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

The concentration of carbon dioxide in end-tidal gas was compared with the tension in arterial or superior vena caval blood during thoracotomy in twelve patients. In six adults requiring pulmonary resection, one-lung anaesthesia did not change the difference between the two measurements. In six children in whom a systemic to pulmonary arterial anastomosis was being created to improve pulmonary blood flow impaired by cyanotic congenital heart disease, occlusion of the pulmonary artery caused in increase in the blood-end-tidal carbon dioxide gradient. This change was particularly marked in two neonates and was of sufficient magnitude to render end-tidal monitoring unreliable in these circumstances.
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PMID:End-tidal carbon dioxide during thoracotomy. Its relation to blood level in adults and children. 679 17

The normoxic ventilatory drive contributes to the normal level of ventilation, and the hypoxic ventilatory drive contributes to the maintenance of adequate gas exchange in the presence of ventilation/blood flow maldistribution and increased mechanical load to breathing. This respiratory drive arises principally from stimuli at the carotid chemoreceptors. The reflex cardiovascular responses to hypoxia also contribute to the delivery of O2 to vital organs, and their efficacy depends on the integrity of the respiratory response and the autonomic nervous system as well as the function of the vascular system. Prolonged exposure to hypoxemia from altitude, cyanotic congenital heart disease, and chronic pulmonary disease impair the ventilatory response to hypoxia. In addition, the respiratory and cardiovascular responses to hypoxemia are impaired by familial or acquired abnormalities of the autonomic effector system. There is growing evidence that impaired respiratory response to hypoxemia is a major factor in recurrent respiratory failure in obesity, obstructive pulmonary disease, idiopathic or familial "hypoventilation," and contributes to disturbances in oxygenation during sleep [152, 189, 192, 202]. Although the ventilatory response to hypoxemia was traditionally thought to be resistant to the effects of inhalational anesthetics, barbiturates, and narcotics, there is abundant evidence that in fact the ventilatory response to hypoxia is more sensitive to depression by drugs than the ventilatory response to CO2. In addition, the hemodynamic responses to hypoxia are modified by anesthesia and anesthetic techniques. The clinical implications of these observations are wide. The ventilatory and cardiovascular response to hypoxemia will be altered, and usually depressed by age, disease processes, premedicant and anesthetic drugs, and autonomic blocking drugs. The cardiovascular responses will be modified indirectly by altered ventilatory control due to neuromuscular blocking drugs and controlled ventilation. Thus, not only will the responses to hypoxemia be depressed by anesthesia but the early clinical hemodynamic signs will be modified or absent, or indeed the cardiovascular response will further impair oxygen delivery. Furthermore, it is not only anesthetic doses that impair the reflex respiratory responses, but also subanesthetic doses of inhalational anesthetics and premedicant doses of barbiturates and narcotics. Hence the patient in the perioperative period continues to have impaired respiratory response to hypoxemia. As anesthetic and surgical care extends to older patients, patients with systemic disease, and recipients of cardiovascular peripheral and central drugs, the clinical implications of the impairment of ventilatory and cardiovascular responses to hypoxia, and the maintenance of organ and system function, escalate. Only a few hesitant steps have been taken into this vast arena of clinical and experimental research.
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PMID:Respiratory and cardiovascular responses to hypoxemia and the effects of anesthesia. 702 55

The purpose of this report is to present the findings in a neonate with tetralogy of Fallot and a history of prolonged sleep-related apnea requiring resuscitation. At a baseline arterial oxygen pressure of 46 mm Hg, his preoperative responses to carbon dioxide during non-REM sleep (26.1 and 26.6 ml/kg/min/mm Hg of alveolar carbon dioxide tension [PACO2]) were identical to those reported in near-miss sudden infant death syndrome. Following a systemic-pulmonary arterial shunt, the arterial saturation reached 95 percent, and no further apnea occurred. The prompt normalization of the response to carbon dioxide following surgery (75.2 and 75.4 ml/kg/min/mm Hg of PACO2) indicates that, unlike infants with the sudden infant death syndrome, a low sensitivity to carbon dioxide in infants with cyanotic heart disease may be dependent on hypoxemia and, thus, reversible.
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PMID:Reversible central apnea in an infant with cyanotic heart disease. 735 86

A dependence is studied between changes in the HCO3- and CO2 levels, the content of pyruvate and lactate in blood and the manifestation of disturbances of external respiration in pregnant women suffering from the rheumatic and congenital heart disease. Changes in the carbonic acid level in the blood of pregnant women with pathology of the cardiovascular system correlate reliably, with the frequency and gravity of complications in the course of pregnancy, labour, the state of the fetus and newborn. Some modern methods are considered for regulating acid-base balance, their brief critical analysis is presented with the view of using them in the obstetric practice. Possibility of carbostimulin application in hypoxic states of the mother, fetus and newborn is discussed.
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PMID:[State of blood acid-base balance of the normal pregnant woman, fetus and newborn and with hypoxia and certain aspects of its regulation]. 738 72

A possible relationship between passive smoking and coronary heart disease has been widely debated during the past decade. Convincing evidence links environmental (passive) tobacco smoke exposure to heart disease morbidity as well as mortality. In the United States, 37,000 coronary heart disease deaths per year are attributed to environmental tobacco smoke exposure, accounting for 70% of all deaths caused by environmental tobacco smoke. The analysis of 10 epidemiologic studies indicated a consistent dose-response effect related to exposure, but more proof is still needed. Evidence indicates that nonsmokers are more sensitive to smoke, including cardiovascular effects, and that sidestream smoke contains higher concentrations of gas constituents, including carbon monoxide. Pathophysiological and biochemical data after short- and long-term environmental tobacco smoke exposure show changes in endothelial and platelet function as well as exercise capacity similar to those in active smoking. Therefore, passive smoking is a relevant risk factor for heart disease morbidity and mortality.
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PMID:Passive smoking and cardiovascular risk. 757 47

From April 1987 to September 1993, 60 infants underwent a Norwood operation for complex congenital heart disease including hypoplastic left heart syndrome (n = 41), ventricular septal defect and subaortic stenosis with aortic arch interruption/severe coarctation (n = 7), complex single right ventricle with subaortic stenosis (n = 8), critical aortic stenosis with endocardial fibroelastosis (n = 2), and malaligned primum atrial septal defect with coarctation (n = 2). Age at operation ranged from 1 day to 3.9 months (mean 9 days, median 3.5 days). The operative mortality (< 30 days) was 33% (20 patients). Late mortality was 17% (10 patients). Nine of the 20 (45%) operative deaths occurred during the first 2 days after the operation as a result of sudden hemodynamic instability. All four infants with premature closure of the foramen ovale had pulmonary lymphangiectasia and died of pulmonary failure. Seven operative deaths have occurred in 36 patients since 1990 (19%); in the past 2 years, no operative deaths have occurred in 22 patients. Overall, there are 30 long-term survivors (50%). Twenty-one of these 30 infants have undergone a two-stage repair with a modified Fontan operation at 7.3 to 27.6 months of age (mean 18.1 months) with no mortality. Six patients have entered a three-stage repair strategy by undergoing a hemi-Fontan procedure at 6.8 to 23.0 months (mean 8.8 months) with no mortality, and two of these patients have now had their modified Fontan operation at 23.0 to 46.7 months of age with no mortality (four are still awaiting surgery). Two patients have undergone a two-ventricle repair with a Rastelli procedure, with no mortality at 7.4 and 14.1 months of age. Early in our experience, infants undergoing the Norwood operation had a high early mortality most often related to sudden hemodynamic instability. After we instituted a protocol that adds carbon dioxide to the inspired gas during postoperative mechanical ventilation, the postoperative course became more stable and there have been no operative deaths. In summary, the operative mortality for the Norwood operation continues to improve. A subsequent Fontan operation can be performed with excellent clinical results.
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PMID:The Norwood operation and subsequent Fontan operation in infants with complex congenital heart disease. 771 12

Since 1988, the National Institute for Occupational Safety and Health (NIOSH) has notified workers who were subjects in occupational epidemiology studies of the study findings ("worker notification"). This paper describes seven notifications and the worker's reactions to them. The chemicals of interest in the studies were: carbon monoxide, o-toluidine, bis-chloromethyl ether, polychlorinated biphenyls, cadmium, acid mist, and dioxin. Materials describing the study results were sent to 15,958 subjects who were notified of their increased risk of arteriosclerotic heart disease, bladder cancer, lung cancer, melanoma, kidney dysfunction, laryngeal cancer, all cancers combined, or soft tissue sarcoma. Workers provided feedback via telephone calls, and for three notifications, by postcards containing workers' comments and ratings of the notification materials. The percentage of telephone calls received from notified workers ranged from 0.3% to 3.8%, and the percentage returning postcards ranged from 8.8% to 17.6%. The two largest categories of callers were those with questions about their disease risk (30%) or who reported on their health status (25%). Most of the comments on postcards (26%) were complimentary or expressed appreciation for receiving the letters; reports of ill health were second (20%). A majority (66%) rated the notification materials well done. Few of the callers (5%) requested information on legal issues. Most (85%) did not find the materials, which ranged in reading level from sixth to ninth grade, too hard to read, although 15% reported difficulty reading them. Although this response system was effective in producing some input from workers, its limitation is that respondents may not be representative of all notified workers. However, such information is useful because there are few data on the effects of notifications on workers.
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PMID:Workers' response to risk notification. 779 20

The authors examine the prophylaxis of infections caused by cholelithiasis in kidney and heart transplant candidates as a new indication for videolaparoscopic cholecystectomy (VLC). The study included 6 patients in dialysis for chronic renal insufficiency and one patient suffering from cyanogenic congenital cardiopathy with asymptomatic gallbladder calculosis. The results obtained show that there are no substantial differences compared to patients without associated pathologies and justifies the inclusion of "prophylactic" VLC in preparatory treatment protocols for kidney and heart transplant in patients suffering from cholelithiasis. The authors emphasise the necessary technical measures to prevent hemorrhage, intraoperative loss of CO2 and postoperative laparoceles.
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PMID:["Prophylactic" video-laparoscopic cholecystectomy]. 780 76

Five infants with congenital heart disease were perfused with the D-901 neonatal oxygenator at the time of their cardiac surgery. The ability to reduce the prime volume below the blood volume as well as the blood handling and gas transfer characteristics were studied. In all cases the prime volume was less than or equal to the blood volume of the patient. This resulted in a reduction in the use of homologous blood products. Due to the concept of the D-901 it was possible to adapt the tubing in such a way that a complete prime of 220 ml was obtained. The device had a maximum oxygen transfer of 45 ml/min. The maximum carbon dioxide removal was 50 ml/min at a blood gas ratio of one. The mean platelet count post bypass decreased to 91% of the baseline value. Mean free haemoglobin levels increased to 86 mg/100 ml at 120 minutes of bypass. We conclude that the D-901 oxygenator opens new perspectives for perfusion in small babies in terms of priming volume and use of homologous blood products while maintaining good gas transfer characteristics. However, larger series are necessary to expand our experience with this device and its limitations. No specific problems related to the device were encountered and all infants had an uneventful postoperative course.
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PMID:D-901 neonatal oxygenator: a new perspective. 783 43

Hyperoxia is a risk factor for retinopathy of prematurity (ROP), a blinding disease in infants. However, ROP develops in human infants without raised arterial oxygen levels, such as in cyanotic congenital heart disease. In these infants raised pCO2 may be a risk factor. We investigated the effect of inspired CO2 on oxygen induced retinopathy in the rat. 56 newborn Sprague-Dawley rats were exposed to high cyclical O2 for seven days. In a control group, 27 rats were exposed to negligible CO2 by the use of soda lime. In the high CO2 group, 29 rats were exposed to elevated CO2 by omitting soda lime from their chambers. Rats in both groups had a recovery period of three days in room air following cyclical O2 exposure. On the eleventh day all rats were sacrificed after intracardiac injections of fluorescein under deep anesthesia and the retinae were dissected and flat mounted for fluorescent microscopy. The ratio of vascularized:total retinal area was calculated using computer assisted image analysis. In the high CO2 group 62% +/- 7% SD of the retina was vascularized vs. 81% +/- 7% in low CO2 group (p < 0.001). Elevated inspired CO2 results in pronounced retardation of retinal vascular development in neonatal rats exposed to fluctuating raised oxygen.
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PMID:The effect of raised inspired carbon dioxide on developing rat retinal vasculature exposed to elevated oxygen. 784 26


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