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

The study summarizes the results of surgical treatment of active infective valvular endocarditis (IE) in two cardiac surgical centres in Hungary and the Soviet Union between 1969-1987. Most (92.9%) of the 241 patients operated on were in severe condition pre-operatively (NYHA Class III and IV), their mean age was 38.2 years. The infectious process was localized predominantly on the aortic valve (169 patients), and developed on previously normal valves in 151 patients. Hospital mortality was 17%, the underlying cause of death was often heart failure, sometimes associated with sepsis. Late mortality was 12.5% (25 patients), only six of these patients died of recurrent infection. The authors stress the high efficacy of surgical treatment of active valvular IE.
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PMID:Surgical treatment of infective endocarditis in the active stage. 272 Dec 4

During a 12 year period from 1974 to 1986, 38 patients with native valve infective endocarditis were treated surgically. All patients were in the active phase of infection at the time of surgery. Surgical intervention was performed as an extreme emergency in 21 patients, 10 patients were operated on the next day, and 7 patients underwent elective surgery within 3-4 days. Indications for operation were heart failure alone in 52% of patients, heart failure accompanied by sepsis and emboli in 42% and uncontrolled sepsis in the remaining 6% of patients. The hospital and late mortality was 10.5% and 5.2% respectively. Recurrence of infection and paravalvular regurgitation was only seen in one case. Thus, we believe that the risk of surgical intervention for infective endocarditis can be minimised if operative treatment is carried out early, before advanced haemodynamic and irrevocable valvular deterioration ensues.
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PMID:Operative considerations in active native valve infective endocarditis. 274 14

Size limitations and technical barriers prohibit the use of many conventional mechanical circulatory support systems for postcardiotomy ventricular dysfunction in pediatric populations. Extracorporeal membrane oxygenation (ECMO), frequently used to treat neonatal respiratory failure, can provide cardiac support and is effective treatment of postoperative myocardial failure in children. From 1981 to 1987, 10 patients aged 2 days to 5 years were maintained on ECMO for 15 to 144 hours (mean duration, 92 +/- 16 hours) after cardiotomy. Operative procedures included repair of tetralogy of Fallot (2 patients), closure of a ventricular septal defect (2), the Senning procedure for transposition of the great arteries (1 patient), repair of interrupted aortic arch with closure of a ventricular septal defect (1), repair of a partial atrioventricular septal defect (2), closure of a ventricular septal defect with excision of an anomalous muscle bundle (1), and the Fontan procedure (1). Venoarterial ECMO was established in all 10 children. Six patients underwent transthoracic right atrium-ascending aorta cannulation, 3 had right internal jugular vein-right common carotid artery cannulation through a cervical incision, and 1 had right internal jugular vein-left axillary artery cannulation. Eight of the 10 patients were successfully weaned from ECMO, and 7 are long-term survivors. There were 3 deaths; 1 was caused by cardiac and acute renal failure complicated by sepsis two days after decannulation, another occurred 19 days after atrioventricular septal defect repair, and 1 was caused by massive pulmonary hemorrhage. Major hemorrhage developed in 3 patients while on ECMO; 2 required premature decannulation for mediastinal bleeding from operative sites and ultimately survived, and 1 died of respiratory failure as a result of endobronchial bleeding. We conclude that the use of ECMO in pediatric populations for transient postoperative ventricular dysfunction improves survival with limited overall morbidity.
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PMID:Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock in children. 275 47

We have retrospectively evaluated 24 sepsis episodes caused by viridans streptococci in 23 neutropenic children during a 21 months period at the Pediatric Hematology Unit of St. Louis Hospital. The underlying malignancies included acute lymphoblastic leukemia, acute non lymphoblastic leukemia, aplastic anemia and solid tumor. In 17 children neutropenia, defined as a neutrophil count of less than 500 per cubic millimeter, was caused by cytotoxic chemotherapy. For 6 other children neutropenia was consequential to pretransplant treatment regimen for autologous bone marrow transplantation including cytotoxic chemotherapy and total body irradiation. All patients had a silicone rubber atrial catheter. In 9 patients sepsis was associated only with fever for less than 48 hours. In 5 other children fever was prolonged more than 72 hours in spite of specific antimicrobial therapy. No other organism was isolated. In 10 patients, however, the infectious syndrome was severe and the features included cardiac failure (7 patients), pneumonia (7 patients) resembling adult respiratory distress syndrome, encephalopathy (3 patients) without meningitis and proteinuria, 7 of these patients needed a management in a pediatric intensive care unit and 2 died in spite of adapted antibiotics. Streptococci were isolated in blood cultures in 23 children.
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PMID:[Frequency and severity of systemic infections caused by Streptococcus mitis and sanguis II in neutropenic children]. 278 Jan 2

A material of 87 patients who underwent cardiac surgery for active infective endocarditis from 1975 to 1987 is analyzed retrospectively. 91 emergency operations were performed in 19 women and 68 men with a mean age of 48 years. 72 native valves and 19 prosthetic valves were involved. Streptococci (41%) and staphylococci (27%) were the most frequent bacteriological isolates, whereas 19% of the cultures remained negative. Heart failure (52%), embolism (21%), uncontrolled infection (11%), prosthetic valve endocarditis (10%), atrioventricular block (4%) and ventricular septal defect (2%) were the indications for surgery an average of 22 days after diagnosis. 17 patients (19%) died, 9 during hospitalization from heart failure or septicemia and 8 in the later course. 16 patients required reoperation for valvular incompetence (5), paravalvular leak (4) or prosthesis infection (7). Five relapses (5.5%) and two reinfections (2.5%) were treated surgically while two reinfections responded to medical therapy alone. Postoperatively, 34 patients (39%) suffered severe complications such as neurological deficits, prosthetic valve endocarditis or anticoagulant haemorrhage. After a mean observation period of 52 months (range 1-147 months) 64 (91%) of the surviving patients were in NYHA classes I + II and 6 (9%) in NYHA classes III + IV.
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PMID:[Heart valve replacement in active infectious endocarditis]. 279 30

Between 1981 and 1987, 29 patients (20 men and 9 women, mean age 46 +/- 15) underwent a valvular replacement for endocarditis (19 aortic and 10 mitral). There were 25 native and 4 prosthetic valves. In 85% of cases, underlying valvular lesions were present. The oropharyngeal and the respiratory tracts were the most common sources of infection. In 81%, the infecting microorganism was gram-positive. In 21% of cases, a gram-negative was detected, always mixed with a gram-positive. One infection was caused by a Candida. Indications for surgery were severe valvular insufficiency or cardiac failure (90%), refractory sepsis (21%), thromboembolic events (11%). In 22%, multiple factors were present. A biologic valve was chosen in 12 cases (40%). Simultaneously with the valvular replacement, 4 ventricular septal perforations were occluded and 3 valvular annulus abscesses debrided. The operative mortality was 10% (3/29). The one-year survival is 96%. Two patients required reoperation at 6 months and 2 years, for partial dehiscence, with good subsequent evolution. The authors concluded that surgical operation is the most suitable treatment for unstable or complicated endocarditis, in case of cardiac failure, iterative thromboembolic events or refractory sepsis.
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PMID:Surgical management of left heart endocarditis. 281 7

The purpose of this study was to determine the incidence of death as the initial manifestation of cholelithiasis. Records of patients who died or underwent cholecystectomy for gallstone-related disease at Duke University Medical Center between 1976 and 1985 were reviewed. Thirty patients died, six of whom (20%) had previous episodes of biliary pain and stone documentation. Twenty-four (80%) were asymptomatic (three with previous incidental diagnosis of cholelithiasis). Reason for admission included acute cholecystitis (nine), pancreatitis (eight), biliary pain (six), cholangitis (four), jaundice (one), and endocarditis (one). Three patients died of gallstone complications without surgical intervention; one patient had renal failure and two had septicemia. Other causes of death were: sepsis (seven patients), cardiac failure (six), pulmonary complications (four), renal failure (three), cerebrovascular accident (three), liver failure (two), pancreatitis (one), and gastrointestinal bleeding (one). During this period, 1731 cholecystectomies were performed without mortality. In this group, the patients were younger (50 +/- 8 years vs. 64 +/- 13 years, p less than 0.001), and had a lower incidence of cirrhosis (p less than 0.001) and diabetes (p less than 0.002). The sex ratio was inverted (p less than 0.001). This study demonstrates that death from gallstones is uncommon (three cases per year), as is death from their initial clinical manifestation (1.2%). The risk of death is two- and ninefold higher in patients with acute cholecystitis or acute pancreatitis. Age, cirrhosis, and diabetes are important determinants of outcome.
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PMID:Deaths from gallstones. Incidence and associated clinical factors. 291 58

Central venous catheter (CVC) vascular erosions are difficult to diagnose, and they cause serious complications. From 1985 to 1987, ten patients receiving the surgical services at the University of Florida suffered CVC vascular erosions. By chest roentgenogram, nine CVC tips were in the superior vena cava (SVC), although three catheter tips abutted the lateral wall of the SVC. One catheter tip was in the right atrium. All patients had sudden onset of symptoms, the most common of which was shortness of breath. Initial diagnosis was respiratory insufficiency in five patients, cardiac failure in three patients, pulmonary embolism in one, and sepsis in one. Four patients required intensive care. Two patients suffered pericardial tamponade, and pleural effusions developed in eight patients. One patient died of cardiac arrest. The average time interval from CVC placement to onset of symptoms was 60.2 hours, and from the onset of symptoms to the time of diagnosis, the interval was 16.7 hours. The mean volume obtained at thoracentesis was 1324 ml and at pericardiocentesis was 250 ml.
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PMID:Central venous catheter vascular erosions. Diagnosis and clinical course. 293 Feb 92

As cardiac transplantation becomes more commonplace in the treatment of end-stage heart failure and as suitable donors become less available, an increasing number of patients will require mechanical circulatory assistance to bridge to transplantation. Since 1982, refractory hemodynamic instability requiring placement of pulsatile ventricular assist devices (VADs) has developed in 11 candidates for transplantation aged 24 to 54 years (mean, 39.6 years). A pneumatic Pierce-Donachy pump was used in 9 patients and an electrical Novacor pump in 2. The cause of the cardiomyopathy was ischemic in 6, postpartum in 2, idiopathic in 2, and doxorubicin hydrochloride toxicity in 1. Seven patients required left ventricular support (LVAD); 4 required biventricular mechanical support (BVAD). Duration of support ranged from 8 hours to 91 days with flows ranging from 4.1 to 8.5 L/min (mean, 5.5 L/min). Although hemodynamic stability was achieved in all 11 patients, contraindications to transplantation developed in 5 patients during VAD support (renal failure in 4, sepsis in 3, disseminated intravascular coagulopathy in 1). The remaining 6 patients (4 with an LVAD, 2 with a BVAD) remained good candidates for transplantation despite major complications in 5 (mediastinal bleeding in 3, driveline infection in 3, development of preformed antibodies in 2, small embolic stroke caused by device malfunction in 1). The 3 patients who were supported the longest (24, 75, and 91 days) were ambulatory while awaiting a donor heart. All 6 patients underwent successful transplantation after 8 hours to 91 days (mean, 24 days) of support. Other than one sternal wound infection, there were no major complications after transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Bridging to cardiac transplantation with pulsatile ventricular assist devices. 304 34

The decision to use bedside pulmonary artery catheterization for managing patients must involve a careful assessment of the risks compared to the benefits. Complications can be minimized by following specific guidelines for catheter insertion and maintenance. Pulmonary artery catheterization has been shown to be more accurate than clinical assessment alone in critically ill patients for determining the cause of shock (hypovolemic, cardiogenic, or septic) or for assessing the cause of severe pulmonary edema (cardiogenic or noncardiogenic). The diagnosis of cardiac failure in medical or surgical patients with invasive hemodynamic monitoring provides physiologic data that guide pharmacologic treatment that may favorably influence preload and afterload in the failing or ischemic heart. Managing hemodynamics with the aid of pulmonary artery catheterization in patients with the adult respiratory distress syndrome has received considerable attention, but a contribution to better patient outcome has not been established. Similarly, although clinical management of hemodynamic instability in septic shock is facilitated by pulmonary artery catheterization, the mortality remains very high because of the lack of specific therapy to reverse the sepsis syndrome. Adequate volume resuscitation and improved tissue oxygenation are universally accepted goals, but specific hemodynamic endpoints are controversial and direct measurements of tissue oxygenation are not possible. Prospective studies to define the clinical value of pulmonary artery catheterization are needed, but must be designed very carefully in order to identify unequivocally the effect of pulmonary artery catheterization on outcome in critically ill patients.
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PMID:Bedside catheterization of the pulmonary artery: risks compared with benefits. 305 59


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