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

In 2711 patients with heart valve replacement performed between 1965 and 1986 the cumulative incidence of prosthetic valve endocarditis (PVE) was 1.19 +/- 0.24% (n = 61). In patients operated on before 1976 (group A; n = 583) early PVE was observed in 3.43%, and in patients operated on between 1976 and 1986 (group B; n = 2128) in only 0.42%. PVE after the 60th postoperative day occurred with a linear incidence of 0.21 events per 100 patient-years (A: 0.11%; B: 0.27%). In 54% of PVE cases the aortic, and in 34% the mitral was involved; in 12% both left-sided prostheses were involved after double valve replacement. In the four weeks before the manifestation of initial symptoms of PVE, bacterial infections and diagnostic or therapeutic interventions had occurred in 74.2%. All interventions had been performed without endocarditis prophylaxis. Diagnosis of PVE was established in 57% by history and clinical examination, in 20% by microbiologic examinations and in 12% by echocardiography. Due to improved diagnostic methods and earlier surgical intervention, mortality declined during the follow-up period from 81% (1965-1970) to 18% (1981-1986). The prognosis was worse in patients who developed therapy-resistant heart failure due to hemodynamically significant prosthetic valve malfunction, or who had sepsis that persisted for more than 72 hours despite antibiotic therapy, major septic embolism or acute renal failure. The retrospective prognosis was more favourable for patients with early valve re-replacement than for patients who had been treated medically alone.
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PMID:[Prosthesis endocarditis: incidence, diagnosis, therapeutic decisions and prognosis]. 332 22

Morphofunctional studies of muscles, heart, liver and kidneys after different periods of compression and decompression, as well as literature data indicate that crush syndrome is one of the most severe forms of traumatic shock. A wide range of pathologic effects of catecholamines and other shock-causing agents in response to the emotional stress and pain occurs already at the compression period and results in hemodynamic disturbances in microcirculation of organs and tissues with the development of dystrophic and necrobiotic processes, depression of the monocytic phagocyte system and immune system. The consequences of shock are mostly manifest after decompression: hypercatecholaminemia, hypovolemia, intoxication with myolysis and pathogenic microflora products result in aggravation of monocytic phagocyte failure, as well as immune system, intravascular coagulation, membrane penetration insufficiency, cell necrosis. Monocytic macrophage depletion favours the progression of hepatic necrobiosis, formation of renal failure and detritus organization in the muscles of the extremities. Hypercatecholaminemia and hypoxia (leading to electrolyte-imbalance contractures of myofibrillar apparatus, metabolism disorder and intracellular conductivity disturbance) from the basis for cardiac insufficiency. Inadequate cardiac function, in its turn, maintains hemodynamic and hypoxic disturbances in tissues. Changes in renal blood flow, hemofiltration and tubular system are shown to reflect different aspects of pathogenesis of the acute renal failure in crush syndrome.
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PMID:[Morphology and pathogenetic problems of the crush syndrome]. 355 89

We use extracorporeal membrane oxygenation (ECMO) to treat respiratory and cardiac failure in children who are unresponsive to standard ventilator and pharmacologic management. All patients have cardiac and abdominal ultrasonography prior to ECMO to identify major structural anomalies and anatomically normal kidneys. Despite this, oliguric renal failure is seen in a number of patients. Acute renal failure (ARF) developed in two of the first 20 patients we placed on ECMO and both of these patients died. Six of the last 27 patients (22%) also developed ARF and were treated with continuous hemofiltration (CH) placed in-line with the extracorporeal circuit. The technique of CH removes plasma water and dissolved solutes while retaining proteins and cellular components of the intravascular space. The duration of CH ranged from 9 to 112 hours (mean 57.5 hours). Indications for CH were hypervolemia, hyperkalemia, and azotemia. The mean serum potassium prior to CH was 5.6 (range 4.3 to 7.0) compared with 4.5 after filtration. We filtered 5 to 10 mL/kg/h and replaced it with crystalloid chosen on the basis of serum and filtrate electrolytes. These six patients had a 33% mean weight gain prior to CH. We were able to remove as much as 2,200 g in the most edematous patient with significant improvement in cardiopulmonary status. Four of the patients on CH died of their primary pulmonary or cardiac disease without specific problems related to ARF. The other two patients were successfully weaned from ECMO, extubated, and have not needed further therapy for renal failure. We conclude that CH is useful in managing the complications of oliguric renal failure during ECMO.
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PMID:Experience with renal failure during extracorporeal membrane oxygenation: treatment with continuous hemofiltration. 364 94

In a series of 604 adults operated on for cardiac surgery with cardiopulmonary bypass (CPB), 21 (3.5%) underwent circulatory assistance by intra-aortic balloon pump (IABP); in 5 of them (24%), acute renal failure (ARF) was observed. ARF occurred in only 26 (4.4%) of the other patients who did not require IABP. Evolution of ARF and its factors were therefore investigated in those patients having received IABP. ARF was defined as serum blood urea nitrogen (BUN) greater than or equal to 16 mmol X 1(-1), urinary urea/BUN less than 10, creatinine clearance less than 40 ml X min-1 X 1.73 m-2. Some perioperative features were compared between patients with postoperative ARF and those without ARF. ARF occurred in the 5 patients with IABP during, or immediately after, weaning from IABP. ARF was more frequent in patients operated on for mechanical complications of myocardial infarction with a significant more severe haemodynamic status. They had significantly longer CPB and aortic clamping times. The prognosis depended on the cardiac failure and not on the ARF. In patients with mechanical complications of infarction, early IABP seemed to be the predominant preventive measure. Other therapeutic implications are suggested, particularly the use of dopamine (1 to 3 micrograms X kg-1 X min-1) because of its renal vasodilating action which can contribute to the maintenance of urinary flow.
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PMID:[Acute renal failure after extracorporeal circulation with aortic counterpulsation in surgically treated patients]. 401 97

2 cases of acute renal failure associated with diclofenac therapy are reported. In the 1st case no other risk factors but diclofenac administration were identified. Renal biopsy showed patchy interstitial infiltration of mononuclear cells and polymorphonuclear leukocytes. In the 2nd case preexisting nephropathy and heart failure were underlying illnesses. In both cases renal function returned to the basal values after stopping the drug.
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PMID:Diclofenac-associated acute renal failure. Report of 2 cases. 402 22

Hemodynamic effects of amrinone were studied in 2 groups of patients after open heart surgery. Group I consisted of 10 patients with moderate heart failure. In the absence of inotropic agents, their mean cardiac index (CI) was 2.02 +/- 0.41 liters/min/m2 and mean pulmonary capillary wedge pressure (PCWP) 19 +/- 3 mm Hg. Amrinone was administered 24 hours postoperatively by bolus injection (2 mg/kg) and by 12-hour infusions (20 micrograms/kg/min). Hemodynamic data and plasma concentrations were obtained 10 and 20 minutes after the bolus injection and at 1, 4, 8 and 12 hours during infusion. Significant beneficial changes were noted in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Group II consisted of 5 patients in severe cardiogenic shock (mean CI 1.97 +/- 0.3 liters/min/m2, mean PCWP 28 +/- 8 mm Hg) despite adrenergic agonists in all patients and intraaortic counterpulsation in 2. After these measures, amrinone was given intravenously for 36 to 72 hours as additional inotropic support. Significant improvement was observed in CI, PCWP, right atrial pressure, systemic vascular resistance and pulmonary vascular resistance. Four patients in this group were discharged; 1 patient died after 5 days in acute renal failure and coma grade IV. No serious adverse effects of amrinone were observed in any group II patient.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Amrinone in the management of low cardiac output after open heart surgery. 402 58

A retrospective analysis of 58 patients with acute renal failure treated by hemodialysis between 1980 and 1984 was carried out to study mortality and the risk factors that might adversely influence survival. Twenty-six factors, suggested by published data to be relevant to the short-term prognosis of such patients, were evaluated by univariate analysis. Survivors were found to be significantly younger, they were less frequently malnourished or jaundiced, and fewer required inotropic drugs (due to hypotension) or ventilator support after the first week of their illness. Sepsis, heart failure, central nervous system depression, and a greater number of the above complications were characteristic in the nonsurvivors. Multivariate analysis suggests that the probability of survival could be estimated by taking into account three of these factors: age, central nervous system depression, and hypotension. Further studies would be appropriate to test the predictive value of such a probability equation.
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PMID:Risk factors influencing survival in acute renal failure treated by hemodialysis. 406 59

Intravenous isoprenaline was given to 10 patients in septic shock, of which occult myocardial failure was the main indication. Isoprenaline expedited recovery in cases of "benign hypotension," where kidney function paradoxically remained satisfactory at low systolic pressures, and was useful in cases of "cold hypotension" which were complicated by renal failure alone. No significant improvement occurred in cases which were complicated by both massive pulmonary oedema and acute renal failure.
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PMID:Intravenous isoprenaline in treatment of septic shock in man. 544 79

During a 6-year period, 24 patients, aged 7 days to 18 years, underwent palliative surgery for single-ventricle heart malformations; 22 has single-left ventricle with outlet chamber (14 with L-transposition); only two had type C malformation (van Praagh). They were subdivided according to physiology into two groups: the first included 15 patients with decreased pulmonary blood flow, whose main clinical feature was arterial desaturation; the second consisted of nine patients with increased pulmonary blood flow, who presented early with unmanageable heart failure. The first group was treated with a Blalock-Taussig shunt (typical or modified) in 12 cases (one death due to preoperative acute renal failure), with a Waterston or Potts shunt in two cases (both died early postoperatively), and by enlargement of the bulbo-ventricular foramen in one (who died at operation). No late deaths were seen and the clinical status of the survivors is judged optimal. Patients of the second group received a pulmonary artery banding plus a number of associated procedures: coarctation repair (2), ligation of a patent ductus arteriosus (2), Blalock-Hanlon atrial septectomy (1), tricuspid valve replacement (1). There was only one early death due to critical subaortic stenosis produced by a restrictive outlet foramen; however, there were five late deaths and two cases of surgical failure with persistent pulmonary hypertension. An analysis of the best palliative approach in patients with single-ventricle heart malformations is made, based upon the results of this series and taking into consideration the possibility of future intracardiac repair.
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PMID:Palliative surgery for single ventricle heart malformations. 619 2

We report a case of acute interstitial nephritis (AIN) after a six weeks' therapy with sulphinpyrazone (Anturane, Ciba-Geigy, Wien). The patient presented with acute renal failure requiring hemodialysis. He died from acute cardiac failure three days after admission. According to our available information, it seems to be the first case of histologically proven acute interstitial nephritis with renal failure requiring hemodialysis after sulphinpyrazone therapy. Our observation underlines the suggestions made by Butler (7) and Mayrhofer et al. (19): During sulphinpyrazone therapy, serum creatinine and urea concentrations should be controlled regularly; the drug must be discontinued immediately when renal function is worsening; and the drug should not be administered in patients with even slightly impaired renal function.
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PMID:[Acute interstitial nephritis and kidney failure requiring dialysis after sulfinpyrazone therapy]. 623 42


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