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

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.
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PMID:Etiology and pathogenesis of thromboembolism. 176 43

The feasibility of percutaneous transluminal cardioscopy of the left ventricle was examined in 35 patients with or without various heart diseases. A guiding balloon catheter (7 or 9 French) was introduced through the right femoral artery into the left ventricle. The balloon was inflated, and a fiberscope (1.6 or 4.3 French) was advanced to the distal tip of the catheter. The balloon was then manipulated against the portion of the ventricle targeted for examination, and heparinized saline (10 U/ml) at body temperature was infused through the catheter at 5 ml/sec for 3 to 6 sec. The images were recorded on videotape and 16 mm cinefilm. In 4 patients without demonstrable heart disease, the endocardial surface of the left ventricle was brown and the trabeculae became prominent during systole. The chordae connected to the mitral leaflets were white. In 3 of 5 patients with dilated cardiomyopathy, the endocardium was light yellow with thin trabeculae which barely contracted during systole. The endocardium was red or reddish-brown in 3 patients with acute myocarditis. In patients with rheumatic mitral stenosis white patches were scattered on the endocardial surface. In 7 of 8 patients the akinetic or dyskinetic segments representing prior infarctions were white. No complications other than transient ventricular arrhythmias were noted. We conclude that percutaneous fiberscopic imaging with a guiding balloon catheter is feasible and safe, and yields highly detailed images of the endocardium.
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PMID:Percutaneous fiberoptic cardioscopy of the left ventricle. 195 16

Catheter therapy has gained an important role in the treatment of congenital heart disease. The cumulative experience with vascular and valvular balloon dilations has demonstrated low mortality and morbidity with short-term results similar to surgery. Currently, balloon dilation is an accepted treatment for valvular pulmonary stenosis, distal pulmonary artery stenosis, recurrent coarctation, rheumatic mitral stenosis, congenital valvular aortic stenosis, and intra-atrial baffle obstruction. Except for patients at high surgical risk, balloon dilation of native coarctation is considered investigational at most institutions but accepted at others. No conclusive evaluation is yet possible for dilation of bioprosthetic valves and membranous subaortic stenosis. Individual pulmonary veins appear undilatable. Various devices are available for closure of extra- and intracardiac communications. Transcatheter closure of aortopulmonary collaterals and arteriovenous malformations is now well established at some centers. In selected patients, therapeutic embolization of surgical shunts can replace surgery. Transcatheter closure of the patent ductus arteriosus has become routine at some centers. Nonsurgical closure of atrial and ventricular septal defects has entered clinical trials, and preliminary results appear very promising. Blade atrioseptostomy and foreign body retrieval are well established. Improvement of existing procedures and implementation of new concepts will consolidate the role of catheter therapy in congenital and acquired heart disease.
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PMID:Balloon dilation catheters. 240

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

Understanding of the mechanisms of cardiovascular and hemodynamic adaptation during pregnancy helps to prevent or manage complications in cardiac patients during gestation. Manifestations of coronary heart disease are exceptional during pregnancy and delivery. The same is true of disorders of the pericardium. Peripartal cardiomyopathy is a myocardial disorder of undetermined cause occurring shortly before, during or after delivery, which may take a fatal course. Hypertrophic obstructive or non-obstructive cardiomyopathy is compatible with gestation and delivery without serious complications in most cases. Rheumatic mitral stenosis was the most common cardiac disorder until the 1950s. Nowadays it is rarely seen in this country. Surgical and other interventional therapies have greatly changed the outlook in pregnant women with valvular heart disease. A highly controversial issue is heart valve replacement in young women and management of anticoagulation during pregnancy. Like any other drug therapy, anticoagulation during gestation requires careful weighing of the benefit for the mother against toxic and teratogenic effects for the fetus. In women with heart disease the management of pregnancy should start, if possible, before conception. Thorough counseling and proper planning of pregnancy and of therapeutic measures is essential in order to avoid or manage complications.
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PMID:[Acquired heart diseases and pregnancy]. 787 9

Most prior efforts of 3-dimensional (3-D) reconstruction of echocardiographic images have focused on quantitation of ventricular size and function. The resulting images have been displayed in the wire mesh format. Recently, a method for 3-D transesophageal echocardiography using a computer-controlled probe that acquires parallel tomographic slices has been described. This technique provides dynamic 3-D volume-rendered images of the heart. This study was designed to determine if surgical visualization of intracardiac anatomy could be simulated using this imaging system. Data acquired from 8 patients with congenital and acquired heart disease were analyzed. Real-time 3-D images of the cardiac chambers and valves were obtained. Images of the cardiac pathology including fibrocalcific nodules on the aortic valve, mitral valve endocarditis, rheumatic mitral stenosis, and an ostium secundum atrial septal defect were displayed in 3 dimensions that simulated surgical exposure of these structures. These 3-D representations of cardiac anatomy were in some ways superior to standard intraoperative visualization in that they demonstrated the heart as a dynamic structure, as opposed to the empty, nonbeating heart observed while on cardiopulmonary bypass. In conclusion, 3-D images of cardiac structures as seen by the surgeon intraoperatively can be provided using a computer-driven tomographic transesophageal echocardiographic probe. This imaging system can be potentially useful in the planning and evaluation of cardiac surgery. Technical improvements such as 3-D representation of flow jets, the ability to manipulate images to simulate cardiac surgery, and on-line reconstruction can make this a powerful tool in the future.
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PMID:Simulation of intraoperative visualization of cardiac structures and study of dynamic surgical anatomy with real-time three-dimensional echocardiography. 814 Oct 92

A total of 170 catheter balloon valvuloplastic (CBV) operations for rheumatic mitral stenosis were carried out in patients aged 19 to 68, 30 of these in pregnant women, at A. V. Vishnevsky Institute of Surgery, Russian Academi of Medical Scients, from 1988 to 1994. Characteristic features of such operations are a minor surgical trauma and no necessity in deep narcosis and artificial circulation. Analysis of the immediate results and of the data of five-year follow-up brings the authors to a conclusion about the efficacy of the new method of treatment of this heart disease and about the physiological nature of forming an adequate route of blood flow into the right ventricle with a balloon. Comparing various balloon catheters for valvuloplasty and methods to carry out this procedure, the authors emphasize the advantages of the instruments and method developed by professor V. A. Silin et al. (St. Petersburg). The possibility of correction of mitral stenosis by CBV in pregnant women appears to be particularly important. Retrospective analysis of the immediate results and follow-up data helped the authors not only formulate the indications for this intervention, but permitted them to develop an original system of comprehensive clinical and instrumental assessment of the degree of involvement of the mitral valve and subvalvular structures, and of hemodynamic disorders.
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PMID:[Catheter balloon valvuloplasty: new possibilities in the surgical treatment of mitral stenosis]. 857 76

Congenital heart disease is related to events occurring in the embryonal stage, while rheumatic heart disease is a sequela of immune-mediated damage following streptococcal infection. We report an unusual association of multiple ventricular septal defects and severe pulmonary arterial hypertension with rheumatic mitral stenosis in a 7-year-old girl. This case highlights the need for careful examination for coexisting rheumatic disease in late presentations of congenital heart disease.
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PMID:Juvenile rheumatic mitral stenosis with multiple ventricular septal defects. 1791 Oct 74

The incidence of rheumatic mitral stenosis is grossly reduced in India. Still, among heart disease complicating pregnancy, rheumatic mitral stenosis occupies a greater segment. The unique physiological changes in pregnancy and the pathological impact of mitral stenosis over pregnancy and labour are discussed in detail. A multidisciplinary approach in the diagnosis and management reduces the mortality and morbidity during peripartum. The labour analgesia technique and the evidence-based regional and general anaesthesia techniques are discussed at length in this article.
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PMID:Mitral stenosis and pregnancy: Current concepts in anaesthetic practice. 2118 82

From heart disease complicating pregnancy, rheumatic mitral stenosis occupies a larger part. Physiological changes during pregnancy and the impact of pathological mitral stenosis on pregnancy and labor are important to know. A multidisciplinary approach to the diagnosis and treatment reduces mortality and morbidity. We report the case of a patient with mitral stenosis moderately tight with term pregnancy and perioperative management.
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PMID:Mitral stenosis with term pregnancy: how to manage this case? 2378 49


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