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

During 1973--1977, 212 infants underwent open heart operations for congenital heart disease at the Thoracic Unit, The Hospital for Sick Children, Great Ormond Street. The current results (75% survival rate) are compared with the results from earlier years (1963--1967) which showed only a 35% survival rate. Two groups are discussed in detail: Infants with Total Anomalous Pulmonary Venous Drainage, and Persistent Truncus Arteriosus. Although the operative risk in both groups remains high, the analysis of the natural history, palliative and corrective surgery and causes of death suggests that early total repair of severely symptomatic infants achieves the optimal results. The importance of careful analysis is emphasised. Palliative surgery still plays an important role in the treatment of congenital heart defects in infancy. The optimal timing and time of operation can only be selected after careful analysis of various factors.
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PMID:Analysis of factors which might improve the survival rate of infants with congenital heart disease. 9 94

Despite the widespread clinical success in open-heart surgery, bleeding after cardiopulmonary by-pass (CPB) has been a common problem especially in cyanotic congenital heart disease. Recently, there have been reports demonstrating that treatment with high doses of aprotinin reduces postoperative bleeding. We studied the effect of aprotinin on postoperative bleeding in patients with tetralogy of Fallot who had undergone total correction in the Department of Thoracic and Cardiovascular Surgery of the Hacettepe University Faculty of Medicine, and compared our results with those in the literature. Ten patients out of 20 in the study were given high doses of aprotinin and were compared with the remaining 10 patients who had not received the drug. Standard anesthesia, perfusion and surgical techniques were used in all operations. The total amount of bleeding in the aprotinin-treated group was found to be 1530 ml, while in the other group it was 4185 ml (p < 0.05). The total quantity of blood transfused in the aprotinin-treated patients was 3250 ml while it was 5865 ml in the control group (p < 0.05). No significant effect of aprotinin was found on Hb, Hct, PT, aPTT and thrombocyte counts (p > 0.05). However, the effect of the drug on bleeding and coagulation time was found to be statistically significant (p < 0.05).
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PMID:The effect of aprotinin (trasylol) on postoperative bleeding in cyanotic congenital heart disease. 172 22

The late radiation response of the heart is of concern because of many reports of heart disease following radiation therapy of thoracic tumors. This study was done because of the clinical relevance of the pathophysiology of cardiopulmonary irradiation and because the heart is a good model for late effects of vasculoconnective tissue due to its lack of acutely responding parenchymal cells. Thoracic irradiation of adult beagle dogs including the heart and one third of the lung volume produced an early response in the heart at 1 and 3 months which consisted of an increase in left ventricle and septal wall thickness, decreased left ventricle ejection fraction, increased heart rates, intraventricular conduction disturbances and a high probability for pericardial effusion at 3 months. Radiation doses were 36, 44, or 52 Gy given in 4 Gy fractions in 4 weeks. Premature atrial contractions, paroxysmal atrial tachycardia, sustained atrial tachycardia and atrial fibrillation occurred at all dose levels. Evidence suggests that both early and late responses were due, at least in part, to direct injury to the cardiac microvasculature. The later effects appeared to be enhanced by injury to the lung. The early response appeared to resolve in 6 to 9 months, after which there was thinning of the myocardium at higher doses and resolution of pericardial effusions. At 12 months, elevations in right atrial pressure, but not pulmonary wedge pressure, were suggestive of right-sided congestive heart failure. Pulmonary hypertension was also present at 12 months presumably due to partial lung irradiations, and may have exacerbated right-sided congestive heart failure. The radiation injury may continue to increase with time leading to serious deficits in cardiopulmonary function. The functional studies may aid in predicting late effects and evaluating residual injury.
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PMID:Canine cardiomyopathy after whole heart and partial lung irradiation. 338 19

Factors associated with outcome were investigated in the British Thoracic Society's study of smoking withdrawal in 1550 patients attending hospital with smoking related diseases. A long term abstinence rate of 9.7% was found. Men did better than women, 12.2% of them succeeding in stopping smoking compared with 5.3% of the women. Success rate increased with age, and people with heart disease did better than those with any other diagnosis. The success rate of the best group, men with heart disease, was 21%. Sex, age, and diagnosis appeared to act independently. If the most important other person in the patient's life was a non-smoker success was more likely. Weight increased by an average of 5.9 kg over a year in those who stopped smoking.
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PMID:Smoking withdrawal in hospital patients: factors associated with outcome. Subcommittee of the Research Committee of the British Thoracic Society. 638 74

Data for 1977-82 obtained from the Cardiac Surgical Register, established by the Society of Thoracic and Cardiovascular Surgeons of Great Britain and Northern Ireland in 1977, were analysed for trends in incidence and mortality of cardiac surgery and regional workload in the United Kingdom. Operative mortality for most types of cardiac operation showed a general decline. The numbers of operations performed for valvular and congenital heart disease had remained unchanged, but a striking increase had occurred in the number of coronary bypass graft operations: 2297 in 1977 to 6008 in 1982. The figure for 1982, representing an annual rate of 107 operations per million population, was still well below that for other countries such as Australia (410 per million in 1982) and the United States (750 per million in 1981). A wide variation was seen in the regional provision of cardiac surgical services within the United Kingdom. This was particularly appreciable for coronary bypass graft surgery, in which there was a 10-fold difference in numbers of operations performed between the various regions. The UK Cardiac Surgical Register provides an important source of information on trends within the specialty that could well be followed by other surgical specialties.
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PMID:The UK cardiac surgical register, 1977-82. 643 86

This report describes the development of the first known national surgical database designed for the practicing community cardiothoracic surgeon. Acceptance by members of The Society of Thoracic Surgeons has been gratifying. The number of patients on the system has grown from 116,109 at the end of 1991 to an anticipated 350,000 to 450,000 by the end of 1993. At the time of this report, 842 surgeons were participating, and more than 1,200 will be on the system by the end of 1993. A risk stratification system has been incorporated into the software, which predicts each patient's risk based on the individual surgeon's past experience. Trend analyses demonstrate a substantial increase in the number of patients at increased risk for perioperative death for coronary artery bypass operations over the past 5 years, while observed mortality has remained relatively constant. Programs are available for adult and congenital heart disease, lung cancer, and esophageal cancer, and modules for mediastinal tumors, pleural disorders, and benign pulmonary disease will soon be added. We anticipate that growth will continue as the need for practice profile data increases because of reimbursement issues.
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PMID:The Society of Thoracic Surgeons National Database status report. 827 77

Thoracic electrical bioimpedance cardiography is a non-invasive, continuous and low-cost method of estimation of cardiac output and other haemodynamic parameters. Though subject to continuous technological refinement controversial opinions exist on its validity in subsets of critically ill patients, patients with heart disease or after cardiac surgery. A comparison study between thermodilution (TD) and bioimpedance (TEB) was performed in 28 patients undergoing elective cardiac surgery (CABG, aortic or mitral valve replacement or combined procedures). 128 pairs of cardiac index estimates at specific time points during 20 hours at the postoperative ICU were evaluated. A poor correlation (r = 0.26, p < 0.05, bias -0.07 l.min-1.m2, precision + 1.1 l.min-1.m-2, 95% limits of agreement -2.27-2.13 l.min-1.m-2) between TD and TEB cannot support the routine use of TEB monitoring in early postoperative period after open-heart surgery. Possible reasons of lack of agreement in this population are discussed. Further studies with technically improved bioimpedance cardiographs will be needed.
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PMID:Thoracic electrical bioimpedance versus thermodilution in patients post open-heart surgery. 1056 76

Based on data reported to the UNOS/ISHLT International Registry for Thoracic Organ Transplantation, we showed that: 1. The number of heart transplant operations performed in the United States has decreased by 164 procedures between 1998 (2,346) and 1999 (2,182). The number of lung transplants increased by 13 in 1999 to 877. 2. The most frequently reported indication for heart transplantation in the US is coronary artery disease (44.8%). For other thoracic transplants, the most frequently reported indications include cystic fibrosis (35.5%) for double lung, emphysema/COPD (49.7%) for single lung and congenital heart disease (46.6%) for heart-lung. The most frequently reported diagnoses for thoracic transplantation outside the US include cardiomyopathy (43.8%) for heart, cystic fibrosis (33.4%) for double-lung, emphysema/COPD (26.6%) for single-lung and primary pulmonary hypertension (24.8%) for heart-lung transplants. 3. US heart transplant recipients are predominately male (76.7%), between 50 and 64 years of age (51.3%) and white (81.4%). US lung transplant recipients are also predominately between 50 and 64 years of age (44.7%) and white (89.9%), but unlike heart recipients are more likely to be female (51.2%). No meaningful variance from the US recipient demographic profile is noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 10.9% of the reported heart transplants and 6.2% of reported lung transplants. 5. One-year survival for thoracic transplants performed in the US is 82.4% for heart, 74.1% for lung and 62.0% for heart-lung. Five-year survival for US thoracic transplants is 66.8% for heart and 43.2% for lung. 6. Long-term patient survival rates are: 22.5% at 17 years for heart, 20.8% at 10 years for lung and 24.3% at 13 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one year and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors include donor age, recipient age and ischemic time. Substantial long-term risk factors include older donor age, recipient age, recipient race and diagnosis. 8. The factors having the most significant impact on lung mortality at all time points are related to either the patient's medical condition (e.g., in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation, recipient race and recipient age have the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of hospitalization during the first year after transplantation is infection alone.
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PMID:Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for Thoracic Organ Transplantation. 1151 24

The field of congenital heart surgery has the opportunity to create the first comprehensive international database for a medical subspecialty. An understanding of the demographics of congenital heart disease and the rapid growth of computer technology leads to the realization that creating a comprehensive international database for pediatric cardiac surgery represents an important and achievable goal. The evolution of computer-based data analysis creates an opportunity to develop software to manage an international congenital heart surgery database and eventually become an electronic medical record. The same database data set for congenital heart surgery is now being used in Europe and North America. Additional work is under way to involve Africa, Asia, Australia, and South America. The almost simultaneous publication of the European Association for Cardio-thoracic Surgery/Society of Thoracic Surgeons coding system and the Association for European Paediatric Cardiology coding system resulted in the potential for multiple coding. Representatives of the Association for European Paediatric Cardiology, Society of Thoracic Surgeons, European Association for Cardio-thoracic Surgery, and European Congenital Heart Surgeons Foundation agree that these hierarchical systems are complementary and not competitive. An international committee will map the two systems. The ideal coding system will permit a diagnosis or procedure to be coded only one time with mapping allowing this code to be used for patient care, billing, practice management, teaching, research, and reporting to governmental agencies. The benefits of international data gathering and sharing are global, with the long-term goal of the continued upgrade in the quality of congenital heart surgery worldwide.
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PMID:Software development, nomenclature schemes, and mapping strategies for an international pediatric cardiac surgery database system. 1199 76

In 1998, the first report of the Society of Thoracic Surgery (STS) National Congenital Heart Surgery Database defined clinical features for 18 congenital heart disease categories, providing a significant amount of important information and pinpointing database strengths and weaknesses. Following this report, the STS Congenital Heart Surgery Committee, working with the European Association of Cardio-Thoracic Surgery and the European Congenital Heart Surgeons Foundation, initiated the International Congenital Heart Surgery and Nomenclature Database Project. To standardize nomenclature and reporting strategies and establish a foundation for an international congenital heart surgery database. The project's first report was published in the Annals of Thoracic Surgery in April 2000. The current report outlines modifications to the minimal dataset and diagnosis and procedure short lists.
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PMID:Congenital heart surgery nomenclature and database project. Update and proposed data harvest. 1247 74


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