Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The pathophysiological consequence associated with cardiopulmonary bypass (CPB) has generated a movement away from this technology in the treatment of heart disease. The negative outcomes are multifactorial in origin and may be associated both with the conduct of CPB and the instrumentation of extracorporeal flow. The purpose of this study was twofold. First, to develop a bedside patient risk assessment to aid in the development of a perfusion care plan. Second, to identify the controllable variables used during CPB that contribute to overall morbidity. Controllable perfusion-related variables that were positively linked to improved patient outcomes were identified from randomized, peer-reviewed human studies. Such variables as hematocrit, mean arterial pressure, thermic perfusion, blood lactate, colloid osmotic pressure, pulsatile perfusion, acid base homeostasis, oxygenation, and coated circuitry were included. Patient risk assessment was developed using the Society of Thoracic Surgeon database, where 61 variables affecting postoperative morbidity were identified. These variables were used to develop a bedside tool, Mortality Assessment Perfusion Score (MAPS), to guide the perfusion patient care plan. The MAPS generates a specific value that may predict patient morbidity and mortality based on past mortalities. In conclusion, the improvement in patient outcome may be associated with both the change in conduct of CPB and the quantitative assessment of patient risk stratification and a patient treatment algorithm.
 ...
PMID:Perfusion treatment algorithm: methods of improving the quality of perfusion. 1497 19

This biennial conference was hosted jointly by the Hong Kong Tuberculosis Chest and Heart Diseases Association (under the auspices of the Eastern Region of the IUATLD), the Hong Kong Thoracic Society and the American College of Chest Physicians (Hong Kong and Macau Chapter). It attracted over 1000 delegates, most of whom came from the Asian Pacific Region. There were 25 countries represented. The main themes of the meeting were strategies for dealing with common lung diseases such as asthma, chronic obstructive pulmonary disease (COPD), lung cancer and tuberculosis and human immunodeficiency virus (HIV).
 ...
PMID:International Union Against Tuberculosis and Lung Disease (IUATLD)--20th Eastern Region conference. 4-7 June 1999, Wanchai, Hong Kong. 1612 50

The "Working Group for Congenital Heart Surgery and Pediatric Heart Surgery" of the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) has analysed and recommended structures for congenital heart surgery departments in Germany. The document was worked out according to a similar paper approved earlier by the European Association for Cardio-thoracic Surgery (EACTS). The "Working Group" unifies the majority of cardiac surgeons involved in congenital heart surgery in Germany. Current structures of cardiac centers vary. Therefore the aim of this document is to elucidate additional structural needs for both highly specialized institutions and those for standard care. Specialized centers should allow for treatment of newborns and adult patients with congenital heart disease, include implementation of assist devices and transplantation, possess research facilities and ensure highest standards of education and training. Standard care units do not necessarily need to cater for the above mentioned spectrum. However, the evaluation of quality of care should be given priority in all centers involved in care of patients with congenital heart disease. Data acquisition and transfer must be guaranteed to both the GSTCVS and EACTS in order to ensure national and international comparison of surgical results. This may also give further guidance for improved patient care.
 ...
PMID:[Current structures of cardiac centers]. 1690 91

Plastic bronchitis is an unusual clinical scenario of unknown cause and occurs in multiple clinical settings. The disease is characterized by the development of arborizing, thick, tenacious casts of the tracheobronchial tree that results in airway obstruction. Patients with congenital heart disease who have undergone a Fontan operation are at high risk for having this problem develop. Management of this distressing situation is difficult with only palliative options being available, such as repeated bronchoscopies, inhaled heparin, tissue plasminogen activator, inhaled bronchodilators, or azithromycin. The patients with Fontan circuits have a myriad of unique complications develop, such as atrial arrhythmias, recurrent pleural effusions, chylothoraces, protein-losing enteropathy, and plastic bronchitis. High intrathoracic lymphatic pressures with nondemonstrable lympho-bronchial fistulas were believed to be the cause for the development of these recurrent bronchial casts in plastic bronchitis. Faced with recurrent plastic bronchitis resistant to medical management in 2 Fontan patients with normal Fontan pressures on cardiac catheterization, we decided to explore a surgical solution by performing a thoracic duct ligation. This resulted in complete resolution of the formation of casts in both patients, who were discharged home and remain asymptomatic on continued follow-up. Thoracic duct ligation provides a surgical cure for plastic bronchitis by decreasing intrathoracic lymphatic pressure and flow.
 ...
PMID:Plastic bronchitis: is thoracic duct ligation a real surgical option? 1673 Nov 70

The German Society for Thoracic and Cardiovascular Surgery (GSTCVS) regards 250 operations on patients with congenital heart disease per institution as an optimal number (Thorac Cardiov Surg 2006; 54: 73 - 77). In addition, all German institutions ought to participate unequivocally on data transfer to the European Association for Cardiothoracic Surgery. However, these "optimal German structures" need to be translated into action now. It will have to be the GSTCVS to ask for a hearing at the Federal Joint Committee (G-BA) (www.g-ba.de). This medical self-governing body, formed from the national associations of doctors and dentists, the German Hospital Federation and the health insurance funds, gives concrete definition to the legal requirements and implements them. Recently, the Federal Joint Committee released concrete measures for the care of newborns (Press release 21. 9. 2005, section sign 91 Abs. 7 SGB V). The obvious thing to do now would be considering measures for care of patients with congenital heart disease. We conclude, that whereas treatment and results should be further improved by quality control and quality transparency, structures of institutions involved in the care of patients with congenital heart disease can only be implemented by the Federal Joint Committee.
 ...
PMID:[Revision of guidelines for the management of patients with congenital heart failure in Germany]. 1654 45

Atrial fibrillation is the most common sustained cardiac rhythm disturbance, affecting an estimated 2.5 million people in the United States. Atrial fibrillation may occur with or without structural heart disease. The medical and surgical literature has seen an exponential growth in reports of ablation techniques and the Cox-Maze procedure to treat atrial fibrillation. There has been no agreement or standards on the proper reporting of these techniques and results. The current literature is in disarray, and this report is an attempt to provide a framework for the necessary elements to be included in reports on this subject. The Workforce on Evidence Based Surgery of the Society of Thoracic Surgeons encourages the adoption of these guidelines for reporting clinical results derived from patients undergoing surgical procedures for atrial fibrillation. Adoption of these guidelines will greatly facilitate the comparison between the reported experiences of various authors treating different cohorts of patients at different times with different techniques and energy sources. These guidelines are also appropriate for catheter-based treatment of atrial fibrillation. Thus, more reliable evaluation and comparisons of results will advance our knowledge and further the development and application of these procedures.
 ...
PMID:Guidelines for reporting data and outcomes for the surgical treatment of atrial fibrillation. 1795 23

This review discusses the historical aspects, current state of the art, and potential future advances in the areas of nomenclature and databases for congenital heart disease. Five areas will be reviewed: (1) common language = nomenclature, (2) mechanism of data collection (database or registry) with an established uniform core data set, (3) mechanism of evaluating case complexity, (4) mechanism to ensure and verify data completeness and accuracy, and (5) collaboration between medical subspecialties. During the 1990s, both the Society of Thoracic Surgeons (STS) and the European Association for Cardiothoracic Surgery (EACTS) created congenital heart surgery outcomes databases. Beginning in 1998, the EACTS and STS collaborated in the work of the International Congenital Heart Surgery Nomenclature and Database Project. By 2000, a common congenital heart surgery nomenclature, along with a common core minimal data set, were adopted by the EACTS and the STS and published in the Annals of Thoracic Surgery. In 2000, the International Nomenclature Committee for Pediatric and Congenital Heart Disease was established; this committee eventually evolved into the International Society for Nomenclature of Paediatric and Congenital Heart Disease (ISNPCHD). The working component of ISNPCHD is the International Working Group for Mapping and Coding of Nomenclatures for Paediatric and Congenital Heart Disease, also known as the Nomenclature Working Group (NWG). By 2005, the NWG cross-mapped the EACTS-STS nomenclature with the European Paediatric Cardiac Code of the Association for European Paediatric Cardiology and created the International Paediatric and Congenital Cardiac Code (IPCCC) ( http://www.IPCCC.NET ). This common nomenclature (IPCCC), and the common minimum database data set created by the International Congenital Heart Surgery Nomenclature and Database Project, are now utilized by both EACTS and STS; since 1998, this nomenclature and database have been used by both the STS and EACTS to analyze outcomes of more than 75,000 patients. Two major multi-institutional efforts have attempted to measure case complexity; the Risk Adjustment in Congenital Heart Surgery-1 and the Aristotle Complexity Score. Efforts to unify these two scoring systems are in their early stages but are encouraging. Collaborative efforts involving the EACTS and STS are under way to develop mechanisms to verify data completeness and accuracy. Further collaborative efforts are also ongoing between pediatric and congenital heart surgeons and other subspecialties, including pediatric cardiac anesthesiologists (via the Congenital Cardiac Anesthesia Society), pediatric cardiac intensivists (via the Pediatric Cardiac Intensive Care Society), and pediatric cardiologists (via the Joint Council on Congenital Heart Disease). Clearly, methods of congenital heart disease outcomes analysis continue to evolve, with continued advances in five areas: nomenclature, database, complexity adjustment, data verification, and subspecialty collaboration.
 ...
PMID:Nomenclature and databases - the past, the present, and the future : a primer for the congenital heart surgeon. 1748 90

This article reviews the challenges in caring for individuals with congenital heart disease in developing countries and is drawn in part from the author's Presidential Address to the American Association for Thoracic Surgery in Philadelphia, May 2006. Economic globalization is resulting in demographic and lifestyle changes which are increasing the incidence of ischemic heart disease worldwide. A massive expansion of cardiothoracic surgery in developing countries is beginning. Although the rate of coronary surgery is contracting in Western countries, the population bulge that is approaching 65 years of age will also stretch surgical manpower and resources in developed countries within 10 to 20 years. The incidence of congenital heart disease is stable, but earlier and more accurate diagnosis is rapidly increasing the numbers of children needing the services of a congenital cardiac surgery team. Many opportunities for philanthropy are available, but care should be taken to assist in the most meaningful way by working with a long-term educational program and avoiding surgical tourism.
 ...
PMID:Congenital heart surgery in developing countries. 1839 18

Intracardiac repair of double outlet right ventricle (DORV) remains controversial. DORV is a particular mode of ventriculo-arterial connection and not a specific congenital heart disease. It can exhibit a wide spectrum of anatomic and physiologic variations. This heterogeneity has naturally led to controversies over the anatomical definition, classification schemes, and the techniques for surgical repair. From a surgical standpoint, the functional classification that was adopted together by the Society of Thoracic Surgeons (STS), The European Association of Cardio-Thoracic Surgery (EACTS) and the Association of the European Pediatric Cardiologists (AEPC), provides useful information to understand the anatomical variations and the choice of the surgical technique. The lesions that remain a surgical challenge are those where "200% of the great vessels" arise from the right ventricle. Namely: DORV-nc-VSD and DORV-AVSD-heterotaxy. Both of these lesions have traditionally been indications for single-ventricle palliation. In our series, there was one death in 15 of these challenging patients (6.7% mortality) following bi-ventricular repair. Two patients required a one and a half repair. Long-term results of biventricular repair of complex DORV are not yet available. These data would be crucial to validate the intracardiac repair technique."
 ...
PMID:Intracardiac repair of double outlet right ventricle. 1839 23

The Congenital Cardiac Anesthesia Society was formed in 2005 by representatives from many of the busiest congenital cardiac surgical programs in North America and is now in the process of partnering with The Society of Thoracic Surgeons to create a joint congenital cardiac surgery and congenital cardiac anaesthesia database. Even the busiest of congenital cardiac programs have a low frequency of anaesthesia-related cardiac complications and deaths. One of the only mechanisms for accurately determining the incidence and outcomes of low frequency events is to aggregate large amounts of data from multiple sources. To that end, the Congenital Cardiac Anesthesia Society has joined with the Society of Thoracic Surgeons Congenital Database Task Force to incorporate anaesthesia-specific data points into their surgical registry, which is now the largest single reporting site for children and adults undergoing surgical repair of congenital cardiac malformations in North America. The Joint Congenital Cardiac Anesthesia Society--Society of Thoracic Surgeons Database will therefore become an optional module of The Society of Thoracic Surgeons Congenital Heart Surgery Database. Initial data fields have been selected and are presented in this article. Efforts are ongoing to make this initiative a global project. Initial collaborative discussions have taken place about the possibility of linking this initiative with the European Association of Cardiothoracic Anesthesiologists. It is certainly possible and desirable that the planned anaesthesia module of The Society of Thoracic Surgeons Congenital Heart Database has an identical module in the congenital heart database of The European Association for Cardio-Thoracic Surgery and The European Congenital Heart Surgeons Association. This project should also ideally spread beyond North America and Europe. Efforts to involve Africa, Asia, Australia, and South America are necessary and already underway. The creation of a joint cardiac surgery and anaesthesia database is another step towards the ultimate goal of creating a database for congenital heart disease that spans both geographical and subspecialty boundaries.
 ...
PMID:Databases for assessing the outcomes of the treatment of patients with congenital and paediatric cardiac disease--the perspective of anaesthesia. 1906 82


<< Previous 1 2 3 4 5 6 Next >>