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

Sixteen patients presenting on 21 occasions with atrial flutter in association with complex congenital heart disease were treated by intracardiac stimulation techniques combined with activation mapping. Nineteen episodes of atrial flutter were successfully converted to sinus rhythm. In the remaining two episodes atrial fibrillation was induced with spontaneous conversion to sinus rhythm within 12 hours in one episode and immediate DC cardioversion to sinus rhythm in the other. Intracardiac stimulation techniques were highly successful in this group and allowed reliable conversion to sinus rhythm without general anaesthesia and high energy cardioversion. In patients with atrial flutter associated with congenital heart disease intracardiac stimulation techniques should be tried first.
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PMID:Successful intracardiac electrical conversion of atrial flutter in patients with complex congenital heart disease. 205 47

Potassium homeostasis was studied in 30 patients undergoing cardiac surgery by employing cardiopulmonary bypass (CPB) and moderate hypothermia, and using morphine, N2O, relaxant anaesthesia. There was a trend for hypokalemia, and for maintaining a K+ level of 4-4.5 mmol/l, K+ infusion was required during CPB (9.017 mmol/m2 BSA/h). K+ infusion required in the post-operative period was considerably less (1.532 mmol/m2 BSA/h). There was no significant difference in the K+ levels of patients receiving preoperative diuretic therapy, as compared to those not receiving such therapy. Potassium requirement was significantly higher in patients under-going CABG and valvular heart disease, as compared to congenital heart disease. The mean urinary loss of K+ during bypass was found to be 2.95 mmol/m2 BSA/h, which was only 32 per cent of that required to be infused (9.017 mmol/m2 BSA/h). The mean excretion of K+ in the post operative period was significantly higher (4.53 mmol/m2 BSA/h) than K+ required to be infused during this period (1.532 mmol/m2 BSA/h).
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PMID:Potassium homeostasis during & after cardiopulmonary bypass. 207 59

In this article, we reported the analysis of two severe diseases complicating pregnancy: 1,918 cases of heart disease in last 36 years and 22 cases of severe hepatitis in last 16 years. The conclusion was that on active therapy and close cooperation with cardiologist, pregnancy complicated with heart disease of grade III-IV cardiac function can be taken as an indication of Cesarean section. This operation performed at a proper time is good for the mother and also the baby. The traditional idea that Cesarean section could only be done for an obstetrical reason is not quite adequate. For primiparas with severe hepatitis, a supportive therapy with fresh blood transfusion, albumin and Cesarean section under local anesthesia might be the method of choice, its mortality rate being much lower than a vaginal delivery.
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PMID:[Cesarean section in pregnancy complicated by severe hepatitis and heart disease]. 232 68

The aims of this study were to: 1) determine the incidences and causes of mortality associated with anaesthesia and surgery, 2) identify important factors associated with mortality in hospital, and 3) estimate the mortality risk associated with anaesthesia and surgery when a combination of risk factors are present. A total of 7306 anaesthetized patients undergoing abdominal, urological, gynaecological, or orthopaedic surgery were included in the study. Of these, 0.05% (1:1800) died during anaesthesia, 0.1% (1:730) during the recovery period, and the overall mortality rate in hospital was 1.2% (1:81). Most deaths occurred in the elderly (greater than or equal to 70 years of age) and were unavoidable due to progression of the presenting condition, such as advanced cancer, or co-existing diseases such as cardiopulmonary or renal failure. Of the patients who developed myocardial infarction (MI) following anaesthesia, 67% (8/12) died in the postoperative period. Half of the MI patients who died received regional anaesthesia, and in addition suffered from periods of cardiovascular dysfunction intraoperatively. By utilizing logistic regression analysis, a model for prediction of mortality risk was developed. The model included five significant preoperative predictive variables: age; patients with history of chronic heart disease, and renal disease; emergency surgery; and the type of operation. With this model it is possible to distinguish between patients with very different mortality risks.
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PMID:A prospective study of mortality associated with anaesthesia and surgery: risk indicators of mortality in hospital. 234 17

Anesthesia of patients suffering from one of the various types of myopathy and with a view to orthopedic operation, cannot be univocal. Operating indications, preparation, results, vary according to the type of suffering. The absence of associated cardiopathy allows surgery even with severe respiratory failures. The experiment of an orthopedic surgery department over a 10 years period shows that these patients may be effectively taken charge of by a multidisciplinary group, thus restricting to a maximum their hospital stay for the benefit of at home hospitalization techniques.
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PMID:[Anesthesia in neuromuscular diseases. Experience in orthopedic and spinal surgery]. 236 82

Oxygen consumption (VO2, ml min-1) and carbon dioxide elimination (VCO2, ml min-1), minute ventilation (VE), tidal volume (VT), rate of ventilation (f) and end-tidal carbon dioxide concentration (E'CO2%) were measured in 38 infants and children (body weights 3.6-25 kg). Four children (body weight less than 5 kg) had congenital heart malformations and were studied during controlled mechanical ventilation, whereas the remainder (n = 34) who were healthy, breathed spontaneously. Anaesthesia was maintained with oxygen in air (FIO2 0.45) and halothane through a non-rebreathing circuit. Minute ventilation was measured by pneumotachography, E'CO2 with an in-line infra-red carbon dioxide meter and gas concentrations with a mass spectrometer. There were no differences in VO2 and VCO2 between children with and without heart disease. VO2 was related to body weight by the equation: VO2 = 5.0 x kg + 19.8 (r = 0.94) and VCO2 to body weight by the equation: VCO2 = 4.8 x kg + 6.4 (r = 0.94). There were no differences between VO2 or VCO2 before and after the start of surgery. In 11 of 21 patients weighing less than 10 kg, a reduced VCO2 was noted, giving respiratory quotients of less than 0.7. It is speculated that this age-dependent variation of VCO2 may result from partial inhibition of lipolysis in brown adipose tissue produced by halothane.
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PMID:Oxygen consumption and carbon dioxide elimination in infants and children during anaesthesia and surgery. 249 15

This article summarized the effects of combined acupuncture-epidural anaesthesia (n = 37) and epidural anaesthesia (n = 37) for operations of patients being in a critical, old, weak or special condition. And, the effects were compared between the two different anaesthetic methods in a similar clinical condition. The patients studied were almost complicated with coronary arteriosclerotic heart disease, hypertension or other types of disease excepting the surgical condition. There were different degrees of functional disturbance in their important visceral organs. The states of the body were all belong to critical or weak condition. This might be a difficulty of considerably great for anaesthesia and operation. By using combined acupuncture-epidural anaesthesia, the advantages of acupuncture anaesthesia and epidural anaesthesia were brought into fully play, and, the defect of incomplete analgesia as well as inadequate muscle relaxation was remedied. By acupuncture for 30 to 40 minutes, the EGGs that were originally abnormal had shown some improvement in parts of case and recovered to normal in individual patient. Even though the EGGs had not shown improvement in some cases, but, took no further steps to deteriorate, although undergoing harmful effects in operative process, such as exploration, hemorrhage or others. In some cases, the circulative function showed stabilization exceeding one's expectations. The result showed that acupuncture has a regulative role on the cardiovascular system, thus enhancing the safety in anaesthetic process.
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PMID:[A summary on effects of combined acupuncture anaesthesia for critical, old, week, special patients]. 251

This report is concerned with presentation of overall experience with abdominal aneurysmectomy, carried out upon 500 consecutive cases during the last 20 years. Emphasis is placed upon substantially improved results of the last decade in terms of survival and late mortality thus, leading to an increased spectrum of operative indications together with justified surgical aggression in the overall management of abdominal aneurysm. Elective surgery was applied upon 385 cases whereas in the remaining 115, emergency undertaking was necessary. Mortality in elective surgery was 3%. From the group of 115 emergency operations, 70 represent formal rupture with a mortality of 32% and 35 exhibited symptomatology compatible with threatening rupture. Mortality in this particular group was 8%. There was an age ranging from 38 to 87 years, with a mean age of 62.2. A definite preponderance of the disease was noted in patients between 60 and 70 years of age (17%-29%). Risk factors including heart disease, hypertension and advanced age, were responsible for the majority of deaths occurred within 30 days. Subsequent decrease of mortality should be attributed to improvements of anesthesia, monitor equipments and other supportive measures during and immediately following the operation within modern intensive care unit. Cardiac cases were the predominant cause of late death (24%) with following cerebrovascular insufficiency (8.1%), cancer (5%) and chronic pulmonary disease (6%). No particular difference in mortality was noted among the three group of patients classified according to the 60, 70 and 80 decade of their age.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Twenty years experience with abdominal aneurysmectomy. Surgical considerations and analysis of late results. 259 92

Changes in plasma level of arginine vasopressin (AVP), arterial pressure, and urine flow were studied before, during and after cardiopulmonary bypass (CPB) in 11 patients with congenital heart disease. Anesthesia was induced with thiopental sodium (3-5 mg/kg) and was maintained with enflurane (1.0-1.5%), 50% N2O in O2 and morphine (0.5 mg/kg). Concentration of plasma AVP increased slightly from 3.8 +/- 1.5 pg/ml after induction and increased 3-fold after sternotomy. Plasma AVP level increased to 132 +/- 26 pg/ml and 218 +/- 54 pg/ml after 5 and 60 min on CPB, respectively. When the circulation returned to normal, plasma AVP level decreased gradually but was still significantly higher at 24 hr (13.4 +/- 2.5 pg/ml). Marked osmolar diuresis was induced with mannitol in the priming solution used during the CPB: increases in urine flow, Na excretion and osmolar clearance. Possible mechanisms of marked increase in AVP release and differences of AVP responses during CPB reported by other investigators are discussed.
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PMID:Responses of vasopressin release in patients with cardiopulmonary bypass anesthetized with enflurane and morphine. 259 63

We reviewed 212 patients whom we consulted before elective surgery concerning their indications of operation and anesthetic risks for the last 18 month periods. Patients' ages were between 6 months to 89 years old, and 46% of the patients consulted were over 60 years of age. Main medical problems related to anesthetic risks included cardiovascular problems (36% of patients), respiratory problems (14%), the abnormality of metabolism or endocrine (8%), hepatic dysfunction (8%), and so on. Most of the patients with ischemic heart disease, hypertension, dysrhythmia, or dysfunction of respiratory system, were over 60 years of age. Those with diabetes mellitus, dysfunction of liver or kidney, or anemia were over 40 years of age. Those with convulsion or congenital heart disease were under 19 years of age. In attempting anesthetic evaluations, patients were assessed according to ASA physical status classification; class I (3%), class II (56%), class III (36%), class IV (5%). Although there was no patient who had intraoperative cardiac arrest or death related to anesthesia, postoperative mortality within 3 months were 19% for ASA class III patients and 60% for class IV. And all ASA IV patients who received their operation died postoperatively. In patients who were classified as ASA III or IV, we feel it is better to add more detailed classification such as Goldman's classification in addition to physical status classification of ASA for preanesthetic assessments of patients, because the majority of patients were elderly with life-threatening complications of cardiovascular and/or respiratory systems.
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PMID:[An analysis and evaluation of anesthetic consultations for patients undergoing elective surgery]. 261 94


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