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

Two cases are reported of migrating Kirschner wires, which had been inserted for stabilisation of bony defects of the thoracic cage. The wires migrated in both patients to the heart and caused life threatening complications like pericardial tamponade, arrhythmias and cardiac insufficiency. Indications for removal of foreign bodies from the heart are discussed. Attention is drawn to the fact that the ends of Kirschner wires must be bent in order to prevent migration.
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PMID:[Iatrogenic foreign bodies in heart (author's transl)]. 77 35

The combined transplantation of heart and lungs, first done successfully by the Stanford Team (USA) in 1982, at present seems to be superseding lung transplantation alone, and has broadened the indications of heart transplantation to include terminal heart failure with fixed pulmonary arterial hypertension. After reviewing the causes for failure in lung transplants, the authors stress the superiority of heart-lung transplants compared to isolated lung transplantations: healing of the tracheal anastomosis, ease of detection of rejects by endomyocardial biopsy and the lack of inhomogeneity of the ventilation/perfusion ratios. This operation still poses problems of surgical technique as the mediastinal nerves need to be preserved and the risk of haemorrhage linked to the mediastinal dissection or to the eventual pulmonary separation under cardiopulmonary bypass is important. Donor subjects for cardiopulmonary transplantation are rare as they ought to have a thoracic cage of matching size to the recipient and to be free of pulmonary infection and trauma. The post-operative complications are essentially those of immediate haemorrhage, graft rejection, pulmonary oedema and infection. The late complications are coronary atherosclerosis and bronchiolitis obliterans. The indications of such a transplant are currently reserved for primary or secondary pulmonary hypertension and to respiratory failure with a normal thoracic cage and ventilatory mechanics.
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PMID:[Heart-lung transplantation]. 310 71

To evaluate how necessary and helpful invasive hemodynamic measurements after thoracic surgery are we studied 25 patients after pneumonectomies (n = 5), lobectomies and bilobectomies (n = 10), partial lobectomies (n = 6) and thoracotomies without lung resection (n = 4). Measurements were taken between half an hour and eighteen hours after closure of the rib cage using a preoperatively introduced Swan-Ganz-catheter. Pulmonary resistance was elevated in 12 out of 17 cases. 6 out of 25 patients had a mean pulmonary arterial pressure greater than 20 Torr. The cardiac index was below the lower limit of normal in 16 of 23 cases. 5 patients had an increased stroke work index. There was no correlation between the hemodynamic parameters and the type of surgery. In 7 patients the measurements indicated hypovolemia. Isolated right or left sided cardiac insufficiency was noted in one case each. Four patients received nitroglycerin intravenously resulting in a dose-dependent reduction in pulmonary arterial pressure, pulmonary resistance and heart work. Hemodynamic monitoring with a Swan-Ganz-catheter seems not to be necessary in every case. But it proved to be a safe method which can help in the management of high-risk patients.
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PMID:[Hemodynamics in the early postoperative period after thoracotomy and lung resection]. 323 37

We have evaluated the reliability of the transcutaneous (t.c.) method of measurement of arterial PO2 and PCO2 in adult man. In 33 simultaneous measurements of 9 normals and 12 patients with a wide range of hypoxemia, we found: t.c. PCO2 = 3.62 + 1.29 PaCO2 +/- 7.3 (r = 0.96) and t.c. PO2 = 11.14 + 0.86 PaO2 +/- 9.89 (r = 0.92). Recalculating t.c. PCO2 to 37 degrees C we can obtain: t.c. PCO2 = 2.7 + 0.97 X PaCO2, stating that there is no significant difference between t.c. PCO2 and PaCO2. The t.c. apparatus detects 10 and 90% O2 pressure changes with a delay of time of about 15 s and 1 min, respectively; the t.c. method is therefore not suitable for detecting changes in PaO2 caused by sleep apnea of short duration. On the contrary the t.c. method provided a useful monitoring of arterial PO2 and PCO2 changes during the night in chronic obstructive pulmonary disease (COPD) and non-COPD patients. A nocturnal monitoring of t.c. PO2 and PCO2 seems: (a) absolutely necessary in non-COPD hypoxemics, especially if total lung capacity (TLC) and/or residual volume (RV) are significantly reduced; (b) not absolutely necessary in COPD hypoxemics, provided they have an enlarged TLC and/or a very expanded RV; (c) advisable in intermediate situations, e.g., in COPD hypoxemics with an associated restrictive disorder caused by heart failure, congestion of pulmonary bed, parenchymal or rib cage disease, in order to establish the optimal concentration of oxygen for each patient and to avoid severe nocturnal hypoxemia without producing a dangerous rise in PaCO2.
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PMID:Value of nocturnal monitoring of transcutaneous O2 and CO2 pressures in adults with respiratory failure. 392 61

Prosthetic valve infective endocarditis was found in 31 out of 275 autopsies on patients with valvular prostheses. Mean postoperative survival was 332 days. Thirty patients had mechanical valves and only 1 had an infected tissue valve. The commonest pathogens were staphylococci, followed by Gram-negative bacilli and fungi. In all the patients with mechanical valves the infection was situated at the host-prosthesis sewing ring interface, and most also had vegetations on the prosthetic struts or cage. The infected tissue valve had vegetations on the prosthetic cusps only. Ring abscesses were present in one-third of cases and had destroyed the bundle of His in 1 patient. Clinically recognized pre-operative infective endocarditis was present in only 3 out of the 31 patients. Seven of the 31 patients died because of malfunction of the prosthesis, 10 died of systemic embolism, 4 of ruptured mycotic aneurysms, and the remaining 10 of other causes including myocardial failure, pyaemic abscesses and toxaemia.
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PMID:Prosthetic valve endocarditis. A clinicopathological study of 31 cases. 396 36

Pregnancy often poses a risk to patients with neuromuscular and skeletal disorders when these affect the respiratory muscles or the rib cage. The outlook is determined both by the severity of the underlying condition and the physiological changes during pregnancy. Patients with a vital capacity of less than 1 to 1.5 litres, hypercapnia, severe scoliosis, diaphragm weakness or pulmonary hypertension before pregnancy are particularly at risk. Pregnancy may adversely affect the conducting airways, respiratory pump and gas exchange in the lungs. Close monitoring of high risk patients during pregnancy is required and either a termination of pregnancy or mechanical respiratory support may be indicated if ventilatory or cardiac failure develops.
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PMID:Pregnancy in neuromuscular and skeletal disorders. 808 20

Chronic cor pulmonale is defined as right-heart hypertrophy or right-ventricular dilatation and/or chronic right-heart failure, secondary to disorders of the respiratory system. Most cases of cor pulmonale are secondary to chronic obstructive pulmonary disease. Other etiologies include restrictive lung diseases (e.g. idiopathic pulmonary fibrosis) and multiple pulmonary emboli, with the important, although small group of patients with chronic major vessel thromboembolism. In some instances abnormal ventilatory drive, disorders of the thoracic cage or neuromuscular diseases will eventually lead to cor pulmonale. Pathogenetic mechanisms involve hypoxic pulmonary vasoconstriction, mechanical narrowing of vessels and obstruction of the pulmonary vascular bed, which are discussed in further detail.
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PMID:[Pathophysiology of cor pulmonale]. 843 3

A 48-year-old man was referred to our hospital because of hypoxemia (PaO2 = 43 mmHg), hypercapnia (PaCO2 = 70 mmHg), complete atrio-ventricular block, and heart failure. He also had limitation of spine flexion, scoliosis, deformity of the rib cage, and constriction of the ankle joints, complicated by cor pulmonale. These findings were compatible with rigid spine syndrome. To avoid progressive pulmonary hypertension and hypoxemia, nasal BiPAP and home oxygen therapy (0.5 liters/minute) were begun. Rigid spine syndrome is clinically characterized by limitation of spine flexion, and the limitation of thoracic movement often causes severe constrictive respiratory dysfunction. This syndrome should be considered when evaluating patients who have both thoracic deformity, especially scoliosis, and respiratory failure.
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PMID:[Rigid spine syndrome associated with marked hypoxemia and hypercapnia]. 875 23

The angiotensin-converting enzyme inhibitor, captopril, is used in the treatment of heart failure after myocardial infarction. This study evaluated whether different behavioral parameters of anxiety are affected by captopril therapy after myocardial infarction in rats. Myocardial infarction was induced by ligation of the left coronary artery and captopril therapy was started after 3 weeks. After 2 weeks of captopril therapy, anxiety-related behaviors were successively measured in four different tests: open field, elevated plus maze, home cage emergence, and open field escape. Myocardial infarction and captopril therapy affected behavior in the home cage emergence test and open field escape test. On the basis of the data from the open field escape test, captopril therapy appeared to decrease anxiety in infarcted rats and increase anxiety in sham rats. Because myocardial infarction and captopril therapy did not affect anxiety-related behaviors in the open field and elevated plus maze tests, it is assumed that these interventions affect anxiety-related behaviors depending on the type of test. This was partially supported by correlation analysis, which suggested that the behavior of the rats in the different tests of anxiety may reflect different anxiety-related traits.
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PMID:Effects of myocardial infarction and captopril therapy on anxiety-related behaviors in the rat. 880 41

Cardiac intervention, myocardial infarction, or postoperative heart failure will sometimes create a need for circulatory support. For this purpose, a new, minimally invasive intra-aortic cardiac support system with a foldable propeller has been developed. In animals, the pump has been shown to have a positive hemodynamic influence, and the present study evaluates the hydraulic properties of the pump in a bench test. The axial flow pump is a catheter system with a distal motor driven foldable propeller (0-15,000 revolutions per minute). To protect the aortic wall, filaments forming a cage surround the propeller. In the present study, tests were done with two different pumps, one with and one without the cage. Two different models were used, one for testing pressure generation and one for obtaining flow-pressure characteristics. Propellers and tubes with different diameters were studied, and pressure and flow characteristics were measured. The mathematical relationships between pressure and rotational speed, pressure, and diameter of propeller and tube were determined. There was a positive relationship between the revolutions per minute and the generated pressure, a positive relationship between the diameter of the propeller and pressure, and a negative relationship between the diameter of the tube and the generated pressure. Within the physiologic range of cardiac output, there was a small drop in pressure with increasing flow in the tubes with a small diameter. With an increasing diameter of the tube, a smaller pressure drop was seen with increasing flow. The present cardiac support system has hydraulic properties, which may be of clinical relevance for patients with left ventricular heart failure.
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PMID:Hydrodynamic properties of a new percutaneous intra-aortic axial flow pump. 1082 45


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