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

Two young Black female patients with pulmonary valve stenosis and intact ventricular septa are presented in protracted congestive cardiac failure with severe tricuspid insufficiency and, in one, atrial fibrillation. Right ventricular systolic dysfunction was manifested by peak systolic pressures below systemic level, raised end-diastolic pressures and low cardiac output, but without right-to-left shunt. These findings are in strong contrast to those found in most patients with pulmonary stenosis of long standing, where persistent impairment of right ventricular function is diastolic with a high end-diastolic pressure and reversal of an interatrial shunt which result from poor right ventricular compliance. Evidence of left ventricular dysfunction was also present in both cases. Protracted heart failure in these patients is believed to have been the result of coincidental cardiomyopathy in a racial group highly predisposed to this disorder. A diagnostic appreciation of this phenomenon is important in the evaluation of heart disease in the Black, since cardiomyopathy may modify or even mask the features of the underlying disorder.
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PMID:Pulmonary stenosis and impaired myocardial function. 12 85

Over a 10 year period, 95 children aged 15 years and less underwent replacement of one or several of their heart valves, usually by a Starr-Edwards ball prosthesis. The predominant pathology was rheumatic heart disease and the most commonly affected valve was the mitral. Severe symptomatology, heart failure, cardiomegaly and high wedged-capillary and pulmonary arterial pressures were practically constant findings. Operative mortality was low (3.2%) and the long-term mortality was 10 patients. With an average follow-up of 40 months, results were excellent in the great majority of patients, with complete regression of symptoms, cardiomegaly and high capillary and pulmonary arterial pressures. Anticoagulant therapy was not systematic and only half the series were so treated. Thromboembolic complications were rare, 5.5% patients, but only affected those without anticoagulant therapy. The problems of evolving rheumatic disease and, above all, of tricuspid incompetence, the persistence of which after surgery on the mitral valve seems to be a sign of advanced myocardial damage, are discussed.
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PMID:[Heart valve prostheses in children with reference to 95 cases]. 16 Feb 16

This is a study of 159 patients with tricuspid incompetence (TI) associated with a mitral or mitro-aortic valve defect. The mean age of the patients at operation was 25.5 years. The TI was left untreated in 84, corrected by semi-circular annuloplasty in 39, and corrected by a prothesis in 28, by a Carpentier ring in 6, and by Kay's plasty in 2. The 33 early deaths (21%) are regrettable. The long-term outlook was studied with a mean follow-up period of 26 months. The overall mortality rises, if these are included, to 42 (26%). By comparing the preoperative findings in those with good and poor results, we have been able to identify a certain number of risk factors: a preoperative course of greater than or equal to 6 years, a number of attacks of cardiac failure greater than or equal to 3, a cardiothoracic ratio greater than or equal to 0.70, a mean right atrial pressure greater than 12, a mean pulmonary arterial pressure of greater than or equal to 50. Severe TI is also a poor prognostic factor. If the three groups of patients are compared, bearing in mind the fact that their preoperative state was very similar, and that the TI was either left untreated or repaired by annuloplasty or prosthesis, it appears that such a correction improves neither the surgical mortality nor the long-term prognosis. It therefore seems to us that a functional TI can be treated expectantly since its resolution depends more on the unified treatment of the whole underlying disorder and on the state of the myocardium than on any localised correction of the TI.
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PMID:[Outcome of corrected and uncorrected tricuspid insufficiency after repair with prostheses in mitral and mitro-aortic valve diseases. Apropos of 159 cases]. 40 58

The authors report a case of carcinoid of the small intestine with liver metastases in whom the entire right side of the heart was affected, with severe tricuspid incompetence and pulmonary stenosis. The extent of the fibrosis, which affected all three layers of the heart on the right side has lead the authors to reconsider the various factors which cause the heart failure in carcinoid syndrome. This must now be included in the wider category of APUD. The severity of the tricuspid lesions compared with the derangement of the valvular and subvalvular structures makes an argument in favour of surgical correction.
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PMID:[Carcinoid of the small intestines with right cardiac involvement. Clinical, phonomechanographical hemodynamic and anatomical study]. 82 47

After Mustard operation for transposition of the great arteries, hemodynamic and angiocardiographic changes were evaluated in 25 patients. In 19 patients, postoperative studies were done electively and, in 6 patients, they were required to investigate symptoms of heart failure, these symptoms were temporary in 4 patients and progressive in 2. Both of the latter had pulmonary venous obstruction which was later relieved successfully by reoperation. After operation, systemic arterial oxygen saturation and blood pressure increased and polycythemia disappeared in every patient. However, several complications-some of them unsuspected clinically-were identified by cardiac catheterization: (a) patch detachment in 5 patients; (b) obstruction of superior vena caval return in 10 patients; (c) obstruction of inferior vena return in 1 patient; and (d) pulmonary venous obstruction in 2 patients. The incidence of pulmonary or systemic venous obstruction was higher in patients who had a Dacron intraatrial baffle (8 of 19 patients). Comparison of 21 sets of preoperative and postoperative right ventricular angiograms demonstrated an increase in right ventricular trabeculations in each patient, poorer right ventricular contractility in 12 patients, and development of tricuspid insufficiency in nine patients. None of the patients with poor right ventricular contractility had had surgical ventriculotomy. Although Mustard operation for transposition of the great arteries is effective in relieving cyanosis, it may be followed by obstruction to systemic or pulmonary venous return, intraatrial patch detachment, tricuspid insufficiency and angiocardiographic evidences of poor right ventricular contractility.
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PMID:Hemodynamic and angiographic changes after Mustard operation for transposition of the great arteries. 113 8

A study of factors predicting mortality was performed in 69 patients with idiopathic dilated cardiomyopathy by analyzing 14 parameters according to clinical, electrocardiographic and echocardiographic findings. On admission 64% of the patients were in NYHA functional class 3 or 4. During a mean follow-up period of 18 months 43 patients died; 31 of refractory heart failure and 12 suddenly. 1 year survival was 58%. Multivariate analysis (Cox model) revealed that the independent predictors for mortality due to refractory heart failure were left ventricular enddiastolic diameter, NYHA functional class and systolic blood pressure; the presence of tricuspid regurgitation predicted mortality due to sudden death.
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PMID:[Factors predicting mortality in idiopathic dilated cardiomyopathy]. 130 76

Aortic valve lesions in progressive systemic sclerosis (PSS) are very uncommon. To our knowledge, aortic regurgitation (AR) associated with PSS has not been reported previously. We would like to report the case of a 58-year-old woman who had PSS with AR due to Raynaud's symptom, fever, positive ANA, accelerated ESR, and diastolic blowing murmur along the left sternal border. After treatment with adreno-cortico steroid and an immunosuppressive agent, the patient improved serologically and symptomatically. However, she was later admitted to our hospital again due to heart failure with progressive AR. She died of refractory heart failure with severe AR and tricuspid regurgitation (TR). The former was caused by aortic cusp lesions and the latter by pulmonary hypertension. An autopsy confirmed the diagnosis of PSS, which was found to have involved the heart, lungs and pancreas. Vasculitis with infiltration and fibrotic changes were noted in these organs. Moreover, there were fibrotic thickenings and shortenings in the aortic cusps with cell infiltration. There were no indications of rheumatic disease. These results suggest that the cause of our patient's aortic valve disease may have been PSS vasculitis.
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PMID:[Report of a case with aortic regurgitation in progressive systemic sclerosis]. 151 78

Thirty-four patients underwent isolated aortic valve replacement with mean pulmonary artery pressures greater than 40 mmHg between 1972 and 1988. The aortic valve disease was stenotic in 10 cases, regurgitant in 14 cases and mixed in 10 cases. Thirty patients (88%) had invalidating cardiac failure (NYHA Classes III and IV). The mean preoperative ejection fraction was 44 +/- 15%. The hospital mortality was 17.6%. Ten patients died secondarily, five with terminal cardiac failure. The 5 year actuarial survival was 70 +/- 16%; the 10 year survival was 60 +/- 18% with an average follow-up of 115 +/- 61 months. None of the patients was lost to follow-up. Fifteen of the 18 survivors (83%) are asymptomatic or pauci-symptomatic after a follow-up of 126 +/- 62 months. Doppler echocardiography (n = 12) showed normal prosthetic valve function in 11 cases and aortic regurgitation in 1 case. Eight patients had tricuspid regurgitation with pulmonary artery systolic pressures less than 30 mmHg in 6 cases and between 30 and 40 mmHg in 2 cases. Severe pulmonary hypertension is therefore a poor early postoperative prognostic factor in aortic valve replacement surgery due to the associated left ventricular dysfunction. However, the long-term results are satisfactory: clinical improvement is usually related to a reduction of pulmonary hypertension.
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PMID:[Long-term surgical prognosis of aortic valve diseases with pulmonary hypertension. Apropos of 34 cases]. 155 Apr 33

An experimental model for right ventricle free wall infarct associated with double ventriculotomy and tricuspid insufficiency was created to evaluate whether right ventricle failure can cause profound refractory heart failure or whether modifications in right ventricular afterload are more influential in this regard. In our model, the left ventricle, interventricular septum and right atrial wall were maintained intact and pulmonary banding made it possible to modify right ventricular afterload during the experiment. The results of our study showed that pure right ventricular failure does affect the hemodynamic state negatively, but it is not itself, a cause of death in dogs. A slight increase in the dysfunctional right ventricular afterload produced a profound deterioration in the hemodynamic state that required pulmonary artery debanding within no more than 10 minutes.
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PMID:Does a critical hemodynamic situation develop from right ventriculotomy and free wall infarct or from small changes in dysfunctional right ventricle afterload? 157 83

A newborn is described in whom the use of a central venous line was complicated by septicaemia and by intracardiac thrombus formation with tricuspid valve insufficiency and heart failure. Besides antibiotics, treatment consisted of tissue type plasminogen activator (tPA) for three days. This treatment resulted in the disappearance of the thrombus and the tricuspid insufficiency. No adverse effects were noted. Treatment with tPA should be considered in intracardiac thrombus formation with rapidly progressive heart failure in the neonate.
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PMID:Intracardiac thrombus formation with rapidly progressive heart failure in the neonate: treatment with tissue type plasminogen activator. 158 89


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