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

Fourteen patients younger than two years of age with persistent truncus arteriosus underwent primary repair. Twelve of them were less than 1 year and 4 less than 3 months of age. Intractable heart failure was the indication for surgery in all patients but one who had increased pulmonary vascular resistance. There were 5 hospital and 2 late deaths. Six out of the 7 survivors (median follow-up: 29 months) were symptom-free. The remaining infant who preoperatively had significant truncal valve regurgitation was doing fairly well 2 1/2 years after repair. Our experience suggests that, although the mortality remains high, primary repair for infants with persistent truncus arteriosus is feasible and offers better overall results than does pulmonary artery banding followed by later intracardiac repair. We advise primary repair for all infants with intractable heart failure or increasing pulmonary vascular resistance with or without truncal valve regurgitation. Elective repair is recommended before the age of 2 years to minimize the risk of pulmonary vascular disease.
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PMID:Surgical repair of persistent truncus arteriosus in infancy. 615 30

Description and discussion of the findings in a five month old infant and a six year old boy, in whom unilateral absence of the pulmonary artery contralateral to the aortic arch could be demonstrated by means of angiocardiography. The infant, having absence of the right pulmonary artery associated with patent ductus arteriosus and obstructive pulmonary vascular disease of the left lung died after recurrent pulmonary infections in acute heart failure. The boy with absence of the left pulmonary artery could be shown to have moderate-severe peripheral stenosis at the origin of the right pulmonary artery from the main pulmonary artery. Pulmonary function studies showed normal values. During a follow-up of 5 years the boy doesn't show any symptoms. In both cases an accessory vessel could be demonstrated on the side of the absent pulmonary artery originating from the innominate artery and leading to the hilum of the corresponding lung. Embryologically these vessels probably represent persistence of the second primitive ductus arteriosus. According to its development the disease more precisely should be designated as unilateral proximal aplasia of the 6th ventral aortic arch, i.e. of the definitive pulmonary artery.
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PMID:[Unilateral proximal aplasia of the pulmonary artery--studies on the clinical significance and embryologic interpretation]. 638 61

In a 15-month-old girl with patent ductus arteriosus (PDA) with pulmonary hypertension, division of the PDA was undertaken, but she died of heart failure 7 months post-operatively. Morphometric study of biopsy and autopsy lungs showed that medial hypertrophy and pulmonary intimal lesions developed markedly after surgery. Severe pulmonary hypertension and hypoxemia were present preoperatively. The pulmonary hypertension remaining postoperatively and aggravated pulmonary hypoxemia are thought to have caused postoperative constriction of the pulmonary vessels and to bring about unusual medial hypertrophy. Since it is known that marked hypertrophy of the media can easily cause vasospasms, it is thought that, in the present case, the smooth muscle cells of the media became necrotic, which brought about damage to endothelial cells. Such damage, in turn, led to the development of occlusive pulmonary vascular disease.
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PMID:Progressive pulmonary vascular disease after surgery in a case of patent ductus arteriosus with pulmonary hypertension. 662 58

Hypertension and obesity are two disorders that have been closely related, each occurring in greater frequency with the other than in an otherwise normal population. Although a causal relationship has not been established between the two, their coincidence carries increased risk of cardiovascular morbidity and mortality. This report summarizes the pathophysiological studies from our laboratory concerning their interrelationship and offers a rational hypothesis for the mechanisms underlying this enhanced risk. Patients with hypertension demonstrate an increased total peripheral resistance that explains hemodynamically the rising arterial pressure with advancing vascular disease. In response to this increased afterload imposed upon the heart, the left ventricle adapts itself structurally through a process of concentric hypertrophy. In addition, in most patients with essential hypertension, plasma volume progressively contracts and renal vascular resistance increases in proportion to the rise in arterial pressure and total peripheral resistance. In contrast, in obesity-hypertension there is a superimposed factor of volume overload upon the hemodynamic abnormality. The result is an additional cardiac stimulus for eccentric hypertrophy due to the increased ventricular preload. This factor enhances left ventricular stroke work and its attendant myocardial oxygen demands, thereby providing a dual overload on cardiac function that can explain the increased risk of heart failure related to these associated conditions. In contrast to the compounding adverse hemodynamic effects on the heart, there does not seem to be an additive hemodynamic effect of obesity on hypertensive renal vascular disease.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The problem of obesity and hypertension. 662 65

Basic methods for the examination including echocardiography are described. Indications for cardiac catheterization, angiography, and a description of the risk of these invasive methods are given. Cardiac catheterisation is necessary as early as possible in all cyanotic infants who are suspected to have heart defects - even in newborns. In transposition of the great arteries the hemodynamics can be improved by balloon septostomy during the first days of life. After septostomy the children can be operated upon during the second half of the first year of life. Non-cyanotic infants with an uncertain diagnosis or recurrent or medically not treatable heart failure have to be examined to clarify the need for an operation. Generally, early operative correction during the first year of life is the best, even more so with unsuccessful - medical treatment. This is valid especially for children with ventricular septal defects, although up to 60% of them tend to close spontaneously. Early correction almost always prevents obstructive pulmonary vascular disease. In contrast in aortic stenosis, cases for operative treatment should be carefully selected. Only critical stenoses have to be operated on very early. To choose the right time for operation and thereby save the childrens life it is necessary to be sure of an intensive and continuous follow-up by a pediatric cardiologist in all children with congenital heart disease.
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PMID:[Recent viewpoints on the examination and therapy of infants and children with congenital cardiovascular defects]. 670 May 98

Since the realization that hypertension was a risk factor for cardiovascular disease, methods of lowering elevated blood pressure have been developed. The main goal of antihypertensive treatment is to prevent or to arrest cardiovascular damage. Based on the successes and failures encountered for over 30 years or more of therapeutic experience in hypertension, several treatment goals have been established. Previously, it was claimed that the advantages of lowering blood pressure were not dependent on the antihypertensive drug used. Now, this is being questioned. For instance, fatigue is often observed in hypertensive patients treated with drugs that reduce cardiac output and limit peripheral blood flow. Is it therefore more rational to reduce blood pressure by returning increased vascular resistance to normal? Since antihypertensive therapy is life-long, we are becoming increasingly aware of the long-term effects (both beneficial and adverse) of antihypertensive drugs. The metabolic changes caused by current antihypertensive drugs are now being studied in detail. The potassium-depleting action of diuretics is well-known, and the significance of such an effect is being re-examined. The effects of various antihypertensive agents on serum lipids are relatively recent observations, the clinical importance of which is worthy of wider discussion and investigation. The abolition or reduction of all vascular complications of hypertension is the goal for which current antihypertensive treatment has most often failed. Whereas prevention of cerebrovascular accidents, renal failure, and heart failure has indeed been successfully achieved, coronary complications (the most frequent adjunct of hypertension) have been little influenced by antihypertensive therapy. Is this because coronary heart disease may be simply an associated disease, rather than a consequence of hypertension? Or is this because the beneficial action of the most widely used antihypertensive drugs on vascular disease is largely counteracted by unfavorable metabolic effects? These and similar questions have to be debated and resolved before we can define treatment goals more precisely and develop the most appropriate means to achieve them.
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PMID:Treatment goals in hypertension. 670 59

Pulmonary vascular structure was analyzed in the lungs of 10 patients with a secundum atrial septal defect (ASD) in whom pulmonary hypertension had developed. Four patients were aged 6 months or less, 5 were aged 2 to 9 years, and 1 was 21 years old. Pulmonary vascular structure was analyzed using lung biopsy tissue in 5 and autopsy material in the other 5. All the infants presented with heart failure and all had a marked increase in pulmonary arterial smooth muscle; only 1 infant survived surgery. Of the 5 older children, 1 presented with cyanosis, but in the rest the ASD was incidental to the presentation. Three patients had severe pulmonary vascular disease, similar to that seen in adults with a hypertensive ASD. Only 2 older children underwent successful surgery. In 1 child and in the 1 adult, the severity of the pulmonary vascular disease precluded surgery. The ASD was closed in 8 patients, but only 3 survived. Pulmonary hypertension develops rarely in secundum ASD in childhood.
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PMID:Pulmonary vascular disease in secundum atrial septal defect in childhood. 682 35

With the use of conventional cardiopulmonary bypass and moderate hypothermia, primary intracardiac repair of large ventricular septal defects was performed in 30 children below the age of two years. All babies were falling to thrive and suffered from cardiac failure resistant to medical therapy, or had evidence of early pulmonary vascular disease. Two patients died after the operation, giving an operative mortality of 6.7%. Twenty-eight survivors have been followed for periods of one month to two and a half years. All are thriving and have normal or mildly enlarged hearts on their chest skiagrams. Primary intracardiac repair of large ventricular septal defects can be performed in infants and small children with a low operative risk when the standard cardiopulmonary bypass technique is being used.
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PMID:Early intracardiac repair of large ventricular septal defects with conventional cardiopulmonary bypass and moderate hypothermia. 693 49

Anuria resulting from obstruction of the renal arteries to both Kidneys or to a solitary kidney is unusual. The tolerance of the kidney to this ischemia is largely dependent upon the presence of collaterals, stimulated by pre-existing arterial disease. Our experience with six patients with anuria caused by renal artery occlusion supports the role of revascularization in the recovery of significant renal function. Four of these patients had hypertension, impaired renal function, and the existence of collateral circulation to an ischemic kidney, prior to occlusion, while two patients had normal renal function (serum creatinine = 0.5 and 0.9 mg/dl) before occlusion. The intervals of anuria for the two previously normal kidneys were six hours and five days, and 2 to 14 days in the four patients with vascular disease. Isotope scanning suggested renal artery occlusion in two patients, but arteriograms confirmed the diagnosis in all six. A thrombectomy restored blood flow through the two previously normal renal arteries. Grafts from the aorta or celiax axis were used for three patients and the splenic artery was used for the sixth patient. Urine flow began during or soon after operation in all patients. Dialysis was necessary for 30 and 45 days in the two patients with normal kidneys, but in only one of the four patients with previous disease (for ten days). Serum creatinine decreased to <2.0 mg/dl after operation, except in the man with a solitary kidney, who five years later has a creatinine of 3 mg/dl. All four patients with previous arterial disease died from cardiac failure within 1 to 30 months after operation. Therefore, anuria of acute onset should be evaluated by renal scan and arteriogram to detect those patients with proximal renal artery occlusion in preparation for revascularization.
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PMID:Successful surgical treatment of anuria caused by renal artery occlusion. 705 45

During a 1-year period all Black patients admitted to two medical wards in the Johannesburg General Hospital were screened for malignant hypertension. Of the 62 patients eligible for inclusion in the study, 51 were thought to have essential malignant hypertension (hospital prevalence 2,2%). There was a striking absence of the cardiovascular and hypertensive risk factors usually described -- excessive smoking, alcohol consumption and obesity. The presenting features and complications were similar to those described in other series. Cardiac failure was present in 45% of the patients, neurological complications in 33%, and advanced renal failure in 47%. Twenty patients required dialysis. No evidence of ischaemic heart disease or atheromatous vascular disease was found. Red cell fragmentation was present in 25% of the patients. The hospital mortality rate was 25%. Only 24% of the patients had previously been diagnosed as having hypertension, although 43% had been examined by a doctor during the preceding 2 years. Of the patients discharged to the hypertension clinic, only 28% returned for short-term follow-up. Malignant hypertension is therefore a major medical and social problem in the Johannesburg Black community.
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PMID:The malignant phase of essential hypertension in Johannesburg Blacks. A prospective study. 708 52


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