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

The ventriculoatrial shunt (VAS) was developed to control hydrocephalic syndromes effectively. Several complications, however, have been described after the procedure. One of the most serious consequences is the development of severe pulmonary hypertension attributed to multiple and recurrent pulmonary embolization caused by the catheter of the VAS; however, the frequency is exceedingly low. Herein we describe the experience with three patients in whom severe pulmonary hypertension developed after a VAS procedure. In two patients, refractory heart failure developed, an outcome that caused death within a brief period. The third patient underwent atrial thrombectomy and then pulmonary thromboendarterectomy; recovery was complete. Scientific evidence shows that initial embolization predisposes pulmonary vessels to develop further in situ thrombosis; thus, the vascular lung disease progresses despite removal of the embolic source. A review of the literature revealed that in patients with a VAS, pulmonary embolism and pulmonary hypertension were clinically diagnosed in only 0.4% and 0.3% of the cases, respectively, whereas postmortem diagnoses of pulmonary embolism and pulmonary hypertension were established in 59.7% and 6.3%, respectively. These discrepancies point out the difficulty of establishing the diagnosis of these serious pulmonary vascular complications while the patient is alive.
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PMID:Development of pulmonary hypertension after placement of a ventriculoatrial shunt. 824 20

The frequency of pulmonary embolism in patients with myocardial infarction (MI) and chronic rheumatic heart disease (RHE) has been investigated in an autopsy series. The series comprised 21530 hospital autopsies from 1960 to 1984. Altogether 5351 patients with MI and 289 patients with RHE as underlying death cause were selected for this study. Patients with RHE or old myocardial infarction (OMI) had a significantly higher frequency of pulmonary embolism than patients with acute myocardial infarction (AMI) or acute and old myocardial infarction combined (AOMI). This was true irrespective of duration of stay in the hospital during last admission. The frequency of pulmonary embolism decreased in patients with OMI or RHE from 1960 to 1984 suggestive of better therapy of chronic heart failure. A similar trend was seen in patients with AMI during a period with consistent anticoagulation treatment.
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PMID:Pulmonary embolism and heart disease. An autopsy study. 830 25

The authors report a case of intravenous leiomyomatosis, a rare uterine tumor, extending to the inferior vena cava and to the right atrium. It seems to be the first case described in France. The wrong diagnosis of massive pulmonary embolism and the distance from a cardiac surgery unit led to emergency tumorectomy without cardiopulmonary bypass. A review of the literature studied the 24 cases with cardiac extension already reported, 19 operated and 5 autopsy reports. Right cardiac failure or syncopes are the most frequent clinical signs. Sometimes histologic examination after hysterectomy leads to the diagnosis. Echocardiography diagnoses an intra-atrial mass. Abdominal ultrasonography and phlebocavography show the iliocaval portion of the tumor. Cardiac angiography and computed tomography are also contributive. Surgical treatment except in extreme conditions should be performed by a cardiac surgical team. If the diagnosis of intra-venoux leiomyomatosis has been made preoperatively a one-stage cardiac and abdominal treatment should be preferred. In the other cases, cardiac surgery should be done first, allowing a precise histologic diagnosis and subsequent treatment of the iliocaval and uterine lesions.
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PMID:[Intravenous leiomyomatosis of the inferior vena cava and the right heart atrium. Apropos of a case and review of the literature]. 833 25

The results of 100 consecutive autopsy studies performed since the introduction and use of cyclosporine (1984 to 1991) in patients who died less than 2.5 months after cardiac transplantation were analysed to try to prevent this type of lethal damage. The lesions were complex but the causes of death may be classified as follows: 44 infections (20 aspergillosis, with 13 septicaemias and 7 predominantly pulmonary complications, 15 severe lung infections, 9 other infections including 7 pyogenic mediastino-pericarditis), 12 acute myocardial rejects, 14 pulmonary arteriolitis reflecting the fact that pulmonary resistances affect the results of cardiac transplantation, 13 non-infectious pericarditis, 17 immediate postoperative deaths (incompetent graft, DIVC). In the discussion, the authors underline the importance of pericardial damage, the direct cause of death in 13 cases but also present in most cases of infection when sometimes clinically confused with the diagnosis of "acute reject". Acute pancreatitis (over 10% of cases) were often labelled "septicaemic shock". Pulmonary involvement is one of the commonest complications related to infection and changes due to passive pulmonary hypertension related to the causal preoperative disease, by silent pulmonary embolism during the 3 months of cardiac failure before surgery and DIVC. Infection was the cause of death in nearly half of the early fatalities, and aspergillosis was particularly common whereas systematic prevention with sulfadoxine-pyrimethamine has eliminated pneumocystosis for example. The management of immuno-depression varies from centre to centre and this is also a factor in the incidence of anatomical complications.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Early fatal lesions after cardiac transplantation. Results of 100 autopsies]. 833 96

The operative approach to constrictive pericarditis still remains a surgical challenge. Subtotal pericardiectomy through median sternotomy was analyzed retrospectively in a series of 84 patients operated on for chronic constrictive pericarditis at our institution between 1979 and 1989. The mean duration of symptoms prior to diagnosis was 20 +/- 6 months (1-264 months). Preoperatively, 72% of patients were in NYHA class III or IV, presented signs of right cardiac failure (88%) or anasarca (18%). Chest X-ray showed pericardial calcifications in 40% of the patients. Echocardiography revealed pericardial thickening in 62%. Among 62 patients in whom cardiac catheterization was performed, a characteristic dip-and-plateau was found in 47 patients (76%). A specific etiologic factor was identified in only 37 patients: tuberculosis (12%), recurrent acute pericarditis (9%), hemopericardium (9%), radiotherapy (5%), previous cardiac surgery (4%), bacterial infection (2%), myocardial infarction (2%) and connective tissue disease (2%). In 47 patients (55%), the constrictive pericarditis remained idiopathic. In seven patients we performed a redo-operation for previous incomplete pericardiectomy. Subtotal pericardiectomy (from phrenic nerve to phrenic nerve) was performed in 75 patients. A palliative procedure consisting of pericardial "meshing" was performed in nine patients due to an unsatisfactory cleavage plane. Cardiopulmonary bypass was used in four patients for coexistent cardiac lesions. The operative mortality was 2.3% (two patients: septicemia and pulmonary embolism). Seven patients (8.2%) developed early on-lethal complications. The probability of survival for patients discharged for the hospital was 94% at 3 years and 87% at 7 years. There were four late deaths and no reoperation for recurrent constriction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of subtotal pericardiectomy for constrictive pericarditis. 851 53

Authors used the Mainz pouch II technique for urinary diversion in 40 patients suffering from bladder cancer. They made minor modifications to the original surgical technique: a longer, 40 cm bowel is detubularized, the ureters are pulled through the mesosigma and embedded in a groove of the bowel's mucosa, the sigma pouch is fixed to the dorsal peritoneum, a straight suture is used. Single-row on the dorsal wall and two-rows on the ventral wall. Within a few days after the surgery suture insufficiency occurred in the abdominal wall in 5 cases, in the bowel in 2 cases. To treat suture disrupture of the bowel authors transformed the pouch, added a newly detubularized bowel segment to create a spheric rectum pouch and performed a definitive colostomy. During the follow-up period of six months to four years 8 of the 40 patients died from bladder cancer, 2 from cardiac failure, 1 from pulmonary embolism, and 6 have had a recurrence of the tumor. In the 23 tumor free patients we found no reflux, one has a slight stenosis of the ureter, febrile pyelonephritis did not occur, the pouch did not slip, the ureter had no kinking, and all patients are continent. Hyper-chloraemic acidosis has been prevented by regular administration of sodium bicarbonate or kalium citrate. Authors believe that Mainz pouch II is to be the most appropriate continent urinary diversion if an orthotopic substitution is not possible.
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PMID:Our experience with the Mainz pouch II: 40 patients; follow-up and complications. 855 96

Chronic Chagas' disease shows several progression modes. Usually, the different clinical syndromes manifest themselves together, however, isolated forms can occur. Cardiac arrhythmias, which are very frequent, are present in about 50% of patients. The cardiac damage manifests itself later, with the emergence of heart failure. Thromboembolism can occur in both pulmonary and systemic circulation. Pulmonary embolism is the most frequent, appearing in more advanced phases of heart disease. Sudden death is the fatal outcome of these patients. It predominates in males and generally occurs in a disease stage when patients have their highest productivity. The presence of serious ventricular arrhythmias, conduction disturbances in the electrocardiogram, and heart failure, provide an unfavorable prognosis.
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PMID:Natural history of chronic Chagas' heart disease: prognosis factors. 865 Apr 78

The results of direct pulmonary embolectomy in 20 cases of pulmonary embolism treated in our facility from 1982 to May, 1995 was analyzed. The ages of the patients ranged from 25 to 72 years (mean: 46 years). The male-to-female ratio was 12:8. The 20 cases were divided into three groups based on the type of pulmonary embolism: Group I (4 cases of acute massive pulmonary thrombo-embolism). Group II (12 cases of chronic pulmonary thrombo-embolism) and Group III (4 cases of tumor embolism). In Group I, 2 patients developed shock and 2 developed severe right heart failure. Emergency thrombectomy using cardiopulmonary bypass succeeded in saving the lives of 3 patients in this group. In Group II, the preoperative NYHA grade was II in 1 case, III in 9 cases, and IV in 2 cases. The preoperative systolic pressure of the pulmonary artery ranged from 24 to 90 mmHg (mean: 74 mmHg). Surgery through a thoracotomy was carried out on 7 cases (on the right side in 4 cases on the left in 3 cases). Of these 7 patients, 2 died of heart failure and respiratory failure because thromboendarterectomy was inadequate. In another 2 patients, symptoms improved enough to allow them to resume their previous lives. The other three patients showed no change in their symptoms after surgery, but they could be discharged. The remaining 5 patients in Group II underwent surgery through the median approach. Deep hypothermia with circulatory arrest was used in the latter 4 of these 5 patients during surgery. 3 patients died during the perioperative period because adequate thromboendarterectomy was not possible and because their preoperative condition was very poor. 2 patients who were able to be performed adequate thromboendarterectomy showed good postoperative courses. Of the 4 patients in Group III, one patient survived 11 months after surgery, but the other 3 died during the preoperative period because very little embolus could be removed. These results allow us to conclude that the lives of patients with acute pulmonary thromboembolism can be saved by early detection and prompt surgery, but that management of chronic pulmonary thromboembolism involves difficulties in selecting surgical cases and in performing thromboendarterectomy.
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PMID:[Review of results after surgery for pulmonary embolism]. 866 69

The results of 58 dorsal root entry zone (DREZ) thermocoagulation procedures in 51 patients are reported. The postoperative analgesic effect was judged by the patients as being good (more than 75% pain reduction), fair (25-75% pain reduction) or poor (less than 25% pain reduction). Of the 14 patients who underwent surgery for pain due to cervical root avulsion, 10 (77%) had permanently good (8) or fair (2) pain relief after a mean follow up period of 76 months, another 2 (15%) experienced recurrence to the preoperative level (initially 1 good, 1 fair) after more than 2 and 4 years, respectively. Twenty two paraplegics were operated upon, 3 of whom twice, for intractable pain. After a mean observation time of 54 months, continuing pain relief was reported by 12 (55%) patients (11 good, 1 fair), and one (initially fair) had recurrent pain after 8 months. All 3 (early) re-operations remain successful for an average period of 75 months. Poor results were seen especially in cases of associated spinal cord cysts (5 out of 7), despite combined drainage, and in patients with diffuse pain distribution (5 out of 6). Continuous marked improvement for longer periods (mean follow up: 52 months) after DREZ lesions was reported only by 2 out of 10 patients with postherpetic neuralgia (12 procedures) and by 1 out of 5 with painful states due to radiation-induced brachial plexopathy (2), previous surgery (2) and malignant tumour infiltration of the brachial plexus (1). Three patients died postoperatively due to acute cardiac failure (2) and pulmonary embolism (1). Major complications, especially permanent gait disturbances were observed in 6 patients (12%) following primary procedures and in 2 out of 7 patients after re-operations, most of them suffering from postherpetic neuralgia. Minor neurological deficits were noted in 9 cases (18%). DREZ lesions revealed to be an effective procedure in patients with pain related to root avulsion and paraplegia. In contrast, it seems to be less successful for painful states due to other plexus lesions or postherpetic neuralgia.
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PMID:Results of DREZ coagulations for pain related to plexus lesions, spinal cord injuries and postherpetic neuralgia. 873 85

The purpose of our study was to assess feasibility, safety and clinical utility of selective pulmonary angiography in patients with suspected pulmonary embolism and a nondiagnostic lung scan. The design was a prospective, descriptive study. The subjects were consecutive patients with clinically suspected pulmonary embolism and a nondiagnostic lung scintigram in whom pulmonary angiography was considered. Angiography was withheld in cases of manifest heart failure, renal failure, mean pulmonary artery pressure above 40 mmHg, or if there were compelling clinical reasons. All patients were followed-up for 6 months. The outcome measures were successful angiography, morbidity, mortality and recurrent pulmonary embolism in patients with normal angiogram in whom anticoagulants were withheld during 6 months of follow-up. Of 487 patients, 196 (40%) had nondiagnostic lung scan findings. In 46 patients (23%) pulmonary angiography was withheld. Pulmonary embolism was excluded in 105 patients (70%), and proven in 40 (27%) patients. In 5 (3%) patients the angiogram was inadequate for interpretation. No fatal complications were encountered [95% confidence interval (CI) 0-2.4%]. Nonfatal complications occurred in 3 patients (2%; 95% CI 0.4-6.0%); all recovered spontaneously. None of 105 patients with a normal angiogram returned with thromboembolism during follow-up (0%; 95% CI 0-3.4%). Pulmonary angiography is safe, rules out pulmonary embolism in two thirds of patients with a nondiagnostic lung scan and can be performed in almost 80% of these patients. It is safe to withhold long-term anticoagulants if a normal angiogram is obtained in this subgroup of patients with clinically suspected pulmonary embolism.
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PMID:Feasibility, safety and clinical utility of angiography in patients with suspected pulmonary embolism. 879 13


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