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

In relation with the report of two cases of branching of one of the pulmonary arteries from the aorta, it was recalled that this is a rare malformation, responsible for a severe cardiac failure with or without cyanosis in the first months of life, intensly suggestive of a left-to-right shunt. Demonstration of surprizing or unhabitual clinical or haemodynamic findings should indicate the performance of a right-sided angiography then an aortography, this being the only way to secure the diagnosis. Combination of such an anomaly with Fallot's tetralogy is exceptional. The clinical diagnosis is made more difficult by the presence of an anastomosis between the pulmonary and the systemic circulations. Only a careful analysis of right angiograms might make it possible to suspect the presence of an abnormal branching of the pulmonary artery, and to perform the aortography. The treatment is surgical in all cases, and should be undertaken early in life, as it is the only way to control the heart failure or to prevent irreversible pulmonary arteriolar lesions.
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PMID:[Origin of 1 of the 2 pulmonary arteries from the ascending aorta. Apropos of 2 surgical cases with 1 being associated with tetralogy of Fallot]. 81 96

Fibrosing alveolitis is a rare, diffuse lung disease characterized by varying combinations of two histological features: thickening of alveolar walls and the presence of large mononuclear cells in the alveolar spaces. Clinical details of 10 children with fibrosing alveolitis are reported. The main symptoms in children are tachypnoea or dyspnoea, cough, poor weight gain, and cyanosis. The condition is similar to that in adults, but it is usually a more acute illness, and if untreated, more predictably fatal. Respiratory failure, pulmonary hypertension, and cardiac failure are the major complications. Less commonly, superimposed bacterial infection and pneumothorax occur. Chest x-rays often show a sequence of changes with a ground-glass appearance and fine mottling in the early stage of the disease, progressing to a picture of mainly hilar linear markings in those children who recover. The histological features at lung biopsy or necropsy are described; these correlated poorly with the radiological features, steroid responsiveness, and clinical course. Lung function tests in 3 older children showed evidence of markedly reduced lung volumes in 2. Static lung compliance in 4 children in the acute stage of the illness was normal in 3 and diminished in one. The response to steroid therapy was analysed in cases from the literature and the 10 reported cases. No spontaneous remissions occurred, all the survivors having been treated with corticosteroids. In children fibrosing alveolitis is almost always a corticosteroid-responsive disease. An appropriate course of prednisolone would be of at least 4 week's, but preferably of 8 weeks' duration, at a minimum daily dose of 2 mg/kg. After improvement the steroid withdrawal should be cautious and protracted, comprising at least a year's continuous treatment.
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PMID:Fibrosing alveolitis in infancy and childhood. 83 51

A follow-up study of 22 patients with Ebstein's anomaly has been performed. Nine patients died 1-21 years (mean 9) after the initial admission while the 13 patients alive at the end of the observation period had been followed for 5-26 years (mean 15). Clinical, ECG, radiological, and haemodynamic features were analyzed with reference to their prognostic significance. The presence or absence of cyanosis due to right-to-left shunt through an atrial septal defect (ASD) distinguished best between a good and poor prognosis. Right-sided heart failure and dyspnoea at rest, often associated with palpitations, precordial pains and syncopes, were grave prognostic findings. After the initial signs of heart failure there was a rapid deterioration, death ensuing within a few years. Operation with insertion of a prosthetic valve (and closure of the ASD) should be seriously considered at the appearance of heart failure.
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PMID:The prognosis in Ebstein's disease of the heart. Long-term follow-up of 22 patients. 85 Oct 41

The early diagnosis of heart disease during or better before pregnancy is one of the most important problems, as cardiac diseases are the most common cause for maternal deaths throughout the world. The knowledge of hemodynamic alterations in circulatory and respiratory physiology during pregnancy complicated by heart disease is a prerequisite for their management. The following indications for therapeutic abortion of pregnancy complicated by heart disease can be concluded according to our own observations: 1. history of significant heart failure (more than grade IV according to the classification of the New York Heart Association), frequent attacks of angina pectoris and longstanding cyanosis: 2. in spite of the most careful heart treatment with digitalis, diuretics and salftree diet cardiac-thorax-rate of more than 55% in congenital heart disease, cardiac-thorax-rate of more than 60% in acquired heart disease, significant signs of heart failure, namely more severe than grade III, tachycardic atrial fibrillation, pulse deficit of more than 30/min, active inflammatory processes of the heart (rheumatic fever, subacute bacterial endocarditis, Takayasu's disease); 3. especially severe metabolic disorders, i.e. diabetes mellitus, malignant hypertension, kidney diseases; 4. primiparae of an age of more than 35 years with any heart disease. Commissurotomy can be accomplished during pregnancy if it is too late for therapeutic abortion. Pregnancy in case of artificial valves is not recommended in general because of impending hemorrhagic diathesis.
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PMID:[Indication for pregnancy interruption in patients with heart diseases]. 85 89

Two case reports of pulmonary arterio-venous fistulae presenting in the neonatal period are described. One child had severe respiratory distress with cardiac failure and the other presented with cyanosis and a continuous murmur. In both, chest X-ray demonstrated a localised lesion and the presence of an arteriovenous fistula was confirmed by pulmonary angiography. Lobectomy cured both children.
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PMID:[2 cases of solitary pulmonary arteriovenous fistula presenting in the neonatal period]. 88 7

Thirteen neonates presented with central cyanosis due to right-to-left shunting across the foramen ovale or the ductus arteriosus or both. In three infants shunting occurred secondary to pulmonary vascular obstruction, presumably related to pulmonary vasospasm (persistence of the fetal or transitional circulation). In ten neonates right-to-left shunting was associated with heart failure; seven of these neonates had systemic hypotension.
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PMID:Disturbances of the transitional circulation: spectrum of pulmonary hypertension and myocardial dysfunction. 95 9

A study was made of 29 cases of single ventricle confirmed by autopsy, hemodynamic study, or both. It must be emphasized that the term single ventricle excludes whatever malformation which shows traces of an intraventricular septum. Thus conceived, the malformation has been seen to have different clinical courses, which only permit partial diagnosis that may suggest the possibility of "single ventricle". In live patients this can only be diagnosed with specialized studies. In outline, there exist 4 types of clinical hemodynamic behavior: 1) The type with marked increase of pulmonary flow, in which the single cavity vascular systems, pulmonary and aortic, had similar pressures. This type behaves, in a certain way, like large interventricular communications. 2) The type which behaves hemodynamically like a large hypertensive communication with delayed cyanosis of rapid evolution and with few manifestations of heart failure. 3) The third type also has pulmonary hypertension with delayed cyanosis. This differs from the preceeding in that there is a preferential flow in such a way that the venous blood proceeding from the right atrium empties into the aorta and the arterial blood from the left atrium empties into the pulmonary artery. 4) The fourth type is characterized by rapid cyanosis and from the anatomical point of view has stenosis or atresia of the pulmonary artery. An analysis was made of the varieties which within these four classes actually ocurred or cases which were present as theoretical possibilities: single ventricle with crossed great arteries; single ventricle with transposition of the great arteries; single ventricle with partial distortion of the great arteries; single ventricle with common trunc. A detailed analysis was made of the clinical, hemodynamic, electrocardiographic, and radiological manifestations which are seen in these combinations and an anatomic-embriologic classification is proposed on the basis of the systematization of the 29 cases of the present study. Finally brief considerations are made of the operability of those cases of single ventricle according to their anatomic variety.
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PMID:[Single ventricle. II. Clinical study. Special studies and surgical treatment]. 101 98

After Mustard operation for transposition of the great arteries, hemodynamic and angiocardiographic changes were evaluated in 25 patients. In 19 patients, postoperative studies were done electively and, in 6 patients, they were required to investigate symptoms of heart failure, these symptoms were temporary in 4 patients and progressive in 2. Both of the latter had pulmonary venous obstruction which was later relieved successfully by reoperation. After operation, systemic arterial oxygen saturation and blood pressure increased and polycythemia disappeared in every patient. However, several complications-some of them unsuspected clinically-were identified by cardiac catheterization: (a) patch detachment in 5 patients; (b) obstruction of superior vena caval return in 10 patients; (c) obstruction of inferior vena return in 1 patient; and (d) pulmonary venous obstruction in 2 patients. The incidence of pulmonary or systemic venous obstruction was higher in patients who had a Dacron intraatrial baffle (8 of 19 patients). Comparison of 21 sets of preoperative and postoperative right ventricular angiograms demonstrated an increase in right ventricular trabeculations in each patient, poorer right ventricular contractility in 12 patients, and development of tricuspid insufficiency in nine patients. None of the patients with poor right ventricular contractility had had surgical ventriculotomy. Although Mustard operation for transposition of the great arteries is effective in relieving cyanosis, it may be followed by obstruction to systemic or pulmonary venous return, intraatrial patch detachment, tricuspid insufficiency and angiocardiographic evidences of poor right ventricular contractility.
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PMID:Hemodynamic and angiographic changes after Mustard operation for transposition of the great arteries. 113 8

In a 54-year-old man who suffered from chronic cardiac insufficiency with terminal graded cyanosis on necropsy a foramen ovale late patens was found with massive chronic thrombosis of the trunk and main branches of the pulmonary artery above extensive partly ulcerous atheromatous plaques. The thrombosis is considered autochthonous by the authors.
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PMID:[Chronic thrombosis of the truncus of the pulmonary artery at the foramen ovale late patens]. 114 42

This review presents the cardiac and non-cardiac malformations in 60 cases with asplenia and polysplenia with special reference to distinguishing factors which may be helpful in the clinical recognition of these syndromes. The asplenia cases were predominantly male and presented with cyanosis. They frequently had transposition of the great arteries (72%) with pulmonary stenosis or atresia (88%) and total anomalous pulmonary venous drainage (72%). Deaths were caused by cardiac failure and anoxia in 57 per cent of cases. Most of the patients died in the first year of life (79%), but longer survival is possible in the asplenia syndrome. The polysplenia cases were predominantly female and survived longer. The characteristic clinical findings were the relatively more benign presenting signs and the leftward or superiorly orientated P wave axis on the electrocardiogram. Conotruncal abnormalities were less common and total anomalous pulmonary venous drainage did not occur. On angiography the inferior vena caval drainage via the azygos system was clearly identified and this was present in all cases at surgery. Our study indicated that the cardiac anomalies in polysplenia were less severe than they were in asplenia and therefore the prognosis in the former syndrome is likely to be more favourable. Three families had two affects sibs but no single genetic factor could be identified. The aetiology of these syndromes remains undetermined.
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PMID:Syndromes of asplenia and polysplenia. A review of cardiac and non-cardiac malformations in 60 cases withspecial reference to diagnosis and prognosis. 119 45


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