDH patients symptomatic in the first hour of life with a gestational age of at least 34 weeks during the period were reviewed retrospectively. Standard criteria were used to select patients for ECMO. High-frequency jet or oscillating ventilators and nitric oxide were not routinely available throughout the study period, but were used in some of the more recent patients. A total of 60 patients presented to the two centers; 24 cases were stabilized with conventional management, repair of the CDH was done elective, and survival was 100%. Eight patients were referred after having repair elsewhere; six survived (75%). The two deaths were attributable to associated lethal lesions--complex cyanotic heart disease and alveolar capillary dysplasia. Eight patients who required ECMO were managed with the intention of repairing the defect on ECMO. Four survived (50%). Two patients died before repair. Twenty patients were managed with ECMO, with the intention of repairing the defect after decannulation. Overall survival was 13 (65%), deaths were caused by pre-ECMO hypoxia, pulmonary insufficiency, and associated cardiac disease. No patient had recurrent pulmonary hypertension after late repair.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support. 747 78

Using Doppler echocardiography, the prevalence of tricuspid and pulmonary valve regurgitation was determined prospectively in 173 normal children, aged 8.3 +/- 2.7 (range 5-14) years. Pulmonary regurgitation was defined as a red-yellow or mosaic coloured regurgitant flow, continuing to end-diastole with continuous-wave Doppler. It was found in 84% of the children. Tricuspid regurgitation was defined as a blue-green or mosaic coloured regurgitant flow from the tricuspid valve into the right atrium lasting > 0.5 systole, as determined by continuous-wave Doppler. Tricuspid regurgitation was present in only 8% of the children. Tricuspid regurgitation flow of very short duration, considered to be due to valve closure, was found in 75%. No effect of age, presence of a vibratory innocent heart murmur or gender on the prevalence of right-sided valvular regurgitation could be demonstrated. All regurgitations were haemodynamically insignificant. Thus right-sided valvular regurgitation in normal schoolchildren is a normal physiological finding with relatively high prevalence. In the absence of functional reasons for these regurgitations and in the absence of structural pulmonary or tricuspid valve disease, these signals should be considered physiological in order to avoid iatrogenic heart disease.
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PMID:Right-sided valvular regurgitation in normal children determined by combined colour-coded and continuous-wave Doppler echocardiography. 819 3

The observed growth failure in infants with pulmonary insufficiency is postulated to be a consequence of elevated rates of energy expenditure. Assessment of energy expenditure by the classical technique of indirect calorimetry has yielded conflicting results. The adoption of the newer, doubly labeled water technique has provided evidence to support increased rates of energy expenditure in infants with chronic lung disease, congenital heart disease and in minimally ill, extremely low birth weight infants. The doubly labeled water technique holds great promise for the detailed study of energy expenditure in a variety of clinical conditions, including very ill as well as free-living subjects.
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PMID:Energy expenditure in infants with pulmonary insufficiency: is there evidence for increased energy needs? 1123 89

The number of single-stage bilateral total hip arthroplasties done each year is increasing. The risk of postoperative complications in medically stable patients is acceptable; complications are approximately 1.3 times more frequent than with unilateral total hip arthroplasty. Although there are no absolute indications for a single-stage bilateral total hip arthroplasty, the procedure is usually contraindicated in patients with such comorbidities as heart disease, pulmonary insufficiency, or diabetes, and it is absolutely contraindicated in patients with a documented patent ductus arteriosus or septal defect. The primary postoperative concern is that the cardiopulmonary insult associated with two surgical wounds and surgeries can lead to an increase in thromboembolic events. The cost for single-stage bilateral total arthroplasty is less than that for a two-stage bilateral total hip arthroplasty, with savings predominantly due to reduced length of acute hospital stay. However, the decision to undergo single-stage bilateral total hip arthroplasty is one that must be made in concert with the patient.
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PMID:Single-stage bilateral total hip arthroplasty. 1204 43

Acquired surgical disease of the pulmonary valve is rare. We report a 72-year-old man who presented with subacute endocarditic pulmonary regurgitation. This lesion was surgically corrected with a stentless bioprosthesis. Previously, homografts and various xenografts have been used for replacement of the pulmonary valve both in the pediatric population and in adult patients with congenital heart disease. Pulmonary regurgitation is a rare lesion, but if it is encountered our case demonstrates that it can be successfully and easily treated with pulmonary valve replacement by using a stentless bioprosthesis.
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PMID:Replacement of a regurgitant pulmonary valve with a stentless bioprosthesis. 1546 23

Ebstein anomaly, an abnormally low insertion of the tricuspid valve, occurs in 0.5% of patients with congenital heart disease. In rare cases, this disorder may be complicated by congestive heart failure in utero and hydrops fetalis. This article reports the prenatal sonographic features of 2 cases of Ebstein anomaly associated with hydrops fetalis. In both cases, fetal echocardiography was performed at 34 weeks of gestation. The 4-chamber view showed fetal cardiomegaly and pericardial effusion. In both cases, the annular attachment of the tricuspid valve leaflets was difficult to demonstrate and so distal that it could easily be confused with papillary muscle in the right ventricular wall. Poor fetal cardiac hemodynamics with severe tricuspid regurgitation was demonstrated by pulsed Doppler imaging. Pulmonary regurgitation was also clearly demonstrated in both cases. Preterm delivery with stillbirth occurred in both cases. Autopsies confirmed the very distal displacement of the tricuspid valve insertion, close to the apex, and enlargement of the right atrium.
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PMID:Sonographic features of Ebstein anomaly associated with hydrops fetalis: a report of two cases. 1575 59


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