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

Mitral valve repair in children has the advantage of avoiding mitral valve replacement with its attendant need for anticoagulation and reoperation. Seventy-nine children between the ages of 2 months and 17 years (mean 4.9 years) underwent mitral valve repair between May 1982 and April 1993. There were five patients with mitral stenosis and 74 patients with mitral regurgitation, and 19 children were less than 2 years of age. Patients were divided into anatomic subgroups on the basis of the primary cardiac pathologic condition. Forty-three had severe mitral regurgitation, 21 had moderate mitral regurgitation, and 12 patients with primum atrial-septal defect and 2 patients with univentricular hearts had minimal to moderate mitral regurgitation. Associated cardiac anomalies were present in 68 patients and 85% of the patients required concomitant intracardiac procedures. The methods of mitral valve repair included annuloplasty in 68 (86%), repair of cleft leaflet in 41 (52%), chordal shortening in 9 (11%), triangular leaflet resection in 8 (10%), splitting of papillary muscles with resection of subvalvular apparatus in 7 (9%), and chordal substitution in 1 (1%). The technique of annuloplasty was modified to allow for annular growth. Follow-up was available from 1 to 10 years (mean 4 +/- 2.5 years). There were three early deaths (4%), all occurring as a result of low output cardiac failure in patients with minimal postoperative mitral regurgitation. Three late deaths (4%) occurred in patients with persistent moderate to severe mitral regurgitation and progressive cardiac failure and eight patients (10%) required either rerepair or replacement of the mitral valve. Actuarial survival was 94% at 1 year, 84% at 2 years, and 82% at 5 years, and actuarial freedom from reoperation was 89% at 8 years. All patients received postoperative echocardiography with 82% having minimal to no mitral regurgitation and 98% of long-term surviving patients being free of symptoms. We conclude that mitral valve repair can be done with low early and late mortality. The need for reoperation is relatively low and valve growth has occurred with the use of a modified annuloplasty.
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PMID:Early and late results of mitral valve repair in children. 817 70

In women with a significative mitral stenosis that become pregnant, medical treatment has limitations and surgical treatment is associated with maternal and fetal mortality. We report two pregnant women in whom a mitral valvuloplasty was performed in weeks 30 and 32 of pregnancy, using the single balloon Inoue technique. The indication for the procedure was the persistence of functional capacity IV heart failure in spite of hospital bed rest and the use of diuretics and beta-blockers. Basal mitral valvular area was 0.6 and 0.9 cm2 and improved to 1.7 and 1.8 cm2 after the procedure; six months later, the areas were 1.5 and 1.7 respectively. The procedure was well tolerated and was performed with abdominal and pelvic shielding. No complications occurred, which allowed hospital discharge in functional capacity I; they were readmitted for delivery, giving birth to two healthy girls. It is concluded that mitral valvuloplasty in safe and effective in pregnant women with mitral stenosis refractory to usual medical treatment.
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PMID:[Percutaneous mitral valvuloplasty in 2 pregnant women]. 819 Nov 22

Sixteen elderly patients (age > or = 60 years, elderly group) with mitral stenosis and 20 young patients (age < or = 59 years, young group) underwent percutaneous transvenous mitral commissurotomy (PTMC) by the single balloon technique. Pulmonary arterial and mean left atrial pressures, mitral valvular pressure gradient and left atrial dimension were significantly decrease in both groups after PTMC. Mitral valve areas by Gorlin formula were significantly increased from 1.14 +/- 0.40 to 1.78 +/- 0.66 cm2 in the elderly group and from 1.25 +/- 0.50 to 2.04 +/- 0.81 cm2 in the young group after PTMC. Thirteen elderly and 19 young patients became in NYHA class I or II after PTMC, and three elderly patients with early gastric cancer had the lower risk of the gastrectomies by preoperative PTMC. But, two elderly patients remained in NYHA class III or IV due to increased mitral regurgitation and late tamponade, and one elderly patient died by heart failure after PTMC. PTMC has the advantages of shorter hospitalization and lower invasion for the patients compared with surgery, therefore PTMC is an effective treatment in both elderly and young groups. Elderly patients with severe mitral stenosis have higher risk of PTMC and are needed discrete strategy.
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PMID:[Percutaneous transvenous mitral commissurotomy in elderly patients with mitral stenosis]. 823 Jul 82

A case of an 8-year-old girl with Bland-White-Garland syndrome (BWG) who successfully underwent a second mitral valve replacement is reported. The patient had a past history of mitral valve replacement under the diagnosis of mitral regurgitation and pulmonary hypertension at one year and 3 months of age. Cardiac catheterization at 6 years and 3 months of age revealed an anomalous origin of the left coronary artery from the pulmonary artery but she was asymptomatic. One year and 7 months later, she was admitted to our institution with a sudden onset of chest pain and respiratory distress. Right heart pressure study using a Swan-Ganz catheter showed severe pulmonary hypertension and elevated mean pulmonary wedge pressure (38 mmHg). Echocardiogram revealed severe mitral stenosis and moderate regurgitation. She was diagnosed under fluoroscopy as acute left cardiac failure due to stuck valve and suspected having myocardial damage due to BWG, thus, emergency surgery was performed. Under cardiopulmonary bypass, aorto-left coronary arterial continuity was established by intrapulmonary arterial tunnel using Hamilton's technique. After resection of the prosthetic valve, of which one of two leaflets had been fixed in pannus, re-MVR was done with a St. Jude. Medical valve (25 mm). Postoperative angiogram demonstrated satisfactorily reconstructed two coronary artery systems. Postoperatively, she has been doing well without complaint for the last eighteen months.
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PMID:[A case of mitral valve re-replacement with radical correction of Bland-White-Garland syndrome]. 828 41

To investigate the mechanism in which plasma noradrenaline concentration (pNA) is elevated in heart failure, the effect of balloon mitral valvuloplasty was used as a model of acute manipulation of the left atrial pressure reduction in ten patients with mitral stenosis. Gorlin mitral valve area and pNA were correlated with New York Heart Association functional class and found to have a significant exponential inverse relationship with each other ([pNA, pg/ml] = 198.9 x [mitral valve area, cm2]-0.696; P = 0.003). Elevated pNA could be partially explained by a reduced cardiac index (CI) ([pNA, pg/ml] = 403.4 x [CI, l/min/m2]-0.889; P = 0.027; r = 0.495), especially in severely failed hearts, but not by pulmonary capillary wedge pressure (PCWP). However, the percent changes (% delta) of variables early after balloon valvuloplasty exhibited a paradoxical contrast; % delta pNA showing a clear negative exponential correlation with % delta PCWP ([% delta pNA] = 436.0 x [% delta PCWP + 80]-0.679 - 80; P = 0.021), but not with % delta CI. These results suggest that pNA should be considered an indicator of cardiac functional class in mitral stenosis. PNA is modulated by both cardiac index and pulmonary capillary pressure, but in different ways.
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PMID:Plasma noradrenaline as an indicator of functional state in hearts with mitral stenosis: the influence of acutely reduced left atrial pressure by balloon mitral commissurotomy. 831 42

Left ventricular end diastolic pressure (LVEDP) in 24 patients with coronary heart, hypertension or rheumatic heart disease (mainly aortic valve pathologic change, exclude mitral stenosis), who had unobvious clinical heart failure. Before left heart catheterization pulmonary function were tested by plethysmogram, results revealed: when LVEDP > 15 mmHg in the patients, pulmonary function parameter expectancy value percentage including FEF25-75%, V25, V50, V75, FVC, VC, FEV1.0 were obviously decreased. RV/TLC expectancy value percentage was obviously increased. Pulmonary function parameter expectancy value percentage including FEF25-75%, V25, V50, V75, FEV1.0, FVC, etc. had significant negative correlation with LVEDP (r = -0.715, P < 0.001; r = -0.699, P < 0.001; r = -0.678, P < 0.001; r = -0.671, P < 0.001; r = -0.648, P < 0.001; r = -0.516, P < 0.01; respectively). RV/TLC expectancy value percentage had significant positive correlation with LVEDP (r = 0.515, P < 0.05). The results indicate that testing pulmonary function parameter helps to evaluate left ventricular function and diagnose early (mesenchymal) pulmonary edema.
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PMID:[The investigation of the correlations between left ventricular end diastolic pressure and pulmonary function parameters]. 840 54

As patients survive to advanced age, they commonly develop degenerative valvular heart disease as well as degenerative diseases of other organ systems. In addition, a reservoir of patients with other forms of valvular heart disease develop progressive symptomatology with advancing age. These patients often present a challenge to the cardiologist in both diagnosis and management. Inasmuch as these patients tolerate cardiovascular surgery less well than their younger counterparts, criteria for surgical intervention may often need modification. Chronologic age must be recognized as but one of many factors affecting physiologic function. Knowledge of aging-related alterations in function must be employed in both diagnostic and therapeutic algorithms. At times, input from other health-care providers who specialize in the care of the elderly may assist in the assessment of these patients. Surgery should be reserved for higher-risk patients who are severely symptomatic or for those in whom severe symptoms are likely to soon develop based on the natural history of the disease process involved. Those less symptomatic elderly patients with otherwise preserved physiologic functions also may be offered valvular surgery. The availability of nonsurgical, albeit at times palliative, techniques to relieve aortic or mitral stenosis provides an alternative therapeutic option to cardiothoracic surgery. Advances in understanding the pathophysiology and medical therapy of heart failure will continue to contribute to an improved quality of life for those for whom only medical options exist.
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PMID:Valvular disease in the elderly. 841 22

We report on a trial of partial kidney transplantation performed on a low body weight child with impaired cardiac function due to mitral valve stenosis and uremic cardiomyopathy. The weight of the donated kidney was successfully reduced by one-third using bench surgery in order to obtain sufficient graft perfusion and function. Our procedure is justified when a graft is too large to be adequately perfused in a recipient suffering from cardiac failure.
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PMID:Partial kidney transplantation: a successful kidney transplantation in a child with severe cardiac failure by surgical mass reduction of an adult donor kidney. 849 71

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

Topical congenital pulmonary vein stenosis is a uncommon defect, both isolated or associated to other cardiac abnormalities. Only the localization of the lesions seems to affect the survival, because 60% of survival cases has unilateral stenosis; the severity of associated cardiac lesions become the prognosis poor. We describe two cases: 1st case, a 43 days old boy presented with heart failure and convulsion and had a diagnosis of pulmonary hypertension, atrial septal defect and tricuspid regurgitation, without pulmonary abnormalities. He had recurrent pulmonary infections and a cerebral ischemia in the following months, and died at 15 months of age for sepsis. Autopsy revealed stenosis and atresia in all pulmonary veins, with venous and arterial hypertension. There was also aortic hypoplasia and aortic and tricuspid valves indifferentiation; 2nd case, a 7 days old girl had a diagnosis of aortic coarctation and atrial and ventricular septal defects. Surgical corrections, at 38 and 46 days old, firstly of the aortic coarctation and after for the septal defects, disclosed and relief a supra-valvar mitral stenosis, but she remained on heavy respiratory insufficiency. At 6 months old, she returned to the hospital with dyspnea and cianosis, heart failure and hemoptisis; a sepsis developed and she died. At autopsy, there were severe pulmonary vein stenosis on the left and in the superior right veins, with pulmonary hypertension and hemorrhage.
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PMID:[Pulmonary vein stenosis. Report of 2 cases and review of the literature]. 854 96


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