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

Ninety-three cardiac transplantations were carried out in 91 patients (2 retransplantations) between March 1st 1987 and November 1st 1989, in 84 adults and 7 children under 15 years of age. The indications were dilated cardiomyopathy (48%), ischemic cardiomyopathy (35%), decompensated valvular heart disease (11%), congenital heart disease (3%) and two cases of Uhl's anomaly. Twelve patients underwent transplantation after external circulatory assistance (13%), 11 patients after inscription on the list of extreme emergencies, and 68 on an elective basis (74%). The postoperative immunosuppressive protocol was triple therapy: Ciclosporine, Azathioprine and Prednisone. Three of the children died. The early adult mortality was 9 cases (10.7%). It was 8% in patients operated electively. Major infectious complications occurred in 10 patients (11%). Rejection was looked for by systematic endomyocardial biopsy and echocardiography. Three hundred and forty-nine biopsies were made. Thirty-five patients (44%) had no problems of rejection. Seventy-nine patients have now been followed up for an average of 19 months. There were 7 late deaths. Seventy seven per cent of the survivors are asymptomatic. Acute rejection and transplant dysfunction were the two main causes of early mortality after cardiac transplantation. Although the long-term prognosis is uncertain, the medium-term results are very encouraging.
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PMID:[Causes of failure analysis after cardiac transplantation. From a consecutive series of 91 cases]. 189 15

Orthotopic cardiac transplantation has become established for selected infants with severe forms of congenital heart disease. This study reviews the combined experience and intermediate term results of infants undergoing orthotopic cardiac transplantation from Children's Memorial Hospital, Chicago, and Kosair Children's Hospital, Louisville. From June 1986 through December 1989, 20 orthotopic cardiac transplantations were performed in 19 patients. Sixteen patients had variants of hypoplastic left heart syndrome. One infant had anomalous origin of the left coronary artery with severe ischemic cardiomyopathy. Two infants had aortic stenosis with endocardial fibroelastosis, and one had extracorporeal membrane oxygenation as a bridge to transplantation. Immunosuppression included cyclosporine, azathioprine (Imuran), and corticosteroids with an effort to wean the patients from steroids by 6 months to 2 years. Three early deaths resulted--from technical errors in two patients and from hyperacute rejection in one patient at 3 days. Four late deaths have occurred. Two patients died at 2 and 13 months of acute rejection. One patient died at 15 months of acute rejection after retransplantation. One patient died at 7 months of respiratory syncytial viral pneumonia. The remaining 12 patients are surviving 5 to 47 months (means 20 months) after orthotopic cardiac transplantation. Rejection surveillance in the first 6 months is by clinical signs supplemented by echocardiography, electrocardiography, and cell cycle analysis; endomyocardial biopsy is used after 6 months of age. For the cumulative series, 24 episodes of suspected rejection have been treated during 277 at-risk patient months with intravenous methylprednisolone (Solu-Medrol) (n = 18) and monoclonal antibody (OKT3) (n = 6), for an incidence of 1.04 episodes of rejection per patient per year. Serious posttransplantation infections including endocarditis, catheter sepsis, meningitis, and colonic perforation were successfully treated in four patients. Subjectively, their quality of life is excellent as shown by normal growth and developmental milestones and a low hospital readmission rate (1.4 episodes per patient per year). These encouraging intermediate term results warrant continued application of infant orthotopic cardiac transplantation for severe forms of congenital heart disease.
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PMID:Intermediate term results of infant orthotopic cardiac transplantation from two centers. 190 39

The proliferation of transplant programs has not been paralleled by a similar increase in the availability of organ donors. This has significantly prolonged the waiting period and consequently has resulted in increased mortality of the patients with end-stage heart disease who are awaiting transplantation. Between 1984 and 1987, 104 orthotopic heart transplants were performed at Loyola University Medical Center. During the same period, 25 patients died while waiting for a suitable donor. To reduce the mortality of our patients waiting for transplantation, we began using the total artificial heart and a ventricular assist device as a bridge to transplantation in 1988. Of 29 patients who underwent transplant procedures in 1988, 18 required either a total artificial heart (15) or a ventricular assist device (3) as a bridge to transplantation. The underlying heart conditions were ischemic cardiomyopathy (11), dilated cardiomyopathy (5), giant cell myocarditis (1), and allograft failure (1). The average duration of mechanical support was 10 days (range, 1 to 35 days). Seventeen of the supported patients had successful transplants. One patient had brain death and did not receive a heart transplant. Of the 17 patients who survived surgery, two died within 30 days: one at 17 days because of acute rejection, the other at 14 days because of a cerebral vascular event. Fifteen patients (83%) were long-term survivors. Nine of the supported patients required reoperation because of bleeding after device implantation. There was no mediastinal or incisional infection. While the mechanical device was in place, the activated clotting time was maintained between 170 and 200 seconds with the administration of heparin (400 to 1000 units per hour).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of the total artificial heart and ventricular assist device as a bridge to transplantation. 227 1

Elevated pulmonary vascular resistance was an incremental risk factor for premature death after heart transplantation (p = 0.0002). Its effect was continuously variable and not dichotomous (yes or no). The rate of rise in risk of death corresponded quite evenly to the progressive increase in pulmonary vascular resistance from low to high values, rather than abruptly increasing at a certain point. This effect was incremental to the risk imposed by congenital heart disease (in contrast to idiopathic or ischemic cardiomyopathy). Expression of the pulmonary vascular resistance in units times square meters provides more accurate predictions than expression in Wood units (p for difference = 0.03).
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PMID:Pulmonary vascular resistance and the risk of heart transplantation. 305 1

Between March 1981 and March 1986, 200 orthotopic heart transplantations were performed at the University of Pittsburgh. Fourteen of those procedures were carried out in children 2 to 16 years of age. Two children received combined liver and heart transplants; one because of familial hypercholesterolemia with associated ischemic heart disease, and the other because of dilated cardiomyopathy associated with intrahepatic biliary atresia. Eight patients had dilated cardiomyopathy, and two had myocarditis. Two had heart transplantations for congenital heart disease: one had multiple muscular ventricular septal defects repaired in infancy and had an associated cardiomyopathy, and the other developed a cardiomyopathic ventricle from a congenital right coronary artery to right atrial fistula. Chronic immune suppression consisted 0.2 to 0.5 mg/kg/d of prednisone and 5 to 50 mg/kg/d cyclosporine, with the addition of antithymocyte globulin for unresolved moderate or severe acute rejection. There were three early postoperative deaths: one from intracranial bleeding, one from Pseudomonas mediastinitis, and one from ischemic injury to transplanted organs. Early postoperative complications included reversible renal failure, hypertension, and seizures. Late problems were related to allograft rejection and side effects of cyclosporine and corticosteroids. Significant rejection episodes occurred in all patients surviving longer than 2 weeks, with seven requiring antithymocyte globulin. Two patients died 8 months following transplantation of severe acute and chronic rejection; another patient required retransplantation for ischemic cardiomyopathy resulting from chronic rejection but subsequently died of recurring rejection 3 months after the second transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Experience with heart transplantation in children. 354 Aug 34

Until recently, congestive cardiomyopathy has had a poor prognosis on standard treatment because of severe congestive failure, arrhythmias, and embolism from endocardial thrombi in both ventricles. This pluricausal disorder differs from other heart disease because of disproportionately small hypertrophy in relation to ventricular dilation, with ultimate severe impairment of systolic function. Absence of hypertrophy adequate to compensate dilation exaggerates ventricular wall stress beyond that seen in other disorders. Newer treatments seeming to promise unprecedented improvement include unloading therapy with vasodilators, nonglycoside inotropic therapy, beta-adrenoceptor blockade (experimental only), combinations of these agents with or without digitalis and diuretics, and intra-aortic balloon pumping for critical failure. New surgical approaches include mitral annuloplasty, coronary bypass (for ischemic cardiomyopathy), and, for appropriate recipients, cardiac transplantation.
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PMID:Effective management of congestive cardiomyopathy. Relation to ventricular structure and function. 612 31

The many changes in classification of cardiovascular disease during the twentieth century reflect changing etiology of diseases, clinical comprehension and technological advances. In particular, the etiology of valvular heart disease has changed dramatically in the last five decades. The significant reduction of acute rheumatic fever and its sequelae, and the recognition of non-rheumatic causes of valvular disease are responsible for the metamorphosis in the etiology of valvular disorders. Valvular heart disease can be classified as follows: 1) Heritable-congenital causes of valvular heart disease e.g., floppy mitral valve with mitral valve prolapse, bicuspid aortic valve, and the Marfan syndrome; 2) Inflammatory-immunologic causes such as rheumatic fever, acquired immune deficiency syndrome, endocardial proliferative disorders, and antiphospolipid syndrome; 3) Myocardial dysfunction-ischemic cardiomyopathy, dilated or hypertrophic cardiomyopathy-resulting in valvular heart disease; 4) Diseases and disorders of other organs as causes of valvular heart disease, e.g., chronic renal failure and carcinoid heart disease; 5) Valvular heart disease related to aging: calcific aortic stenosis and mitral annular calcification; 6) Valvular disease following interventions such as valvuloplasty, valve reconstructive surgery and valve replacement; and 7) Valvular disease related to drugs and physical agents, such as chronic ergotamine use, radiation therapy and trauma. In clinical practice the most common causes of mitral regurgitation are floppy mitral valve with mitral valve prolapse, ischemic heart disease, dilated cardiomyopathy and mitral annular calcification, while the most common cause of mitral stenosis is rheumatic fever. The most common causes of isolated aortic regurgitation are bicuspid aortic valve and floppy aortic valve, while the most common causes of isolated aortic stenosis are related to the bicuspid aortic valve and the development of calcific senile aortic stenosis. The most common causes of tricuspid regurgitation are dilated cardiomyopathy, ischemic cardiomyopathy, floppy tricuspid valve with tricuspid valve prolapse and infectious endocarditis. Combined mitral and tricuspid regurgitation occur with heritable connective tissue disorders, dilated or ischemic cardiomyopathy, while the most common cause of mitral stenosis plus aortic regurgitation is rheumatic fever. Statistics obtained from cardiac surgery and necropsy may underestimate the true incidence of certain valvular diseases by selection bias. This is particularly so with valvular disease associated with significant ventricular dysfunction, or in the elderly who may not be surgical candidates, or in cases where the valvular disease is not severe enough to require surgical intervention. Recent advances in hemodynamic and imaging technology allow clinicians to define valvular structure and function and to accurately classify valvular heart disease in clinical practice.
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PMID:Valvular heart disease: the influence of changing etiology on nosology. 800 Jun 16

Nutritionnal status remain poor in hospitalized elderly for cardiopathy compared to healthy controls, secondary to bad general status. Selenium rate appears significantly lower in ischemic cardiomyopathy than in valvular or hypertension cardiopathy.
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PMID:[Nutritional and trace elements status in cardiomyopathies in the elderly]. 800 65

Utilization of endocavitary defibrillation electrodes avoids thoracotomy used in implantable cardioverter-defibrillator procedures, reducing associated morbi-mortality. In our institution we have used this approach in 16 patients during a two years period (July 1990-July 1992). Fifteen were males, with a mean age of 56.9 +/- 10.6 (range 32-73). Nine patients suffered ischemic cardiomyopathy, 4 non ischemic cardiomyopathy and in three there was no structural heart disease. Mean ejection fraction was 44.3 +/- 18.3% (range 20-73%). Clinical arrhythmia was ventricular tachycardia in 8 cases, ventricular fibrillation in 6 cases and both types in 2. Endocavitary implantation procedure was not completed in 3 patients, thus an open trans-sternal approach was performed. In 13 patients it was completed successfully, using a total amount of 14 units (1 patient required two procedures due to sepsis in the generator pouch). Most important intraoperative incidences have been defibrillation thresholds between 20-24 J in 4 cases, displacement of defibrillation electrode from vena cava into coronary sinus in 4 cases, epicardial patch implantation via subcostal approach in 1 case and right ventricle perforation in 1 case. No operative mortality was registered. One patient suffered sudden death during follow-up. Surgical complications were few: 1 case of lead dislodgement and 1 infected wound in the generator's pouch. Non-surgical complications were also few: 1 case with superior vena cava syndrome and 1 patient with inadequate discharges. In conclusion, due to our early experience, we believe that endocavitary implantation of an implantable cardioverter-defibrillator is the procedure of choice at the present time.
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PMID:[The implantable endocavitary cardioverter-defibrillator: the initial and short-term results]. 821

Thallium-201 scintigraphic defects are observed in most patients with ischemic cardiomyopathy and also can be found in idiopathic dilated cardiomyopathy. To determine the ability of qualitative and quantitative perfusion parameters to differentiate these entities, thallium-201 exercise testing was performed in 51 patients with coronary arteriography referred for evaluation of severe congestive heart failure. All patients had a left ventricular ejection fraction < 35%. Thirty-one ischemic patients had coronary stenosis > 70% in > or = 1 artery, and 20 idiopathic patients had no coronary stenosis or identifiable cause of heart disease. Similar exercise capacity, ejection fraction and sex distribution were found in both groups. Ischemic patients more often had severe perfusion defects (97 vs 25%; p = 0.00001), large perfusion defects involving > or = 40% of the left ventricular contour (100 vs 80%; p = 0.01), and increased thallium-201 lung uptake (94 vs 65%, p = 0.01). Large severe defects were present in 90% of ischemic and only 5% of idiopathic patients. On quantitative analysis, the area of the thallium-201 curve less than normal was greater in ischemic than idiopathic patients (14.8 +/- 9.5% vs 3.3 +/- 2.8%; p = 0.001). The degree and severity of redistribution were similar in both groups. Multivariate analysis identified the qualitative parameters of increased thallium-201 lung uptake, severe defects and large severe defects as the only independent predictors of the presence of ischemic disease. The presence of large severe defects had a 97% predictive value for ischemic cardiomyopathy. The absence of severe defects had a 94% predictive value for idiopathic dilated cardiomyopathy.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Usefulness of thallium-201 for distinction of ischemic from idiopathic dilated cardiomyopathy. 844 64


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