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

We have treated 39 infants and children with congenital heart disease with extracorporeal membrane oxygenation during the past 5 years. Thirty-six were treated for low cardiac output or pulmonary vasoreactive crisis after repair of congenital heart defects. Twenty-two (61%) survived. Most patients were cannulated from the neck via the right internal jugular vein and the right common carotid artery. Six patients were cannulated from the chest, including three who had separate drainage of the left side of the heart with a left atrial cannula. Two of these patients survived and were the only survivors of the nine patients cannulated in the operating room because they could not be weaned from cardiopulmonary bypass after open cardiac operations. We also reviewed 312 patients (the predictor study series) having open cardiac operations before the availability of extracorporeal membrane oxygenation; 27 of these patients died. Data were collected at 1 and 8 hours postoperatively to determine if any parameters might predict early mortality. With these parameters used as criteria, patients who went on extracorporeal membrane oxygenation were as sick as those who died before extracorporeal membrane oxygenation was available. The most common complication was bleeding related to heparinization. The mean transfusion requirement in survivors was 1.50 +/- 1.13 ml/kg/hr, 5.63 +/- 7.0 ml/kg/hr in the nonsurvivors, and 7.46 +/- 8.29 ml/kg/hr in those cannulated in the operating room because they could not be weaned from bypass. Four children had intracranial hemorrhage, and two of them died. There was one late death. Nine of the 22 survivors are entirely normal. All survivors who do not have Down's syndrome are considered to have normal central nervous system function. We conclude that extracorporeal membrane oxygenation can improve survival in patients with both pulmonary artery hypertension and low cardiac output after operations for congenital heart disease.
J Thorac Cardiovasc Surg 1990 Oct
PMID:Extracorporeal membrane oxygenation for the circulatory support of children after repair of congenital heart disease. 221 28

Due to surgical advances, cardiac tumors now represent a potentially curable form of heart disease. Primary cardiac tumors are very rare; secondary, metastatic tumors are 10-40 times more frequent. The majority (75%) of primary tumors is benign. Cardiac tumors may produce hemodynamic disturbances, mechanical hemolysis, biochemical effects and constitutional symptoms. According to the anatomic location of the tumor, some special symptoms and physical findings can be grouped with regard to pericardial, myocardial, and endocardial involvement. Several laboratory data (elevated sedimentation rate, anemia, thrombocytopenia etc.) may give additional hints to suggest cardiac involvement in neoplastic disease. Among the diagnostic procedures, two-dimensional echocardiography has become the most important method for non-invasive detection of cardiac tumors. The importance of invasive procedures has declined by the improvement of non-invasive imaging techniques, but pressure measurements within the cardiopulmonary system, left-sided, pulmonary angiography as well as coronary angiography give additional useful and necessary information prior to surgery. Within the spectrum of differential diagnosis, particularly mitral, aortic, or tricupid valve disease, bacterial endocarditis, or autoimmune diseases have to be ruled out. Thus, in the vast majority of cases the correct diagnosis can be made. This is crucial for further management of the patient since the majority of primary cardiac tumors can be successfully treated by surgery.
Thorac Cardiovasc Surg 1990 Aug
PMID:Clinical aspects of cardiac tumors. 223 94

In 1986, a total of 18 430 open-heart procedures was performed in Japan. Whereas surgery of congenital heart disease amounted to 46% of all operations, cardiac tumors caused only 0.8% (148 cases). The results of an investigation based on data from 9 Japanese institutes over a period of 5 years show that myxomas are the most frequent tumors of the heart (74 out of 89 cases). Among 89 cardiac tumors there were 6 malignant neoplasms. More females were affected than male patients. Most of the myxomas were localized in the left atrium (66 out of 74). The majority of the myxomas originated from the atrial septum, two myxomas derived from atrio-ventricular valves. Inflow and outflow obstruction, valvular dysfunction and arrhythmias were the most common symptoms of cardiac tumors. In 88 patients resection of the tumor could be performed, in 4 cases combined with mitral valve replacement and in one case mitral valvuloplasty. In one patient, only a tumor biopsy was possible. Reoperation for recurrent myxoma had to be carried out in 4 patients after an interval of 1-6 years. In the case of a large left atrial tumor the circular incision of the biatrium is preferred by our group. This large approach facilitates the removal of the tumor, enables the repair of the left atrial posterior wall and atrial septum as well as the surgery of the mitral valve. If necessary, this surgical technique can easily be switched to cardiac autotransplantation. With regard to new operative procedures we are convinced that surgical intervention for cardiac tumors can be applied more widely in future.
Thorac Cardiovasc Surg 1990 Aug
PMID:Tumors of the heart. Incidence and clinical importance of cardiac tumors in Japan and operative technique for large left atrial tumors. 223 3

Infective endocarditis in young children is uncommon, especially where there is no underlying structural heart disease. While septic embolization in adults occurs in up to 43% of the cases of endocarditis, there is little data on systemic embolization in cases of children. We present an unusual case of a 25-month-old child with infective endocarditis and an embolomycotic aneurysm treated by mitral valve replacement and aortoiliac reconstruction.
J Cardiovasc Surg (Torino)
PMID:Infective endocarditis and an embolomycotic aneurysm in a 25-month-old child. 226 12

Assessment of indications for cardiac transplantation is a complex process including first a comparison of expected survival of a patient with end-stage heart disease, mostly ischemic or dilative cardiomyopathy, allocated either to conventional medical or surgical therapy or to cardiac transplantation, second the expected increase in exercise tolerance and quality of life after transplantation. Furthermore the exclusion of contraindications is required: severe irreversible secondary organ damage (especially of kidneys and liver), malignant tumors and systemic malignancies, severe pulmonary hypertension, florid infections, unstable psychosocial conditions of the patient and his surrounding. Although a considerable number of clinical, electrocardiographic, echocardiographic and hemodynamic factors have been defined as indicating very poor prognosis, there exists no prognostic index combining all these factors into a precise prediction of survival of an individual patient with end-stage cardiac failure. Whereas high survival rates have been concordantly documented for the first years after transplantation, the long-term prognosis cannot be estimated as yet with equally sufficient certainty, due to increasing observation of vasculopathies and of progressive myocardial (mostly diastolic) dysfunction of transplanted hearts. These problems suggest to continue with very careful selection of candidates for transplantation. Even in the case of cardiac decompensation and poor prognostic factors, usually a single examination of the patient is not sufficient, but rather a thorough observation of the patient over a period of time including an evaluation of the rate of clinical and hemodynamic decline and of the response to medical therapy.
Thorac Cardiovasc Surg 1990 Oct
PMID:Indications and selection criteria for cardiac transplantation. 226 35

This review concerns the clinical impact of treating hyperlipidemia. The U.S. Lipid Research Clinics Coronary Primary Prevention Trial, the Helsinki Heart Study, and the Oslo Primary Prevention Trial all consistently showed that intensive and long-term (5-7 years) lipid-lowering treatment is successful in reducing the incidence of fatal and nonfatal myocardial infarction. Secondary prevention trials (Coronary Drug Project and the Stockholm Ischaemic Heart Disease Secondary Prevention Study) have overall confirmed this result. Assessment of progression/regression of atherosclerosis by invasive or noninvasive methods has shown that an important mechanism underlying the reduction of coronary events with long-term lipid-lowering treatment is that involving stabilization or regression of arterial lesions. An additional advantage from lipid-lowering treatment might come from useful hemodynamic changes, occurring shortly after the start of an intensive cholesterol-lowering treatment with low-density lipoprotein apheresis.
Cardiovasc Drugs Ther 1990 Oct
PMID:Clinical relevance of hyperlipidemia. 227 73

To assess the antiarrhythmic efficacy of oral d,l-sotalol, 68 patients with sustained monomorphic ventricular tachycardia (SMVT) (n = 62) or ventricular fibrillation (VF) (n = 6) were studied by programmed ventricular stimulation (PVS). Fifty-one patients had coronary artery disease with a previous myocardial infarction and there were 17 patients without coronary disease: 11 patients had right and/or left ventricular dysplasia, one patient an aortic-valve replacement, and five patients had no visible heart disease. Prior to sotalol patients were treated with a mean of 3.6 +/- 1.3 antiarrhythmic class I drugs. None of these drugs prevented SMVT or VF. During control PVS (PVS 1), VF was induced in 8 patients (12%), SMVT in 47 patients (69%), and nonsustained ventricular tachycardia (NSVT) in 13 patients (19%). After loading with oral d,l-sotalol (320 mg/day), PVS (PVS 2) was repeated 4.2 +/- 3.3 weeks after PVS 1. In one of the patients (1%) VF was inducible, in 15 patients (22%) SMVT was induced, and in 18 patients (26%) NSVT was induced. In 34 patients (50%) either no or a short ventricular response was inducible. Our data show that oral d,l-sotalol is an effective antiarrhythmic agent in patients with SMVT or VF.
Cardiovasc Drugs Ther 1990 Oct
PMID:Sotalol in patients with life-threatening ventricular tachyarrhythmias. 227 75

During a 7-year period, 11 adult members of the religious sect Jehovah's Witnesses underwent cardiac surgery with extracorporeal circulation. No homologous blood transfusions were given. Blood-conserving procedures were employed, viz. initial collection of autologous blood, haemofiltration or processing (Cell Saver) of blood collected during extracorporeal circulation and reinfusion of shed mediastinal blood. The total perioperative blood loss averaged 1080 ml (15 ml/kg body weight), equalling 19% of total body blood volume. The mean haemoglobin on discharge from hospital was 11.0 g/100 ml. There was no perioperative mortality. Postoperative pulmonary function was good and there was no serious morbidity. Jehovah's witnesses with serious, surgery-necessitating heart disease can be offered operation comprising recognized blood-conserving procedures.
Scand J Thorac Cardiovasc Surg 1990
PMID:Open-heart surgery in Jehovah's Witnesses. 229 52

Orthotopic heart transplantation has become standard therapy for end-stage cardiomyopathy in children and adults, but there has been much less experience with transplantation for complex congenital heart disease. In this report experience with orthotopic transplantation in seven children with various forms of complex congenital heart disease is reviewed. Diagnoses included hypoplastic left heart syndrome in two (after stage I palliation), left ventricular diverticulum in one, single ventricle in two (dextrocardia, atrial situs inversus, and total anomalous pulmonary venous return in one patient and post-Fontan repair in the second), D-transposition of the great arteries and ventricular septal defect (post-Senning repair and ventricular septal defect closure) in one, and Ebstein's anomaly with biventricular dysplasia in one. Six of the seven were hospital survivors and there has been one late death at 2 1/3 years. Modifications of the standard operative technique to fit the anatomic variations in these defects are reviewed.
J Thorac Cardiovasc Surg 1990 Mar
PMID:Orthotopic heart transplantation for complex congenital heart disease. 230 66

Six patients with no hemodynamically significant atherosclerotic lesions of the lower limb arteries but with ischemic changes of the feet or toes were studied and diagnosed as having atherothrombotic microembolism. All patients were non claudicators and had peripheral Doppler examinations on admission. Five patients experienced more than one separate episode of microembolization involving both extremities. None presented with a history of heart disease or diabetes. Biplanar arteriograms revealed in every case atherosclerotic degeneration of the aorta without any obstructing lesions and anatomical arterial continuity between the aorta and the site of distal embolization. Three patients who refused operation, were treated conservatively, with a combination of dipyridamole plus aspirin. Three other patients had surgical repair of their atheromatous infrarenal aorta: in two cases thromboendarterectomy was performed, and in the other a Dacron bifurcated graft interposition. No amputations resulted in the patients treated medically, but one of the surgical group lost one toe. This study confirms that atherothrombotic microembolism from an ulcerated atherosclerotic aorta is a potential threat to the extremities and indicates that the optimal therapy for this syndrome has yet to be found.
J Cardiovasc Surg (Torino)
PMID:Atherothrombotic microembolism of the lower extremities (the blue toe syndrome) from atherosclerotic non-aneurysmal aortic plaques. 232 90


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