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Query: UMLS:C0019209 (hepatomegaly)
 5,798 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A calf into which a biolized, total artificial heart (TAH) had been implanted survived for 145 days. All measured physiological parameters except central venous pressure (CVP) were back to normal one month after implantation, and thereafter the animal's physiological development was similar to that of a normal calf. The intimal weight, which was 96 kilograms at implantation, reached 190 kilogram at the end of experiment, with a daily gain rate of 0.9 kilogram per day. After the nineteenth postoperative week, signs of congestive heart failure appeared, such as high venous pressure, ascites, and enlarged liver although the calf outwardly appeared well. On postoperative day 146, the animal started foaming at the mouth, and a convulsion occurred; then, the experiment was terminated after 3,494 hours of pumping. At autopsy, there were acute bilateral bronchopneumonia involving mostly both upper lobes, pulmonary edema, slight chronic pneumonitis, and hepatomegaly. There were no serious thrombotic deposits inside the cardiac prosthesis.
J Thorac Cardiovasc Surg 1977 Apr
PMID:Survival for 145 days with a total artificial heart. 83 53

From Jan. 1, 1961, through Dec. 31, 1987, 530 patients underwent an intracardiac operation that included a tricuspid valve procedure. The tricuspid valve was repaired in 351 patients (66%) and replaced in 179 (34%). Mean age was 56.9 years. Risk factors associated with tricuspid valve replacement included tricuspid stenosis (p = 0.02), jugular venous distention (p = 0.04), previous operation (p = 0.05), and angiographic severity of tricuspid valve incompetence (p less than 0.001). There were 78 hospital deaths (15%). Risk factors for hospital death included previous operation (p = 0.03), male gender (p = 0.03), hepatomegaly (p = 0.03), De Vega or Carpentier annuloplasty (repair group only), (p = 0.01), and older age at operation (p = 0.06). Ninety-eight percent of the patients were followed up. There were 185 late deaths (41%). The actuarial survival rate was 20% at 180 months. Risk factors for late death included male gender (p = 0.03), hepatomegaly (p = 0.04), and lack of postoperative warfarin therapy (p less than 0.001). Actuarial freedom from reoperation was 25.5% at 180 months. There was no difference in reoperation rates (p = 0.10) or survival (p = 0.42) whether the tricuspid valve had been repaired or replaced. We conclude that the requirement for surgical treatment of tricuspid valve insufficiency in patients with multivalvular disease constitutes a high risk group for cardiac surgery. Preoperative variables may predict the result of tricuspid valve replacement. Tricuspid valve replacement may be performed with the expectation of a low risk of valve-related events.
J Thorac Cardiovasc Surg 1990 Jan
PMID:Tricuspid valve operations in 530 patients. Twenty-five-year assessment of early and late phase events. 229 45

The knowledge of factors determining the risk of postoperative myocardial failure (MF) should allow a more rational approach to the timing and the management of mitral valve replacement (MVR). Using multivariate logistic regression analysis the influence of 41 preoperative and perioperative variables on MF was assessed in a training group of 353 consecutive patients undergoing isolated primary MVR between 6/76 and 12/82. Early MF mortality was 4.2%. Strongest independent preoperative predictors of MF were advanced NYHA functional class (p less than 0.001), hepatomegaly (p = 0.001), and reduced body weight (p = 0.01). Amongst preoperative and perioperative variables independent determinants of MF were NYHA functional class (p less than 0.001), hepatomegaly (p = 0.002), hypotension during extracorporeal circulation (ECC) (p = 0.005), body weight (p = 0.007), ECC duration (p = 0.008), female sex (p = 0.061) and the absence of cardioplegia (p = 0.065). From the combination of these determinants estimates of the probability of MF were calculated and adjoined to low or high risk by means of an optimum cutoff point. The sensitivity of this test performed before and after operation was 0.80 and 0.93, the specificity 0.92 and 0.94, respectively. The reliability of this prognostic test was prospectively evaluated on data of 107 consecutive MVR patients between 1/83 and 12/84. The observed diagnostic characteristics of the test group were comparable to those predicted from the training group. Multivariate logistic regression analysis selects independent determinants, estimates the risk of MF or other modes of postoperative events and identifies patients with low or high risk with a definable validity as an objective aid for medical decision-making.
Thorac Cardiovasc Surg 1987 Feb
PMID:Estimation of the operative risk of mitral valve replacement by multivariate logistic regression analysis. 243 42

Heart-lung transplantation for treatment of end-stage cardiopulmonary disease continues to be plagued by many problems. Three primary ones are the technical difficulties that can be encountered, particularly in those patients who have undergone previous cardiac operations, the additional restriction on donor availability imposed by the lack of satisfactory preservation techniques, and the need for lung size compatibility. Two of these difficulties and others surfaced postoperatively in a heart-lung transplant recipient who presented a series of unique operative and therapeutic challenges. A 42-year-old woman with chronic pulmonary hypertension and previous atrial septal defect repair underwent a heart-lung transplantation in August 1985. The operative procedure was expectedly complicated by bleeding from extensive mediastinal adhesions from the previous sternotomy and bronchial collateralization. Excessive chest tube drainage postoperatively necessitated reoperation to control bleeding from a right bronchial artery tributary. Phrenic nerve paresis, hepatomegaly, and marked abdominal distention caused persistent atelectasis and eventual right lower lobe collapse. Arteriovenous shunting and low oxygen saturation necessitated right lower lobectomy 15 days after transplantation, believed to be the first use of this procedure in a heart-lung graft recipient. Although oxygenation improved dramatically, continued ventilatory support led to tracheostomy. An intensive, psychologically oriented physical therapy program was initiated to access and retrain intercostal and accessory muscles. The tracheostomy cannula was removed after 43 days and gradual weaning from supplemental oxygen was accomplished. During this protracted recovery period, an episode of rejection was also encountered and successfully managed with steroid therapy. The patient continued to progress satisfactorily and was discharged 83 days after transplantation. She is well and active 20 months after discharge.
J Thorac Cardiovasc Surg 1987 Sep
PMID:Postoperative complications necessitating right lower lobectomy in a heart-lung transplant recipient with previous sternotomy. 311 65

A 7 year old boy with single ventricle with pulmonary stenosis underwent a modified Fontan procedure. He had a very stormy postoperative course complicated by continued pleural effusion, hepatomegaly, and chylothorax. He eventually died after an atrial septum reopening. At autopsy, massive thrombi were found in the inferior vena cava, right atrium, and pulmonary artery. This complication was probably due to multiple factors, but a routine anticoagulation therapy may be required after Fontan procedure.
Thorac Cardiovasc Surg 1988 Aug
PMID:Massive systemic venous thrombosis after Fontan operation: report of a case. 318 86

A 65-year-old male patient underwent two bypass operations because of coronary artery disease. After the second operation he developed congestive heart failure with breathlessness, ankle swelling, hepatomegaly and poor exercise tolerance. Echocardiographic and haemodynamic findings were characteristic of constrictive pericarditis. Pericardiectomy was performed three months after the second operation. The retrosternal space was replaced with fibrotic, patchy hyalinic tissue, and the pericardium was thick and rigid. Histologically, the thickened pericardium showed dense fibrosis and foreign-body granulomas with large multinuclear giant cells and irregular crystals. This report indicates that foreign body reaction following coronary artery bypass operation may result in constrictive pericarditis with severe heart failure.
J Cardiovasc Surg (Torino)
PMID:Constrictive pericarditis following coronary bypass reoperation. Fibrotic pericardium and a foreign body reaction. 353 48

The factors associated with survival in 40 neonates (age less than 28 days) with critical aortic stenosis undergoing either open (22 patients) or closed (18 patients) transventricular aortic valvotomy were reviewed. Significant adverse correlates with survival included evidence of poor perfusion preoperatively (low pH, greater than Grade 2/6 soft ejection systolic murmur) and marked congestive heart failure (hepatomegaly, cardiomegaly, elevated left atrial pressure). Congenital mitral stenosis (anulus less than 11 mm), a small aortic anulus (less than 6.5 mm), and failure to achieve an adequate aortic orifice (greater than 6 mm), at operation were identified as factors associated with increased mortality. Initial perioperative survival was better with closed aortic valvotomy. However, there was no significant difference in overall operative survival between closed (9/18, 50%) and open (8/22, 36%) aortic valvotomy (p = 0.26). The incidence of early reoperation (less than 1 year of age) was greater in perioperative survivors undergoing closed valvotomy (7/13, 54%) rather than open valvotomy (1/10, 10%) (p less than 0.05). In conclusion, long-term survival among patients with critical neonatal aortic valve stenosis remains disturbingly low (13/40, 32%) and has not significantly improved over the past 20 years.
J Thorac Cardiovasc Surg 1987 Oct
PMID:Critical aortic stenosis. Survival and management. 365 53

Four of 44 patients who had undergone the Fontan operation had persistent low cardiac output necessitating takedown of the shunt 6 to 65 hours (average 23 hours) postoperatively. All four were in a group of 22 patients with complex lesions other than tricuspid atresia with ventriculoarterial concordance. The development of postoperative right atrial hypertension (average 24 torr), hepatomegaly, marked ascites, and decreasing lung compliance led to severe systemic hypotension with systolic arterial pressure ranging from 55 to 82 torr (average 68 torr), persistent metabolic acidosis, and oliguria despite massive colloid and crystalloid infusions (11,000 ml/m2/24 hr) and inotropic support. At reoperation the atriopulmonary anastomosis, which was found to be wide open, was taken down and an atrial septal defect was created in all patients. Three patients were left with a Glenn shunt and an aortopulmonary shunt to the left lung. One patient had bilateral aortopulmonary shunts. Two patients who survived reoperation had immediate postoperative improvement in systolic arterial and mean right atrial pressure (average 100 torr and 11.5 torr, respectively). Both are well 5 months and 4 years later. Repeat Fontan operation remains a possibility with acceptable risks because of the presence of the Glenn shunt in both patients. We believe that takedown should be considered in patients with persistent low cardiac output after the Fontan operation.
J Thorac Cardiovasc Surg 1986 Sep
PMID:Persistent low cardiac output after the Fontan operation. Should takedown be considered? 374 71

A series of 146 consecutive patients who underwent tricuspid valve replacement at the University Brugmann Hospital between 1967 and 1987 was reviewed. Mean age at operation was 51.4 years (+/- 12.1 years). Different types of prostheses were implanted including porcine and bovine pericardial bioprostheses and older and bileaflet mechanical valves. Most patients were severely disabled by their cardiac disease before operation, with 30.1% in New York Heart Association functional class III and 69.9% in class IV. Operative mortality and hospital mortality rates (30 days) were high (16.4%). Incremental risk factors for hospital death included icterus (p < 0.005), preoperative hepatomegaly (p = 0.012), and New York Heart Association functional class IV (p = 0.013). Multivariate analysis only selected preoperative icterus (p < 0.01) as being independently significantly related to hospital mortality. The hospital survivors were followed up for a median of 94 months. A complete follow-up was available for all patients except two for 30 months or more. At 30 months the only two significant parameters were the type of myocardial protection (p = 0.024) and the year of operation (before 1977 or after [precardioplegia era or after], p = 0.011). There were 70 late deaths during the entire follow-up period. The univariate (log-rank statistics) incremental risk factor for late death was the type of tricuspid prosthesis (Smeloff-Cutter and Kay-Shiley versus St. Jude Medical versus bioprosthesis) (p = 0.04). A trend was observed for the type of operative myocardial protection (normothermia and coronary perfusion) (p = 0.06) and preoperative New York Heart Association functional class IV (p = 0.055). Actuarial survival was 74% at 60 months and 23.4% at 180 months. Cumulative follow-up added up to 1015 patient-years. In a more detailed analysis of the effect on survival of the type of tricuspid prosthesis, a significant difference was observed between the bioprostheses and some older mechanical prostheses (Smeloff-Cutter and Kay-Shiley) (p = 0.04) but not between the bioprostheses and the bileaflet valves (p = 0.15). When the follow-up period was stratified according to less than 7 years and more than 7 years of follow-up, no difference was observed for the first period, but for the late follow-up the new mechanical prostheses did better than the bioprostheses (p = 0.05), suggesting a degradation of the bioprostheses after 7 years and favoring mechanical prostheses for those patients with a good long-term prognosis.
J Thorac Cardiovasc Surg 1995 Sep
PMID:Tricuspid valve replacement: postoperative and long-term results. 756 33

The right ventricle in patients with severe outflow obstruction or atresia and a small tricuspid valve often remains too hypoplastic even after optimal palliation to tolerate biventricular repair with closure of the atrial septal defect. In these patients, nonpulsatile cavopulmonary (Glenn) anastomosis has traditionally facilitated biventricular repair. In 1989, Billingsley and associates reported the addition of a bidirectional cavopulmonary anastomosis to the definitive biventricular repair in patients with hypoplastic right ventricle, pulmonary atresia, and intact ventricular septum. The atrial septal defect was left open with an adjustable snare for later closure. We report five patients with hypoplastic right ventricle (mean diastolic volume 48.4%, mean stroke volume 40.2% of predicted value) who had the atrial septal defect closed at the time of the biventricular repair. Four patients, who had the bidirectional cavopulmonary anastomosis supplementing the biventricular repair, had no evidence of excessive right atrial or superior vena cava hypertension postoperatively. One patient, who had atypical tetralogy of Fallot with tricuspid stenosis, developed recurrent pericardial tamponade and marked hepatomegaly following conventional tetralogy repair with closure of the atrial septal defect. These complications were controlled with the addition of bidirectional cavopulmonary anastomosis 2 months later. Postoperative hemodynamic or Doppler studies in these patients revealed pulsatile flow in the entire pulmonary artery system, including the artery distal to the Glenn anastomosis. This modification of biventricular repair allows primary closure of the atrial septal defect and provides pulsatile arterial flow in the entire pulmonary artery, even when the right ventricle is significantly hypoplastic.
J Thorac Cardiovasc Surg 1993 Jan
PMID:Biventricular repair of hypoplastic right ventricle assisted by pulsatile bidirectional cavopulmonary anastomosis. 841 91


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