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

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

Three patients over 70 years of age underwent surgical repair of secundum atrial septal defect (ASD). All patients had preoperative symptoms such as heart failure, atrial fibrillation and cardiomegaly. According to the New York Heart Association (NYHA) functional classification, two patients belonged to class II and one class III. Cardiac catheterization data revealed mild pulmonary hypertension and mild to moderate tricuspid regurgitation in all the patients. An ASD was directly closed in all the patients, and two of them required tricuspid anuloplasty. The use of catecholamine continued for two or three weeks in two patients because of postoperative cardiac dysfunction. Postoperative physical activity has improved in all the patients. Surgical repair of an ASD is recommended even for patients over 70 years of age unless they have major risks and severe pulmonary hypertension.
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PMID:[Surgical repair of atrial septal defect in patients over 70 years of age]. 866 80

Damage to the tricuspid valve apparatus has been described after endomyocardial biopsy and may be associated with hemodynamically significant tricuspid regurgitation (TR). This study was performed to determine the prevalence of TR and flail tricuspid leaflet in cardiac transplant recipients and to evaluate the use of a 45 cm sheath placed directly in the right ventricle during endomyocardial biopsy to reduce the incidence of these complications. Echocardiograms and right heart catheterization data of 72 orthotopic cardiac transplant recipients were assessed for the presence of flail tricuspid leaflet, TR, and right-sided cardiac dysfunction 29 +/- 20 months (mean +/- SD) after transplantation. Moderate or severe TR was present in 23 patients (32%). Ten patients (14%) had flail tricuspid leaflet, with 7 of these having severe TR. Right atrial pressure (10 +/- 5 vs 6 +/- 5 mm Hg, p < 0.05) was higher, cardiac index (2.0 +/- 0.2 vs 2.5 +/- 0.7 L/min/m2, p < 0.05) was lower, and right-sided cardiac dimensions were greater in patients with flail leaflets than in those without flail leaflets. Both the prevalence of flail tricuspid leaflet (41% to 6%, p < 0.0001) and mean grade of TR (2 to 1, p < 0.0001) were reduced after the use of a 45 cm sheath. We conclude that TR secondary to biopsy-induced damage to the valve apparatus occurs in cardiac transplant recipients and is associated with signs of early right-sided heart failure. Use of a 45 cm sheath during endomyocardial biopsy reduces the prevalence of flail tricuspid leaflet and the severity of TR.
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PMID:Biopsy-induced flail tricuspid leaflet and tricuspid regurgitation following orthotopic cardiac transplantation. 867 76

Recent studies have demonstrated that pulmonary artery diastolic (PAD) pressure can be measured from a transducer positioned in the right ventricle (RV) based on the finding that PAD and RV pressures are equal at the time of pulmonary valve opening, which is associated with the time of maximum positive rate of pressure development (dP/dtmax) in the ventricle. The objective of this study was to assess the correlation between estimated PAD (ePAD) pressure, obtained through a RV transducer, and actual PAD (aPAD) pressure in patients with heart failure who have abnormal hemodynamics, reduced systolic function, and variable degrees of mitral regurgitation (MR) and tricuspid regurgitation (TR). Simultaneous measurements of pulmonary artery and RV pressures were obtained with a high-fidelity Millar catheter (Millar Instruments, Houston, TX) in 10 patients with New York Heart Association class III-IV heart failure who were being evaluated for cardiac transplantation. The overall correlation between ePAD and aPAD pressures was .92 (R2 = .878). This was not significantly different during the Valsalva maneuver (r = .96, R2 = .943), submaximal bicycle exercise (r = .87, R2 = .756), or infusions of dobutamine and nitroglycerin (r = .82, R2 = .730). The overall average difference between the average ePAD (24.6 +/- 7.0 mmHg) and aPAD (23.6 +/- 7.0 mmHg) pressures was 1.0 +/- 3.4 mmHg. The average difference between the two pressures in patients with mild to severe MR or TR was not different compared to those patients with no or trace MR or TR. The estimation of PAD pressure from an RV transducer is valid in patients with heart failure who have abnormal hemodynamics, reduced systolic function, and variable degrees of MR and TR. This correlation was observed at rest and during several provocative maneuvers. These data will be important for the development of a chronic, implantable hemodynamic monitor for patients with heart failure.
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PMID:Measurement of pulmonary artery diastolic pressure from a right ventricular pressure transducer in patients with heart failure. 879 4

Two cases of Candida endocarditis are reported. The first case was of a 63-year-old man who had a positive blood culture for Candida albicans during treatment for liver abscess and early gastric cancer. He was transferred to our department, and aortic and tricuspid regurgitation due to Candida endocarditis was diagnosed. The patient was successfully treated with aortic valve replacement, tricuspid valve plasty and anti-fungal agents. The second case was of a 65-year-old man who complained of fever. Despite a diagnosis of common bile duct cancer and resection of the tumor, the fever persisted. He was transferred to our department and was diagnosed having aortic regurgitation due to Candida endocarditis, complicated by heart failure. Although intense medical therapy including antifungal agents, diuretics, catecholamines and digoxin was initiated, the patient died from multiple embolisms 9 days later. In the treatment of Candida endocarditis, early diagnosis and early decision-making for either surgical or medical therapy is indispensable. Although the prevalence of Candida endocarditis is low, the differentiation of this disease should be taken into account in febrile elderly patients with long-standing therapy with antibiotics.
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PMID:[Two cases of Candida endocarditis associated with abdominal disease]. 886 24

A 63-year-old woman with atrial septal defect, mitral regurgitation, and tricuspid regurgitation underwent mitral valvuloplasty with 30 mm Carpentier ring, patch closure of atrial septal defect and tricuspid annuloplasty with 36 mm Carpentier ring. She was doing well now. In this case, preoperative catheterization showed left-to-right shunt ratio of 32% and right-to-left shunt ratio of 51%. The existence of right-to-left shunt was considered to be related to the grade of tricuspid regurgitation. It is concluded that in these cases, surgical repair should be recommended before the onset of severe progressive heart failure.
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PMID:[Successful surgical repair of atrial septal defect associated with mitral regurgitation and tricuspid regurgitation]. 899 48

To date, a paucity of information is available on the optimal management of obstructive sleep apnea in Down syndrome, which may have particularly important implications in this already vulnerable patient population. The objective of this study was to evaluate prospectively the results of a new surgical approach for the treatment of obstructive sleep apnea. Patients with Down syndrome and obstructive sleep apnea underwent preoperative and postoperative polysomnography and clinical and radiologic evaluation to determine prospectively the efficacy of sleep apnea surgery. Statistical testing of apnea index, respiratory disturbance index, and lowest oxygen saturation were compared by means of paired t tests. Seven children (five boys, two girls) from 3 to 12 years of age were subjected to a management protocol that included an aggressive surgical approach to the treatment of obstructive sleep apnea. Clinical symptoms and signs of obstructive sleep apnea, apnea index, respiratory disturbance index, lowest oxygen saturation, and surgical morbidity were the main outcome measures. Surgical treatment consisted of a combination of soft-tissue and skeletal alterations including tongue reduction (n = 6), tongue hyoid advancement (n = 4), uvulopalatopharyngoplasty (n = 7), and maxillary or midface advancement (n = 2). Polysomnography was obtained preoperatively and postoperatively in six patients. One patient was intubated preoperatively. Mean preoperative apnea index and respiratory disturbance index were 34.00 and 52.46 compared with mean postoperative values of 1.62 and 6.46, respectively. Clinically, all patients were improved symptomatically in terms of snoring, noisy breathing, and oxygen requirements. The one patient who had been intubated preoperatively for respiratory failure was extubated successfully but later developed recurrent tricuspid regurgitation and was found to have fixed pulmonary hypertension with cor pulmonale. This patient represented the only treatment failure and underwent tracheostomy. An aggressive surgical approach aimed at correcting all anatomic abnormalities associated with upper airway obstruction was applied successfully to the treatment of obstructive sleep apnea in Down syndrome. We suggest periodic polysomnography in patients with Down syndrome, especially if there is unexplained deterioration in mental capacity or other signs and symptoms of obstructive sleep apnea. Surgical treatment should address both the soft-tissue abnormalities and the skeletal deformities such as midface retrusion. Preoperative cardiac ultrasonography is important to determine the presence of right-sided heart failure, which may be an indication for cardiac catheterization to determine pulmonary venous pressures.
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PMID:Down syndrome: identification and surgical management of obstructive sleep apnea. 904 80

The cardiac manifestations of the hyperthyroidism (HT) are diverse and frequent. However, sometimes, the initial symptoms are atypical and are difficult to diagnose. We present the case of a patient whose HT began with heart failure secondary to a severe tricuspid regurgitation (IT). This data suggests that when confronted with IT of unclear etiology, a possible HT must be investigated.
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PMID:[Severe tricuspid insufficiency as main manifestation of hyperthyroidism]. 930 83

A 76-year-old woman with a history of repeated right-sided cardiac failure during the past 2 years presented with tricuspid and mitral regurgitation due to congenital hypoplasia of atrioventricular valves. Two-dimensional echocardiography demonstrated enlarged right atrium and right ventricle, and discoaptation between the leaflets. Color Doppler echocardiography revealed severe tricuspid regurgitation through the gap between the leaflets. Autopsy showed congenital hypoplasia of the leaflets and the chordae tendineae in the tricuspid and mitral valvular apparatus.
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PMID:[Tricuspid and mitral regurgitation due to congenital hypoplasia of atrioventricular valves in the aged: a case report]. 906 21

A left ventricular assist device (LVAD) is intended for use as a temporary bridge to transplantation in patients with end-stage cardiac failure until a donor heart becomes available. This case report discusses the anesthetic management of a patient undergoing implantation of an LVAD. Tremendous advances have been made in cardiac transplantation; however, there is an acute donor shortage in the face of an increased need for donor hearts. These two factors have been the impetus for the development and testing of a mechanical assist device. A new U.S. Food and Drug Administration approved assist device, the Thermo-Cardiosystems, Inc. (Woburn, Massachusetts) implantable pneumatic LVAD is proving to be very successful as a bridge to transplantation. A case is presented of a 40-year-old male with debilitating cardiomyopathy in conjunction with mitral regurgitation, pulmonary hypertension, and mild tricuspid regurgitation. He had reached the point of multisystem organ failure which had left him incapacitated while awaiting cardiac transplantation.
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PMID:Anesthetic implications for implantation of a left ventricular assist device: a case study. 938 77


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