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

A review of the literature shows a very variable mortality, especially after emergency operations for abdominal aortic aneurysm (AAA) (14-70%). We therefore analyzed the mortality of our patients in different subgroups. The hospital data of 82 patients operated on for abdominal aortic aneurysm were analyzed retrospectively. 42 patients underwent emergency operations and 40 patients elective surgery. The mean age was 67.5 +/- 9.4 and 70.7 +/- 7.3 years respectively. The overall 30-day mortality in elective cases was 5% (2/40); elective patients under the age of 75 years had a mortality of 0%. 33% of the emergency cases died within 30 days. The mortality in various subgroups was as follows: "asymptomatic AAA" 5.4% (2/37), "symptomatic AAA" 10% (1/10), "retroperitoneal rupture" 34% (11/32) and "intraperitoneal rupture" 66.6% (2/3). Preoperatively 21/42 patients who underwent emergency surgery were in hypovolemic shock (systolic blood pressure < or = 90 mm Hg). The mortality of these patients was 52% (11/21) compared to 9.5% (2/21), (p < 0.01), in emergency patients without preoperative shock. The causes of death after emergency procedures were hypovolemic shock in 6, heart failure in 4, and multi-organ failure, respiratory insufficiency, unknown and pulmonary embolism in 1 each. 5/14 patients died in theatre. Two patients died after elective procedures: one 9 days postoperatively from myocardial infarction and the second 23 days after the operation from an unknown cause. Reoperation rate after elective and emergency procedures was 7.5% and 16.6% respectively. Mortality after reoperation was 40%.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Abdominal aortic aneurysm. Risks and early postoperative course]. 144 85

Equilibrium radionuclide angiocardiography (ERNA) was employed preoperatively in 183 patients undergoing elective abdominal aortic reconstruction to measure left ventricular ejection fraction (LVEF) and to detect abnormal regional wall movement. Abnormal ejection fractions were virtually confined to the 97 patients who had clinical, electrocardiographic or radiographic evidence of heart disease. An operative mortality of 8.7% was recorded. Major cardiac events (defined as myocardial infarction, cardiac failure or malignant ventricular arrhythmia) occurred in 15 of 86 abdominal aortic aneurysm patients (17.4%) and six of 96 (6.25%) patients with aorto-iliac occlusive disease. Patients with an abdominal aortic aneurysm and abnormal LVEF or regional wall motion abnormality were more likely to suffer a cardiac event (p less than 0.001), the event rate exceeding 60% in patients whose LVEF was less than 35%. An abnormal LVEF failed to predict a cardiac event in patients with aorto-iliac occlusive disease. While not indicated in patients lacking clinical evidence of heart disease, ERNA can refine the assessment of cardiac risk, particularly in patients with previous myocardial infarction and define a high risk group in whom aortic reconstruction should be avoided except for the most compelling of indications.
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PMID:Equilibrium radionuclide angiocardiography prior to elective abdominal aortic surgery. 203 89

From March 1978 through July 1985, 23 patients underwent implantation of 24 intraluminal ringed prostheses (IRP). There were 18 men and 5 women, with a mean age of 54.7 years, range 15-74 years. Eleven IRP were placed in the ascending aorta, two in the transverse arch, and 11 in the descending aorta. Pathology included acute aortic dissection in four patients, chronic dissection in four, and aortic aneurysm in 16. There were eight hospital deaths (35%). Causes of death included acute cardiac failure in seven patients, and ruptured abdominal aortic aneurysm in one. IRP complications requiring revision included right coronary artery occlusion in three of 11 patients (27%) with an IRP in the ascending aorta. Graft revision was also required in three of 11 IRP implanted in the descending aorta (27%), due to graft occlusion in one and graft stenosis in two. Of the six patients with IRP complications, there were three hospital deaths (50%). All 15 hospital survivors were followed for a mean of 68.5 months, range 5-112 months. There were four late deaths (26.7%). Causes of late death included hemoptysis in one, cardiomyopathy in one, and aortic redissection and rupture in two. We conclude that patients undergoing repair of aortic pathology with IRP have an important risk of early phase events, as technical problems can occur due to malposition and slippage of the securing rings.
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PMID:Events following implantation of an intraluminal ringed prosthesis in the ascending, transverse, and descending thoracic aorta. 225 97

Aortocaval fistula is an uncommon complication of ruptured abdominal aortic aneurysm and is only seen in 4% of all ruptured aneurysms. The symptoms may vary from one patient to another but the characteristic physical findings are high output heart failure, widened pulse pressure with low diastolic blood pressure and venous hypertension. When these signs are combined with an abdominal aortic aneurysm and a continuous abdominal bruit, the diagnosis of aortocaval fistula must be seriously considered. It is important to diagnose the fistula before surgical intervention, so as to prevent intraoperative bleeding and complications. In our surgical department we have operated 103 ruptured abdominal aortic aneurysms but only one with an aortocaval fistula. This case is discussed in the light of the literature on the subject.
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PMID:[Ruptured abdominal aortic aneurysm with aortocaval fistula]. 236 46

This case report describes pelvic venous congestion without associated high-output cardiac failure as an unusual presentation of an aortocaval fistula as a complication of a contained rupture of an abdominal aortic aneurysm. Options for caval control and management of perioperative problems unique to this situation are discussed.
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PMID:Aortocaval fistula and contained rupture of an abdominal aortic aneurysm presenting with pelvic venous congestion. 236 53

During a period of 13 years 11 patients were operated on because of a spontaneous aortocaval fistula caused by a ruptured abdominal aortic aneurysm. The classic diagnostic signs of an aortocaval fistula (pulsatile abdominal mass with bruit and high output heart failure) were present in approximately half of the patients, whereas hematuria was a constant finding in all patients. Six patients had macrohematuria, and five had microhematuria. Seven patients (64% survived, and four had postoperative complications: 1 ileus, 2 postoperative pneumonias, 2 deep venous thrombosis, 1 postoperative hemorrhage. The mean operative blood loss was 7 L. After operation the average follow-up time was 4 years. In four patients who died the perioperative (within 30 days) causes of death were renal failure, a bleeding duodenal carcinoma, myocardial infarction, and operative bleeding. It is concluded that hematuria is a more frequent finding than earlier assumed among patients whose abdominal aortic aneurysm has ruptured into the vena cava. The presence of hematuria in a patient suffering from an abdominal aortic aneurysm is an indication for aortography to rule out an aortocaval fistula.
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PMID:Hematuria is an indication of rupture of an abdominal aortic aneurysm into the vena cava. 203 12

Patients presenting for abdominal aortic surgery have a high incidence of vascular disease elsewhere, manifested primarily by hypertension, coronary and cerebrovascular disease, as well as co-existing respiratory, renal and metabolic disorders. Routine clinical assessment, electrocardiogram, chest roentgenograms, resting and exercise radionuclide ventriculography and echocardiography, dipyrdiamole-thallium scanning are all designed to assess the functional status of the myocardium and to detect the presence of significant coronary artery disease. Patients with no abnormalities on physical examination, routine evaluation and no redistribution on dipyridamole-thallium scanning should proceed to surgery with the expectation of very low perioperative cardiac risk. Patients with evidence of coronary artery disease and significant redistribution on dipyridamole-thallium scan should undergo coronary angiography and possible myocardial revascularization before definitive aortic vascular surgery. For high cardiac risk patients with no bypassable lesions presenting for abdominal aortic aneurysm resection a conservative policy of serial three monthly ultrasound or CT assessment may be adopted, with selective resection for rapid aneurysm expansion or symptom development. A variety of extra-anatomical and angioplastic techniques is available for similar high cardiac risk patients with aortoiliac occlusive disease. The haemodynamic consequences of aortic cross-clamping, especially in aneurysm patients, include a significant reduction in stroke volume, cardiac index, and myocardial oxygen consumption with an increased systemic vascular resistance. Patients with coronary artery disease may respond to aortic cross-clamping by increasing pulmonary capillary wedge pressure and by demonstrating ECG evidence of myocardial ischaemia. Pulmonary artery catheterization is especially indicated in patients with a history of previous myocardial infarction, angina or signs of cardiac failure and in patients with evidence of diminished ejection fraction, abnormal ventricular wall motion or myocardial redistribution on preoperative scanning. The more widespread application of intraoperative transoesophageal two-dimensional echocardiography and radionuclide cardiography monitoring techniques into anaesthetic practice will enable measurement of left ventricular dimensions, myocardial performance and wall motion. Suggested guidelines for anaesthetic management are presented in Table VI. A combined opiate-oxygen-volatile anaesthetic agent technique will best ensure a hypodynamic circulation with preservation of myocardial oxygenation.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Anaesthesia for abdominal aortic surgery--a review (Part II). 267 22

Gated heart pool scan measuring left ventricular ejection fraction (LVEF) was performed preoperatively in 72 patients presenting for elective repair of abdominal aortic aneurysm. Patients with a positive cardiac history were more likely to have a LVEF of less than or equal to 45 per cent (P less than 0.001). The operative mortality rate was 4 per cent. Each of three patients who died had a LVEF less than or equal to 35 per cent and developed cardiac failure which led to renal failure. Five other patients developed cardiac failure manifested by acute pulmonary oedema during the early postoperative period. There was no statistically significant association between a positive cardiac history and the occurrence of postoperative cardiac failure or death. However, patients with a LVEF of less than or equal to 45 per cent were more likely to develop postoperative cardiac failure (P = 0.004) while patients with a LVEF of less than or equal to 35 per cent had a greater chance of dying (P less than 0.001). No patient died with a LVEF greater than 35 per cent. Preoperative evaluation of LVEF can select patients at high risk of cardiac death from repair of abdominal aortic aneurysm. Such patients could be followed conservatively if they remain asymptomatic and the aneurysm does not enlarge. If operation is considered mandatory, patients with a low LVEF should receive intensive perioperative monitoring with enhancement of ventricular performance.
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PMID:Risk of aortic aneurysm surgery as assessed by preoperative gated heart pool scan. 275 81

The treatment of coronary artery disease (CAD) prior to abdominal aortic aneurysm (AAA) surgery has reduced the operative mortality, but there is no consensus regarding how best to detect CAD. In this study, 160 patients with AAA were divided into 4 groups according to Goldman's weighted risk factors. All patients were evaluated for CAD by clinical and laboratory methods, including stress electrocardiogram (ECG) and radionuclide studies, and monitored perioperatively with serial ECGs, measurements of serum enzymes, filling pressures, and cardiac output. No one died, but 3.7% had myocardial infarct, 2.5% had heart failure, and 8.1% had arrhythmias. Cardiac complications were rare in patients without clinically evident CAD and in those in Goldman's classes I and II. It appears that patients without clinically detectable CAD can be operated upon with a low risk if they are carefully evaluated and monitored.
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PMID:Abdominal aortic aneurysm surgery: the basic evaluation of cardiac risk. 319 95

The patient, male and 70 years of age, was suspected of having a ruptured abdominal aortic aneurysm during the laparotomy, and referred to our department. After admission it was found that a ruptured abdominal aortic aneurysm complicated with dissecting aneurysm. Urgent surgical intervention should have been scheduled but an initial conservative control was necessary because of impaired hepato-renal function and hemorrhagic gastroduodenal ulcer. Meanwhile, pleural effusion, edema in lower extremities and abdominal continuous vascular murmur appeared, and cardiac failure symptoms gradually aggravated. The formation of arteriovenous fistula was suspected. Aortography revealed the DeBakey IIIb type dissecting aortic aneurysm complicating an abdominal aneurysmal rupture with the fistula formation to inferior caval vein. Neither enlargement nor progress of a thoracic aortic aneurysm were observed by CT scanning examination and the closure of fistula and Y grafting were performed successfully. So far, only one case of a ruptured abdominal aortic aneurysm forming the aorto-caval fistula and complicating dissecting aortic aneurysm was reported in Japan, and, to the best of our knowledge, this is the first case treated successfully.
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PMID:[Aorto-caval fistula complicated by a DeBakey IIIb-type dissecting aortic aneurysm: report of a case]. 320 Feb 43


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