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

Between January 1968 and March 1980, 202 hearts had been transplanted into 185 patients at Stanford University Medical Center. Occasionally, patients after transplantation develop myocardial failure which is amenable only to retransplantation. Sixteen patients underwent initial orthotopic allograft using standard techniques. Eight patients developed accelerated arteriosclerotic coronary disease, six had unrelenting rejection, and two had donor heart dysrrhythmia or right ventricular failure requiring retransplantation. One patient required a third transplant because of donor left ventricular ischemia. All sequential transplants were managed similarly to the primary transplant. Of the initial transplant hearts at risk, 60% survived for more than 1 year, and 57% survived for more than 2 years. These results are similar to those of patients not requiring retransplantation. Of the secondary transplant hearts at risk, 31% survived for more than 1 year and 29% survived for more than 2 years. The severity of infection and/or rejection contributed most significantly to secondary heart transplant mortality. Sequential orthotopic cardiac transplantation offers an acceptable alternative to patients with allograft failure. Survival is not as favorable as with initial transplantation because of the prolonged immunosuppression during sequential transplantation.
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PMID:Sequential orthotopic heart transplantation in man. 700 86

At the present time mechanical assisted circulation is indicated in patients with cardiac failure after open heart operations. The results after clinical implantation of the left ventricular assist devices are not encouraging. However, most of these patients suffer from irreversible cardiac failure and no restitution is to be expected. In patients with postoperative cardiac failure, a distinction must be made between isolated left heart failure and total heart failure. In patients with total heart failure - for example with diffuse, marked coronary sclerosis - both left and right ventricle failure exists. In these patients, no left ventricular assist device per se can bring the desired effect, since due to the right heart failure syndrome, the left system does not work adequately. With the biventricular bypass it is possible to maintain complete circulation in cases of cardiac insufficiency. The cannulation concept is biventricular transatrial to the aorta or to the pulmonary artery. The technique is simple and can be carried out very quickly. In cases of clinical emergency this device can be recommended due to the satisfactory haemodynamic effects achieved and the small degree of traumatic haemolysis. It represents an easy and quick implantable system for total functional heart replacement.
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PMID:[Heart replacement (biventricular assisted circulation) with the ellipsoid heart (E-BVAD) (author's transl)]. 732 82

The case reports of five patients who manifested severe hepatocellular injury secondary to heart failure are presented. All had evidence of severe left ventricular dysfunction and low cardiac output state. The clinical findings of right heart failure were variable and not always present. Liver histology, when obtained, revealed evidence of centrilobular necrosis (CLN). Rapid normalization of the biochemical abnormalities occurred in all patients, irrespective of clinical improvement of their cardiac status.
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PMID:Hepatic dysfunction secondary to heart failure. 733 82

In eight patients from 1976 until 1980, tricuspid atresia (TA) was corrected with valved xenograft conduits between either the right atrium and the main pulmonary artery or between the right atrium and the rudimentary right ventricle. All patients suffered from transient right-heart failure postoperatively and eventually developed normalized cardiac function throughout the first two months after operation. At recatheterization one year postoperatively, the right atrial pressure had generally only increased slightly, the pulmonary artery pressure was normal in all patients and only minor pressure differences were present across the valved conduits. X-ray examination showed normalization of the heart size in the majority of the patients, and in those with conduits between the right atrium and the right ventricle a considerable enlargement of the right ventricular chamber together with normalization of right ventricular contractility had developed. Arterial oxygen saturation, haemoglobin and haematocrit valves had normalized in all patients. One patient died postoperatively of intractable right ventricular failure, septicaemia and intravascular coagulation, and another was uneventfully re-operated on two years postoperatively because of conduit thrombosis. Clinical results were gratifying. Two patients with valved conduits between the right atrium and the right ventricle showed a normal unrestricted level of activity without medication, while patients with valved conduits between the right atrium and the main pulmonary artery were digitalized with an almost normal level of activity. Early repair with valved conduits of patients with TA is advocated.
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PMID:Tricuspid atresia corrected with valved xenograft conduits. 734 94

A case of intractable right ventricular failure following open heart surgery is presented which responded dramatically to moderate whole-body hypothermia. In addition to its depressant effect on heart rate, allowing improved ventricular filling when this is impaired by severe tachycardia, evidence is presented that hypothermia also has a direct positive may make hypothermia valuable in the management of severe heart failure.
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PMID:The treatment of intractable myocardial failure after open-heart surgery by whole body hypothermia. 735 88

Water restriction is a slow and difficult way to treat dilutional hyponatremia during diuretic therapy of congestive heart failure. An i.v. infusion of 400-1 400 mmol hypertonic saline combined with repeated i.v. injections of loop diuretics was used instead in 9 cases (6 patients). In 4 cases with dominating left heart failure the serum sodium concentration increased and the heart failure was not aggravated as judged from pulmonary rales and body weight. Two of the five cases with dominating right heart failure responded in the same favourable way, but body weight increased 1-2 kg and hyponatremia reappeared in three. The only difference observed between responders and non-responders was that the responders were free from leg edema. This treatment of dilutional hyponatremia seems worth further cautious use in situations in which water restriction is troublesome, but it should probably be reserved for patients without severe right heart failure.
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PMID:Treatment of dilutional hyponatremia in congestive heart failure. 738 23

The efficacy and side effects of the combination therapy of thiazide and furosemide administered to patients with refractory heart failure, for a prolonged period of time, were assessed. Thirty-two patients were hospitalized during the years 1985-1991. Left heart failure (left ventricular ejection fraction (LVEF = 22.4% +/- 6.6%) was present in 26 patients, right heart failure in 3 patients, chronic renal failure, cirrhosis and bilateral pleural effusion were present each in one patient. Chlorothiazide 0.5 g daily was added to conventional therapy. Patients were monitored closely during hospitalization and later as outpatients. During hospitalization, addition of chlorothiazide caused a reduction of 4.8 +/- 4.0 kg in patients' weight, serum potassium decreased from 4.4 +/- 0.6 to 4.0 +/- 0.5 mmol/l (P < 0.005) and serum sodium from 139.0 +/- 4.7 to 136.8 +/- 5.5 mmol/l (P < 0.05). The duration of the combined therapy was 17.2 +/- 19.1 months. Thirteen patients had short treatment (1.6 +/- 0.8 months) and 19 patients had prolonged treatment (26.5 +/- 19.0 months). No specific characteristics distinguished patients in both groups. Thiazides were discontinued in 19 patients, 10 of which had side effects. In only 5 of the 19 patients treated for the prolonged period had thiazides to be discontinued because of side effects. Addition of thiazides to furosemide is efficacious in severe heart failure. The combination should be started during hospitalization. Many patients can be maintained on this combination for a prolonged period of time on an ambulatory basis.
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PMID:Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions. 759 35

A 62 year-old woman with a bilateral carotid body paraganglioma presented, 2 years after the removal of the right one, with signs of right-heart failure. Hypoxemia, hypercapnia, polycythemia and pulmonary hypertension with normal ventilatory capacity were found. Central alveolar hypoventilation was diagnosed on the basis of absence of ventilatory response and sensation of provoked hypercapnia, prolonged breath-holding time and correction of hypercapnia by voluntary ventilation. Progesterone (200 mg/d during 3 weeks) or naloxone did not improve either arterial blood gases (ABG) or the P 0.1/PCO2 curve. Hypoxemia and hypercapnia were not corrected during metabolic acidosis provoked by acetazolamide (250 mg/d). Nasal CPAP did not control hypoventilation periods. Mechanical ventilation was initiated with negative pressure (NPV) through a poncho. The patient presented severe discomfort with NPV and obstructive apneas were verified during it. She refused to continue NPV. Mechanical ventilation was initiated with positive intermittent pressure (IPPV) through a nasal mask. The patient had excellent tolerance to the procedure. SpO2 during IPPV was always higher than 95%. During sleep induction (under IPPV), respiration in phase with the ventilator 1: 1 was observed; instead, during consolidated sleep there was a complete dependence of the ventilator with apnea for over 2 min when IPPV was interrupted (Fig. 1). After 2 months of treatment, a relief of right ventricular failure occurred and hematocrit fell to 39%. There was an improvement of day-time ABG (Table I). The P. 0.1/PaCO2 curve 3 months after IPPV was the same as the previous one (Fig. 2). The patient has been for 18 months on home ventilation.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Central alveolar hypoventilation with cor pulmonale: successful treatment by non-invasive intermittent positive pressure ventilation]. 771 33

A patient with a severe liver injury and an acute cardiac failure due to a traumatic tricuspid valve failure is presented. During liver surgery, massive venous bleeding was caused by regurgitation of blood through the insufficient tricuspid valve. Right ventricular failure, leading to persistent hemodynamic instability, and caused by massive posttraumatic tricuspid regurgitation, has been treated with biological valve replacement. Diagnosis and management of posttraumatic tricuspid insufficiency are discussed.
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PMID:Severe liver rupture and tricuspid valve rupture in a patient with multiple trauma. 776 Apr 22

Transposition of the great arteries is a complex cardiac malformation with poor prognosis without surgical correction. Since the introduction of surgical procedures such as the intra-auricular reorientation of the venous return (Mustard procedure), an increasing number of patients may reach adulthood and experience pregnancy. Because long-term complications after the Mustard operation include systemic heart failure, arrhythmias, venous return stenosis and pulmonary edema, hemodynamic changes during pregnancy and delivery may potentially engender life-threatening complications in these patients. We report the case of a 24-year-old primigravida who underwent a Mustard procedure at the age of 2 years for transposition of the great vessels, and who carried out a full-term pregnancy. The pregnancy was uneventful until the 34th week, when the woman developed signs of moderate right ventricular failure and frequent episodes of accelerated junctional rhythm. Digitalisation improved symptoms and elicited return to normal sinus rhythm. The patient delivered at term by elective cesarean section, under close hemodynamic monitoring.
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PMID:Successful term pregnancy after Mustard operation for transposition of the great arteries. 778 53


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