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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between January 1990 and October 2001, arch replacement was performed in 99 patients with aortic arch aneurysm at Omiya Medical Center. For brain protection during surgery, antegrade selective cerebral perfusion was performed. There were 11 (11.1%) hospital death, and causes were heart failure (3), pneumonia (2), respiratory failure (1), mediastinitis (1), cerebral infarction (1), sepsis (1), myocardial infarction (1), and bleeding (1). During follow-up, 24 patients died, and causes were pneumonia (4), malignancy (3), heart failure (2), cerebral infarction (2), rupture of residual aneurysm (2), asthma (1), myocardial infarction (1), sepsis (1), multiple organ failure (1), traffic accident (1), and unknown (6). Postoperative survival was 75.2% at 3 years, 61.5% at 5 years, and 35.3% at 8 years. Event free ratio was 71.8% at 3 years, 58.6% at 5 years, and 30.8% at 8 years. Surgery of the aortic arch using selective cerebral perfusion is a safe and demonstrated acceptable short- and long-term outcomes.
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PMID:[Long-term surgical outcomes of aortic arch aneurysm]. 1196 8

To prevent cerebral infarction during perioperative period, we have used an axillary artery for systemic perfusion and selective cerebral perfusion for aortic arch operation. Since 1996, 34 aortic arch operations were performed in our institution. Simultaneous 5 CABGs, 4 AVRs, 2 aortic root replacements and 1 MVR were performed. There were 2 hospital deaths (5.9%, sepsis and acute heart failure) and only 1 (2.9%) cerebral infarction. There were no deaths in patients over 75 years of age and in patients with extensive aneurysm which were replaced by 2-staged operation. Overall 3 years survival was 94.1% with no further death. We conclude that aortic arch operation through an axillary artery perfusion and with hypothermic selective cerebral perfusion can be performed with very low mortality and morbidity.
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PMID:[Mid-term outcome of aortic arch operation for true aneurysms; using an axillary artery perfusion]. 1196 14

First developed for clinical use in the late 1980s, the phosphodiesterase inhibitors were found to increase the levels of the ubiquitous second messenger cyclic adenosine monophosphate and could effect changes in vascular tone, cardiac function, and other cellular events. After several early studies using high doses of phosphodiesterase inhibitors in patients with severe heart failure suggested adverse consequences, they fell out of favor. However, recent investigations of phosphodiesterase inhibitors in patients with intermittent claudication have demonstrated profound benefits. Furthermore, these agents have proven useful in prevention of cerebral infarction and coronary restenosis, and their use in the treatment of heart failure is being reevaluated. The reemergence of phosphodiesterase inhibitors can be attributed to a better understanding of dosing and drug-specific pharmacology, the use of concomitant medications, and a recognition of unique ancillary properties; however, their use still requires caution.
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PMID:Reevaluating the role of phosphodiesterase inhibitors in the treatment of cardiovascular disease. 1205 87

The development of renal failure after open heart surgery is associated with a high mortality. Thirteen patients were treated with continuous hemodiafiltration (CHDF) for renal failure following open heart surgery since April 1999 to December 2001. The indication of CHDF was blood purification in 8 patients and water balance control in 5 patients. Two patients with hemodialysis (HD) before operation returned to usual HD early after operation, and discharged. One patient died of severe heart failure, and another patient died of sepsis and multi organ failure. In these 2 patients, CHDF could not withdrawn. Seven patients weaned from CHDF 1 to 19 days after operation. Five of 7 patients discharged, but 2 patients died of cerebral infarction 4 month after operation. The remaining 2 patients could not wean from CHDF, and were introduced HD. Only 1 of 13 patients had bleeding tendency (cardiac tamponade). CHDF did not influence the hemodynamic state and was very effective for the treatment of renal failure in many patients.
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PMID:[Analysis of continuous hemodiafiltration after open heart surgery]. 1263 20

Long-term prognosis in dialysis is poor compared to that in healthy control persons. A worsening of the prognosis is noted especially for patients who at initiation of dialysis have congestive heart failure, ischemic heart disease, or left ventricular dysfunction or hypertrophy. This is the main reason that cardiovascular causes are the most common for morbidity in these patients. The weight obtained when normal urine output is present is the dry weight. With reduced ability to excrete the volume by the kidneys in end-stage renal disease (ESRD), the body will retain water and the patient will gain weight. This extra weight is due to volume overload. While volume overload may induce a rise in blood pressure, if the heart is in acceptable condition, a fast removal of fluid by ultrafiltration (UF) during dialysis may instead cause hypotension. Ultrafiltration failure in peritoneal dialysis (PD) patients may lead to successive water retention and overhydration with subsequent cardiac failure, while volume overload may occur over a few days in hemodialysis (HD) patients. Anemia or even too-high hematocrit may impair cardiac function further and worsen conditions caused by wrong dry weight. Thus, during long-term and sustained volume overload, left ventricular (LV) hypertrophy will occur in an eccentric manner. A sustained overload then may lead to cell death and LV dilatation and, eventually, systolic dysfunction. Once a severe left ventricular dilatation has developed, the blood pressure may decrease during volume overload. A worsened prognosis is seen if malnutrition and low albumin levels are present. Volume overload necessitates ultrafiltration to achieve dry weight. Thereby, volume contraction contributes to exaggerated stimulation of or response to activation of the RAS and alpha-adrenergic sympathetic systems. If ultrafiltration goes beyond these compensatory mechanisms, hypotension will occur and increase the risk for hypoperfusion of vital organs. Such episodes may cause cardiac morbidity, aspiration pneumonia, vascular access closure, or neurological complications (seizures, cerebral infarction), besides a more rapid lowering of residual renal function. Preventive measures are, first, finding the right dry weight; second, minimizing interdialytic weight gain; third, optimizing the target for hemoglobin (110-120 g/l); fourth, lowering dialysate calcium (1.25 mmol/l); and fifth, eventually using higher dialysate potassium if long dialyses are performed.
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PMID:Ultrafiltration and dry weight-what are the cardiovascular effects? 1266 7

The Japanese Rhythm Management Trial for Atrial Fibrillation (J-RHYTHM study) is a randomized comparative evaluation of rate control and rhythm control, both combined with antithrombotic therapy, as therapeutic strategies for the treatment of atrial fibrillation (AF). This study differs from the earlier AFFIRM and RACE studies in that it has a composite primary end-point representing mortality and also physical/psychological disablement (total mortality, symptomatic cerebral infarction, systemic embolism, major bleeding, hospitalization for heart failure requiring intravenous administration of diuretics, and patient disablement). Patients' will to change the therapeutic strategy to the other is also considered as an end-point representing disablement under the assigned strategy. The secondary end-point includes quality of life scores and the efficacy and safety of drugs used in treating AF. The J-RHYTHM study emphasizes patient-reported experience and perception of AF-specific disablement, and the safety of antiarrhythmics available in Japan; it will follow 2600 patients treated at more than 150 sites in Japan for a 3-year period.
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PMID:Investigation of the optimal treatment strategy for atrial fibrillation in Japan. 1293 46

Patients with paroxysmal atrial fibrillation have a risk of thromboembolic complications probably equivalent to those with permanent atrial fibrillation. Patients with a previous cerebral infarction, hypertension, age above 65, diabetes, previous myocardial infarction, reduced left ventricular function, heart failure or enlarged left atrium with or without a visible thrombus are especially prone to thromboembolic complications. International guidelines recommend anticoagulation therapy with warfarin to INR levels between 2.0-3.0 for the majority of patients with atrial fibrillation. Acetylsalicylic acid provides inferior protection and can only be recommended for a selected subpopulation of patients. Patients with atrial fibrillation who convert spontaneously or after medical or electrical treatment, should have low molecular weight heparin administered prior to conversion and warfarin for at least four weeks after successful conversion. The rationale for choosing a treatment strategy in conflict with recommended guidelines should appear in writing in the patient's file in any individual case.
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PMID:[Anticoagulation therapy in paroxysmal atrial fibrillation]. 1506 Jun 44

Paroxysmal atrial fibrillation (PAF) is a common complication of patients with hypertrophic cardiomyopathy, often leading to acute or progressive heart failure and cerebral infarction. We assessed the echocardiographic data of 141 consecutive patients with hypertrophic cardiomyopathy, with and without PAF. In all, 31 patients (22%) had a history of PAF with spontaneous conversion to in sinus rhythm. Left atrial volume and left atrial volume indexed to body surface area were significantly increased for patients with PAF compared with those without PAF. Maximum left atrial volume was the most sensitive and specific parameter for the occurrence of PAF in patients with hypertrophic cardiomyopathy.
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PMID:Left atrial volume and the risk of paroxysmal atrial fibrillation in patients with hypertrophic cardiomyopathy. 1516 36

The practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners provides the general practitioner with guidelines for the diagnosis and management of patients with atrial fibrillation. Atrial fibrillation can be detected by observation of the cardiac rhythm during every measurement of the blood pressure. The diagnosis 'atrial fibrillation' must be made on the basis of an ECG. Atrial fibrillation must not be looked upon as an isolated phenomenon: possible comorbidity (cerebral infarction ('transient ischaemic attack'; TIA), hypertension, diabetes mellitus, heart failure, coronary heart disease, hyperthyroidism) should be taken into consideration in the evaluation. Particular attention should be given to determining whether heart failure is also present. An important goal of treatment is the prevention of thromboembolic complications. Cardioversion is not generally recommended. The symptoms may be an indication that an attempt should be made to restore sinus rhythm. This constitutes one of the indications for referral for specialised treatment.
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PMID:[Summary of the practice guideline 'atrial fibrillation' from the Dutch College of General Practitioners]. 1532 42

A 60-year-old man was admitted to our hospital for evaluation of intracardiac vegetative masses detected by echocardiography in September 2001. He had undergone surgery for oral cavity cancer in 1999. He presented with severe embolic symptoms including cerebral infarction, but had few symptoms of heart failure. Antibiotic therapy was started under the diagnosis of infective endocarditis, but the embolic symptoms persisted. An autopsy revealed that the intracardiac vegetative masses consisted of tumor cells originating from the oral cavity cancer. Intravascular tumor thrombi were also found widely distributed in other organs such as the liver, lung, spleen and kidney, and had similar histological features. This is a very rare case of cardiac metastases of oral cavity cancer without adhesion to the endocardium or other myocardial tissue.
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PMID:[Vegetative cardiac metastases of oral cavity cancer: an autopsy case report]. 1533 83


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