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

A cyanotic newborn is described to illustrate and discuss the rare transient tricuspid insufficiency together with functional pulmonary atresia. Etiologically the manifold causes of perinatal asphyxia are to be taken into consideration. The clinical appearance corresponds to type A of transient myocardial dysfunction according to the classification of Rowe together with respiratory distress syndrome and heart failure. Pathogenetically the disease is based on the different histological consequences of myocardial ischaemia of the right ventricle in connection with a delayed fall of the pulmonary arterial resistance. Fetal connections lead to a pronounced right-to-left-shunt. The diagnosis is primarily established by the way of clinical and echocardiographic investigation and pulsed doppler examination. The most important differential diagnosis are in Ebstein-anomaly, obstruction and atresia of the right ventricular outflow tract. Therapy is conservative. Its aim is to improve myocardial performance and to lower right ventricular afterload. Outcome of patients with neonatal tricuspid insufficiency is uncertain and depends on the severity of myocardial ischaemia. In our patient the course has been uneventful after initial difficulties.
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PMID:[Neonatal tricuspid insufficiency--a contribution to the differential diagnosis of the cyanotic newborn infant]. 395 89

Twenty-nine patients with isolated (18) or predominant (11) mitral insufficiency were treated by mitral annuloplasty. This post-operative follow-up study, lasting from 3 to 5(1/2) years (average 48 months), resulted in the following conclusions. The clinical, radiological, and electrocardiographic conditions usually followed a parallel course. Initial good results were maintained for up to 4 years in only 16 patients. Subsequent deterioration was related to progression to mitral stenosis (2 patients), recurrence of severe mitral insufficiency (13 patients), occurrence (5 patients) or recurrence (8 patients) of tricuspid insufficiency. Poor results were more often observed in the eldest patients, with conspicous pre-operative cardiac enlargement, atrial fibrillation, and long-standing cardiac failure. The indications for annuloplasty are reduced and apply primarily to mitral insufficiency without obvious cardiac enlargement, with normal sinus rhythm, and with short-standing congestive cardiac failure.
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PMID:Long-term prognosis after mitral annuloplasty for acquired mitral insufficiency. Clinical evaluation. 424 16

A case with Ebstein's anomaly associated with large left to right atrial shunt was operated upon. The patient did not demonstrate any tricuspid insufficiency in spite of the downward displacement of the septal and posterior leaflets of tricuspid valve. The surgical closure of the atrial septal defect relieved the impending heart failure. The pulmonary congestion disappeared but the cardiomegaly persisted after the operation.
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PMID:Ebstein's anomaly associated with a definite atrial left to right shunt--case report. 446 71

Reoperation for secondary deterioration after mitral commissurotomy is associated with a higher immediate postoperative mortality than other open heart operations. We analysed the factors responsible for this increased mortality. A total of 232 patients reported for clinical deterioration after closed heart mitral commissurotomy were reviewed. Mitral valve prostheses were implanted in 202 cases; open heart commissurotomy was possible in 30 cases. Associated procedures included 14 tricuspid valve replacements, 53 tricuspid annuloplasties and 30 aortic valve replacements. The global mortality was 12 p. cent (30 deaths). The causes of death were myocardial failure (19 cases), cerebrovascular accidents (4 cases), prosthetic valve thrombosis (4 cases), infection (2 cases), section of the mitral annulus (1 case). The clinical hemodynamic and anatomical criteria influencing the operative prognosis were analysed: 1. Operative mortality was related to the clinical stage (zero mortality at Stage II, 10,3 p. cent at Stage III, 38 p. cent at Stage IV, p less than 0,001); 2. There was a significant correlation with cardiothoracic ratio: 23 p. cent mortality when greater than 0,60; 9,8 p. cent mortality when less than 0,60 (p less than 0,02); 3. There was a significant correlation with cardiac index: 19 p. cent mortality when less than 21; only 9 p. cent mortality when greater than 21 (p less than 0,04); 4. There was a significant correlation with systolic pulmonary arterial pressure: mortality of 11 p. cent when less than 60 mmHg; mortality of 22 p. cent when greater than 60 mmHg (p less than 0,06). 5. The presence of tricuspid regurgitation increased the operative risk (mortality rose from 12 to 22 p. cent, p less than 0,05) when the surgeon detected moderate or severe tricuspid regurgitation. These results show that the clinical, radiological and hemodynamic aggravation of these patients has a bad influence on operative mortality. This aggravation is not related to the delay between the initial commissurotomy and reoperation but to the delay between the recurrence of symptoms after the first operation and reoperation. Operative mortality was 12 p. cent when this delay was less than 10 years but 23 p. cent when the delay was over 10 years (p less than 0,02). Our findings suggest that these patients should be reoperated earlier if the prognosis of this type of surgery is to be improved.
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PMID:[Recurrence of mitral disease after commissurotomy. Criteria influencing operative mortality during reintervention using extracorporeal circulation]. 640 25

The authors report the long-term results of 309 patients undergoing isolated mitral valve replacement with a 6120 Starr Edwards mitral valve prosthesis in the great majority of cases, mainly for rheumatic mitral valve disease, with predominant mitral regurgitation. The average age was 26 +/- 14 years with 25% of children. The operative mortality was 9% and late mortality after a mean follow-up period of 4 years was 13,5% mainly due to thromboembolic complications and to myocardial dysfunction. The long-term results with an average 45 month follow-up showed a 10 year survival rate of 70,6% with an excellent clinical result in 71% of cases and an acceptable result in 10%; 20% of patients were considered poor long-term results because of myocardial dysfunction and thromboembolic complications. Endocarditis and perivalvular leaks were rarely observed (9 cases). A study of preoperative parameters which could influence long-term results showed that the quality of long-term survival was significantly correlated to age, the duration of cardiac disease before surgery, cardiomegaly and the presence of preoperative cardiac failure and tricuspid regurgitation. The incidence of thromboembolism was 4,7% patient years and the frequency of these complications was not related to the quality of anti-vitamin-K therapy. Patients under effective anticoagulant therapy had the highest incidence of haemorrhage (10%). This study confirms that the Starr Edwards 6120 prosthesis is a satisfactory choice for mitral valve replacement considering its durability (no cases of abnormal wear) and the 70% ten year survival rate. The problem of myocardial dysfunction could be resolved by earlier surgery.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Fate of Starr-Edwards prostheses in the mitral position. Prognostic factors. Apropos of 309 cases]. 643 71

A case of a one month old girl admitted in hospital because of cardiac failure who died at three months of age is described. Her necropsy demonstrated a ventricular septal defect and showed a blood cyst in the tricuspid valve. It might be possible that the "precordial honk" or "whoop" heard during life, the cottony, shaggy pictures recorded in the echocardiogram behind the anterior tricuspid leaflet in diastole, the tricuspid regurgitation appreciated in the angiocardiography, and the failure of the pulmonary artery banding were related to the blood cyst 4 mm. in diameter attached to the atrial surface of the anterior tricuspid leaflet near the free margin. The microscopic findings of haemosiderin loaded macrophages and calcified deposits in the haemorrhagic cyst speak in favour of its relatively ancient nature, not associated with an asphyxial mode of death.
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PMID:[Systolic honk and blood cyst of the tricuspid valve in an infant (author's transl)]. 645 78

The efficacy of orally active 3, 4-dihydro-6-[4-(3,4- dimethoxybenzoyl )-1-piperazinyl]-2(1H)- quin olinone ( OPC -8212) as a positive inotropic agent was examined using model right-sided heart failure dogs and compared with those of dobutamine and amrinone. Heart failure was produced in beagle dogs by a combination of tricuspid insufficiency and pulmonary stenosis, and then drugs were administered intravenously or orally. Intravenous OPC -8212, 1 and 3 mg/kg, amrinone, 1 and 3 mg/kg, and dobutamine, 0.01 and 0.03 mg/kg, increased the dP/dt of the right ventricular pressure for 5 to 10 min. These positive inotropic effects were accompanied by simultaneous increase in the heart rate in the cases of amrinone and dobutamine, and was accompanied by hypotension in the case of amrinone. However, OPC -8212 did not show such effects. This indicates that OPC -8212 has a relatively selective positive effect on cardiac contractility. Oral administration of OPC -8212, 10 to 100 mg/kg, and amrinone, 10 and 30 mg/kg, also showed a positive inotropic effect, appearing 1 h after administration and lasting up to the 5th h. Amrinone had about a 3 times stronger effect, but for similar positive inotropic effects, only amrinone showed positive chronotropic effect. The hypotensive effect of amrinone was also observed after oral administration, while such an effect was scarcely observed when using OPC -8212.
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PMID:Positive inotropic effect of 3, 4-dihydro-6-[4-(3,4-dimethoxybenzoyl)-1-piperazinyl]-2(1H)-qu inolinone (OPC-8212) in the dog with experimentally-induced right-sided heart failure. 654 94

Misinterpretation of confusing cardiac, constitutional, and embolic symptoms delayed the diagnosis of cardiac myxoma and caused two of 18 patients to undergo acute operations during cardiogenic shock with pulmonary edema. In recent cases echocardiographic screening of unclear cardiac symptoms gave the correct diagnosis early. Despite the simple surgical procedure (excision of tumor and underlying endocardium), the postoperative course was complicated by cardiac failure, arrhythmias, and systemic reactions. Prosthetic valve thrombosis and malignancy caused two early deaths. Two patients died later of cerebrovascular insults. Both belonged to a group of five patients having preoperative emboli from fragile myxomas. Four of these five had coronary or cerebral myxomatous pseudoaneurysms. A 6 year follow-up, including recatheterization, showed no tumor recurrence and generally normalization of the clinical condition, heart size, and catheterization findings. Even pronounced mitral insufficiency accompanying left atrial myxomas had subsided spontaneously. Tricuspid insufficiency in two patients with right atrial myxomas persisted, necessitating reoperation in one. When diagnosed, a cardiac myxoma should be removed promptly to reduce cardiac and embolic complications, including myxomatous pseudoaneurysm formation, which might be more frequent than previously recognized.
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PMID:Surgical considerations in the treatment of cardiac myxoma. 669 16

Two patients aged ten and fourteen years presented with clinical signs of acute viral myocarditis and cardiac failure. Within three months both showed clinical deterioration with development of severe mitral and tricuspid incompetence. From their third month of illness myocardial antibodies were constantly found by indirect immunofluorescence technique. Both were treated with prednisone 2 mg/kg/d and azothioprine 2-2,5 mg/kg/d from their ninth and third month of illness for fifteen and twelve months respectively. Both showed considerable improvement within weeks with resolution of their valve incompetence, diminution of heart size and normalization of their ECGs. Results from myocardial biopsies suggest that a number of patients with chronic congestive cardiomyopathy may have long lasting viral inflammation of the myocardium or myocardial fiber destruction by autoimmunmechanisms after viral infection. Our cases probably had acute myocarditis which led to chronic congestive cardiomyopathy. Immunosuppressive therapy seems to be justified in cases where chronic inflammation or destruction of the myocardium is suspected because of the results of cardiac biopsies, myocardial scintigraphy or demonstration of myocardial antibodies.
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PMID:[Immunosuppressive therapy in congestive cardiomyopathy in childhood]. 672 81

A newborn baby is admitted in the second week of life with osteomyelitis and septicemia due to Staph. aureus infection. In his tenth week of life--the osteomyelitis nearly overcome--the infant shows signs of heart failure with a murmur and cyanosis. Cardiac catheterization reveals tricuspid insufficiency and thrombosis of the right pulmonary artery. Postmortem examination shows isolated polypous endocarditis of the tricuspid valve together with thrombosis of the right and recent embolus of the left pulmonary artery. A similar case has to the best of our knowledge not been described.
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PMID:[Isolated endocarditis of the tricuspid valve in early infancy]. 720 2


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