Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018801 (heart failure)
72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Prolonged circulatory support for cardiac failure has been increasingly successful in adults but has had very limited use in children. From January 1982 to December 1985, 13 children with postoperative cardiac failure refractory to conventional therapy were treated with extracorporeal membrane oxygenation. Ages ranged from 9 days to 17.6 years (mean = 3.8 years); weights ranged from 2.8 to 50 kg (mean = 13.8 kg). Seven patients had obstructive lesions of the right ventricle, such as pulmonary stenosis and tetralogy; the other patients had tricuspid atresia, truncus arteriosus, complete transposition, total anomalous pulmonary venous connection, pericardial tamponade, and a drug reaction after heart transplantation. One patient (nonsurvivor), who could not be separated from cardiopulmonary bypass, required extracorporeal membrane oxygenation in the operating room. In the remaining 12, the interval between operation and the start of extracorporeal membrane oxygenation ranged from 9 to 50 hours (mean = 22.2 hours). Four patients were cannulated through the groin and nine through the chest. Peak flows ranged from 1.05 to 2.74 L/min/m2 (mean 1.92 L/min/m2). Duration of oxygenator support ranged from 12 hours to 9 days (mean = 3.4 days). Seven patients required reexploration for bleeding. Renal insufficiency developed in five patients, four of whom underwent hemodialysis or ultrafiltration during extracorporeal membrane oxygenation. Two patients had evidence of clots in the oxygenator circuit. Seven patients were weaned from extracorporeal membrane oxygenation. Failure to wean from the oxygenator was related to neurologic sequelae of prolonged hypotension before institution of oxygenation in three patients. Mediastinitis developed in three of the seven patients who were weaned. One of these three died in the hospital 74 days after being weaned from the oxygenator. There has been one late death 6 months after oxygenator support was withdrawn. At most recent examination, five children were well, with normal cardiac function 7 months to 4.3 years postoperatively (mean = 32 months). This series suggests that profound cardiac insufficiency in children after cardiac operations can be successfully managed with extracorporeal membrane oxygenation with excellent functional recovery, although major complications are common in this critically ill group of patients.
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PMID:Extracorporeal membrane oxygenation for postoperative cardiac support in children. 379 29

Acute rupture of the left ventricular free wall was suspected in a 53 year old hypertensive patient at the 12th hour of primary antero-septo-apical myocardial infarction. He developed acute tamponade with severe cardiogenic shock during his transfer to hospital. Cardiac compression due to hemopericardium was confirmed by M mode echocardiography (pericardial effusion), right heart catheterisation (adiastole and low cardiac output) and pericardial puncture during which several ccs of blood were aspirated leading to a slight improvement in the patient's condition. At operation under cardiopulmonary bypass 2,5 hours after hospital admission, the surgeon found a hemopericardium related to fissuration of an acute apical infarct which was sutured on a Teflon support. The initial postoperative course was complicated by unexplained gastro-intestinal hemorrhage, transient functional renal failure, cardiac failure and mediastinitis, but the final outcome was successful with a follow-up of 24 months. This appears to be the 9th reported case of long-term survival after surgical repair of rupture of the heart in the acute phase of myocardial infarction.
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PMID:[Acute rupture of the left ventricle 12 hours after an anteroseptal myocardial infarct. Successful surgical repair]. 640 36

We carried out univariate and multivariate analysis of outcome among 122 patients with prosthetic valve endocarditis (PVE) admitted to our ICU between 1978 and 1992. The predominant pathogens were Staphylococcus aureus (33%), streptococci (20%), coagulase-negative staphylococci (12%), enterococci (10%), and Gram-negative bacilli (9%). At 4 months, overall survival was 66% (42 deaths). Staphylococcus aureus was the main predictor of death (75% vs 15% with other pathogens). In S aureus PVE, multivariate analysis identified the following predictors of death: prothrombin time < 30% (relative risk [RR]: 8.3), concomitant mediastinitis (RR: 4.9), heart failure (RR: 4.4), and septic shock (RR: 2.6). In PVE due to other pathogens, prothrombin time < 30% (RR: 32.26), renal failure (RR: 7.31), and heart failure (RR: 6.07) were associated with death. In S aureus PVE, survival was higher in patients who received medical-surgical therapy than in those who received medical therapy alone (9/20 [45%] vs 0/20) (p < 0.01). In PVE due to other pathogens, there was no difference in survival between patients who underwent prosthesis replacement (89%) and those who received only medical treatment (81%). Among the 65 patients who underwent heart surgery, the mortality rate and incidence of postoperative paravalvular leakage did not correlate with positive prosthesis cultures. We conclude that non-S aureus and uncomplicated PVE may be managed without valve replacement but that prompt surgical intervention should be required in all other situations.
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PMID:Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision. 765 17

The aim of this study was to assess the type and frequency of cardiac and extracardiac complications of coronary artery surgery in patients referred for cardiac rehabilitation (for which it is one of the principal indications): this was a prospective study carried out simultaneously in 30 cardiac rehabilitation units during December 1992 and including 533 patients (81 women, 452 men) with a mean age of 62.1 years. The total number of coronary grafts was 1,361 (on average 2.5 per patient); the internal mammary artery was used in 87% of cases; revascularisation was complete in 66.4% of patients. One or more complications were observed in 79% of patients during the hospital period (68.9%) and/or during the rehabilitation phase (44.7%), independently of age, sex, duration of cardiopulmonary bypass, or the interval to cardiac rehabilitation. The main extracardiac complications were respiratory (31.5%), disturbances of cerebral function (15.6%) and renal failure (10.3%). Cardiac complications comprised arrhythmias, essentially supraventricular (21.3%), infarction and residual postoperative ischaemia (8.4%), large pericardial effusion (7.5%), cardiac failure (4.5%), and wound infection (4.3% including 2.8% mediastinitis). Anaemia, a secondary effect of cardiopulmonary bypass, was observed in 25% of patients. This prospective study, though affected by a bias of selection and not fully representative of the surgical outcome, shows the need for a personalised management of these patients, the early indication of cardiovascular rehabilitation contributing to the optimisation of coronary artery surgery at less cost and with improved safety.
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PMID:[Cooperative survey of the results of coronary surgery during cardiac rehabilitation]. 777 70

We report a case of severe mediastinitis infected by methicillin-resistant Staphylococcus aureus (MRSA) after a coronary arterial bypass using the internal thoracic arteries and the right gastroepiploic artery (RGEA) in which mediastinitis was treated by an omental transfer. The patient was a 60-year-old man diagnosed as having an acute myocardial infarction of the left anterior wall. There was severe coronary stenosis of three vessels involving the left main trunk. The patient underwent a coronary arterial bypass with four grafts using the internal thoracic arteries, the RGEA, and the saphenous vein. Postoperative heart failure led to wound infection, resulting in mediastinitis infected by MRSA. Debridement and immediate closure with omental drainage was successfully performed without irrigation. After the establishment of the RGEA graft, the omentum is still viable and usable for mediastinal drainage.
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PMID:Mediastinitis with an infection of methicillin-resistant Staphylococcus aureus treated by an omental transfer following CABG using a right gastroepiploic arterial graft: report of a case. 794 74

Long-term survival at our institution for postcardiotomy cardiogenic shock patients supported with the BioPump is 36% (29/80 patients). A heparin-coated extracorporeal membrane oxygenator (ECMO), first introduced in 1991, may reduce organ injury associated with cardiopulmonary bypass. The device can be employed rapidly because it connects directly to the cardiopulmonary bypass cannula. In an effort to improve our results in the treatment of postcardiotomy cardiogenic shock, we used ECMO in 21 patients with this syndrome and accompanying complications. The patients were divided into three groups: group 1, ECMO after coronary artery bypass grafting; group 2, ECMO after mitral valve operation; and group 3, ECMO after open heart operation with prolonged cardiac arrest. Survival in group 1 was 80% with 12 of 14 patients discharged to home. All three deaths were caused by cardiac failure. Bleeding complications in this group were moderate. There was no evidence of disseminated intravascular coagulation, and levels of fibrin split products remained within the normal range. Postoperative complications included stroke (2), renal failure (1), mediastinitis (1), and prolonged respiratory failure (6). Mortality in group 2 was 100%. The major problem limiting recovery was left ventricular distention secondary to inadequate left ventricular decompression. Mortality in group 3 was 100%; all 4 died of brain death. Extracorporeal membrane oxygenation without left ventricular drainage clearly is not effective in patients undergoing mitral valve operations as it does not effectively decompress the left ventricle, but it was highly effective in treating postcardiotomy cardiogenic shock in our coronary artery bypass grafting patients. Extracorporeal membrane oxygenation also proved to be safe as the patient-related complications of stroke, renal failure, and mediastinitis were low. Our preliminary success with heparin-coated ECMO now needs to be confirmed by studies from other centers with larger groups of patients.
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PMID:Extracorporeal membrane oxygenation: preliminary results in patients with postcardiotomy cardiogenic shock. 801 Jul 88

The performance of open heart surgery in a patient with a tracheostoma can present difficult problems, including postoperative mediastinitis and inadequate operative exposure. Recently, we experienced two cases in which tracheostomy had been done preoperatively due to heart failure and reported the satisfactory results in this paper. Case 1; A 59-year-old woman who had mitral stenosis and massive regurgitation received mitral valve replacement and left atrial raphy. The approach to heart was performed in according to the following. A transverse submammary skin incision was made from right anterior axillar line to left mammary line and then a bilateral thoracotomy was made at the fourth intercostal space. Case 2; A 73-year-old man who had old myocardial infarction and postinfarction angina received coronary artery bypassgrafting to right coronary artery and left anterior descending branch, using saphenous vein grafts. A skin incision was placed at the second intercostal space in the fashion of "collar skin incision" and then made from the center of collar skin incision to the xiphoid process. The sternum was transected at the second intercostal space and divided longitudinally to the xiphoid process. These two approaches provided the adequate operative field. The cannulation of the ascending aorta, the superior vena cava and the inferior vena cava presented no difficulty and the operative procedure could be performed easily in a routine manner. We think that in a case of open heart surgery of a patient with a tracheostoma the approach in which the skin incision is distant from the area of a tracheostoma and no dissection near a tracheostoma is necessary have to be selected in order to decrease the risk of postoperative wound infection and mediastinitis.
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PMID:[Experiences of the approaches to heart for a patient with a tracheostoma]. 853 Aug 57

From 1978 through 1995, surgical treatment for active infective endocarditis (native valve) was performed in 17 patients. The indication for operation at the active phase was progressive heart failure in 5 (A-group) and uncontrolled infection in 12 (B-group). Operative findings showed vegetations in all cases, perforations of the valve in 6, rupture of tendon in 2, and annular abscesses in 2. One patient in B-group died 14 days after the operation with postoperative mediastinitis and sepsis. There was no perioperative complications in A-group. In B-group before operations 8 patients (66.7%) has an embolic event before operations. The anatomic sites of embolization were the central nervous system (3 patients), viscera (2 patient) and peripheral arteries (3 patients). And after operation there were 2 mycotic aneurysms of the hepatic artery and the popliteal artery, and 1 pyogenic spondylitis. We conclude that the risk of embolization is high in patients undergoing surgery at active phase of infective endocarditis because of uncontrolled infection ; thus, such patients should be carefully monitored for emboli and mycotic aneurysms.
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PMID:[Surgical treatment for active infective endocarditis : septic embolization and mycotic aneurysms]. 874 37

The prognostic factors of 122 patients suffering from prosthetic valve endocarditis between 1978 and 1992 were studied by univariate and multivariate analysis. The principal causative organisms were Staphylococcus aureus (33%), streptococci (20%), coagular-negative staphylococci (12%), enterococci (10%) and gram-negative bacilli (9%). The 4 month survival rate was 66% (42 deaths). The main predictive factor for death was infection with S. aureus (75% vs 15% with other organisms). In S. aureus infection, multivariate analysis identified the following predictive factors for death: a prothrombin ratio less than 30% (RR = 8.3), mediastinitis (RR = 4.9), cardiac failure (RR = 4.4) and septic shock (RR = 2.6). In cases of infection with other organisms, the following factors were predictive of death: a prothrombin ratio of less than 30% (RR = 32.26), renal failure (RR = 7.31) and cardiac failure (RR = 6.07). In patients with S. aureus infection, survival was better after than without surgery: 9/20 (45%) versus 0/20 (p < 0.001). In infection with other organisms, there was no difference in a survival after surgical (89%) or medical therapy (81%). Chronic endocarditis relapses over 1 to 5 years was observed in 9 cases. All patients were reoperated a total number of 18 times with 5 deaths. Very prolonged antibiotic therapy is recommended in these patients. The authors conclude that endocarditis not due to S. aureus and without complications may be treated medically. Rapid reoperation is necessary in all other cases.
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PMID:[Prognostic factors of prosthetic valve endocarditis. Apropos of 122 cases]. 876 Jun 51

Fifteen cases with ischemic cardiac rupture were reviewed. Three cases with subacute free wall rupture of the left ventricle, ten with ventricular septal perforation, and one with both ventricular septal perforation and blow-out type free wall rupture were included in this study. Six patients required mechanical circulatory assist such as IABP (Intra-Aortic Balloon Pumping) and/or V-A bypass before operation. Four patients underwent an emergent operation after establishment of the circulatory assist and two patients had an urgent operation 5 and 10 days after the establishment respectively. Another patient underwent repair of cardiac rupture following manual cardiopulmonary resuscitation. Thus, preoperative mechanical circulatory assist was initiated in seven patients. Eight patients who were not supported by any preoperative mechanical circulatory assist underwent an emergent operation. At operation, infarcted free wall myocardium was resected and repaired with or without a patch, and ventricular septal perforation was repaired with a heterogeneous patch. The seven patients with preoperative mechanical circulatory assist and a patient without it required postoperative mechanical circulatory assist because of intractable heart failure. Six patients with perioperative circulatory assist, however, could not get recovery from their impaired cardiac function, and one died from infective mediastinitis after being weaned from IABP and V-A bypass with PCPS (Percutaneous CardioPulmonary Support). Seven patients who did not have perioperative mechanical circulatory assist uneventfully recovered but one. We concluded that mechanical circulatory assist can give a chance of survival to a patient with far advanced heart failure following ischemic cardiac rupture, and that a prompt and definite diagnosis and a prompt surgical repair are inevitable to get better clinical results.
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PMID:[Repair of ischemic cardiac rupture and perioperative management with mechanical circulatory assist]. 907 Nov 32


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