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Query: UMLS:C0020538 (hypertension)
 170,190 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Certain cardiac morphologic findings are described in 16 necropsy patients having operative closure of an acquired ventricular septal defect (VSD) during acute myocardial infarction (AMI). Of the 16 patients, 6 were women (mean age 69 +/- 7 years) and 10 were men (mean age 60 +/- 11 years). The AMI associated with the VSD was the first coronary event in 13 patients (81%). At least 6 patients had a history of systemic hypertension. Conduction disturbances were diagnosed by electrocardiogram in 5 patients (31%). The median interval from the onset of the AMI to death was 11 days, and from the onset of the AMI to operative closure of the VSD, 4 days. Eight patients died in the operating room or within 2 hours of operation. Coronary artery bypass grafting was performed simultaneously with the VSD closure in 7 patients. Death was attributed to unsuccessful VSD closure in 5 patients, to inadequate left ventricular cavity after resection of necrotic myocardium in 5 patients and to inadequate viable left ventricular myocardium in 4 patients. Heart weights were increased in 14 patients (88%). The AMI associated with the VSD was anterior in 9 patients and posterior (inferior) in 7. Healed myocardial infarcts were present in 3 patients. All 16 patients had severe (greater than 75% in cross-sectional area) narrowing of 1 or more of the 4 major epicardial coronary arteries.
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PMID:Cardiac morphologic observations after operative closure of acquired ventricular septal defect during acute myocardial infarction: analysis of 16 necropsy patients. 367 16

In 25 patients, aged eight months to 31 years, with ventricular septal defect (VSD; isolated in 15, the others with atrial septal defect, PDA, coarctation or patent ductus arteriosus + coarctation), each with severe pulmonary artery hypertension (pulmonary artery systolic pressure [Ppa] at least 75% of systemic and an elevated pulmonary vascular resistance), we related morphologic and morphometric data from open-lung biopsy to hemodynamic measurements obtained at cardiac catheterization during the same hospital admission. Of the hemodynamic features measured, only the ratios of pulmonary-to-systemic flow and pulmonary-to-systemic resistance correlated significantly with structure. Neither pulmonary artery pressure (Ppa) nor pulmonary vascular resistance correlated significantly with any structural feature studied. The increased external diameter of respiratory bronchiolar arteries in those with the more advanced Heath-Edwards grades reflects dilatation and suggests that it is in the small arteries of the distal arterial bed that the changes of pulmonary hypertension are most significant. Neither age nor body weight correlated significantly with the degree of structural or hemodynamic abnormality. In the ten patients who underwent VSD closure, Ppa was measured postoperatively. The Heath-Edwards grade (no more than one grade-III lesion) and arterial density (at least one-half that normal for age) were the best correlates of the difference between preoperative Ppa and Ppa immediately after corrective surgery. The presurgical catheterization data, including pulmonary resistance and the resistance ratio, did not correlate significantly with change in Ppa following VSD closure.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Pulmonary arterial changes in patients with ventricular septal defects and severe pulmonary hypertension. 380 93

Hemodynamic values measured 12 to 24 hours postoperatively in the intensive care unit (ICU) were compared with those measured at a later cardiac catheterization in 68 patients after closure of ventricular septal defect (VSD). A pulmonary arterial (PA) saturation of more than 80% or a pulmonary to systemic blood flow ratio (Qp:Qs) greater than 1.5 in the ICU were sensitive indicators for identifying patients at risk of having a hemodynamically significant residual left-to-right shunt (Qp:Qs greater than 1.5) at catheterization. Measurement of PA pressure in the ICU was a useful predictor of PA pressure at catheterization. In the absence of factors known to alter PA pressure, measurement of PA pressure in the ICU overestimates what it will be at a subsequent cardiac catheterization. Early assessment of hemodynamics after closure of VSD is useful in identifying patients at risk of having hemodynamically significant residual VSD and those who may have persistent PA hypertension.
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PMID:Assessment of hemodynamic status in the intensive care unit immediately after closure of ventricular septal defect. 396 94

Postoperative right (RV) and left ventricular (LV) volume characteristics in patients with complete transposition of the great arteries were studied to compare ventricular function after Senning and Jatene procedures and to analyze RV dimensional change during systole in patients after the Senning procedures. RV end-diastolic volume (EDV) was 181 +/- 74% of normal (mean +/- standard deviation) and RV ejection fraction (EF) was 0.48 +/- 0.09 in 15 patients who underwent the Senning procedure. In 9 patients who underwent the Jatene procedure, LVEDV was 152 +/- 27% of normal and LVEF was 0.61 +/- 0.09. One patient with aortic regurgitation, 1 with aortic regurgitation and residual ventricular septal defect, and 1 with aortic regurgitation and generalized LV wall hypokinesia of unknown cause had large LVEDVs. Pulmonary ventricular EDV and EF were within normal ranges except in the patients with persistent pulmonary hypertension, who had large EDVs and low EFs regardless of the anatomic type of ventricle, either the left or right. The study of RV dimensional change in the Senning group showed a reduced systolic shortening of the anteroposterior diameter compared with the preoperative transposition of the great arteries and normal. This reduced shortening may be related to postoperative adhesion of the RV free wall to the anterior chest wall and fixation of the atrium secondary to the intraatrial repair. In conclusion, systemic ventricular function after intraatrial repair for complete transposition of the great arteries is depressed by unavoidable residua and sequelae: persistent RV hypertension, anatomy of the right ventricle and, possibly, postoperative adhesions.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of ventricular function after Senning and Jatene procedures for complete transposition of the great arteries. 396 95

Extravascular lung water (EVLW) was measured in 16 patients with congenital heart disease by the cold green dye, double indicator dilution technique. Five patients with optimally corrected tetralogy of Fallot served as controls, and EVLW in this group was 4.7 +/- 0.5 ml/kg (111 +/- 13 ml/m2) (mean +/- standard deviation). In 5 asymptomatic patients with atrial septal defect (ASD), normal pulmonary artery (PA) pressure and increased pulmonary blood flow, EVLW was 5.7 +/- 2.8 ml/kg (132 +/- 63 ml/m2), which was not significantly different from the value of control patients. However, in 6 patients with ventricular septal defect, PA hypertension, normal left atrial pressure and an equivalent left-to-right shunt to ASD patients, EVLW was 15.9 +/- 3.8 ml/kg (270 +/- 60 ml/m2). This was significantly different from values in both control and ASD patients (p less than 0.01). It is concluded that in the face of normal pulmonary vascular resistance, PA pressure is transmitted to the microvasculature, causing hydrostatic pulmonary edema. Other factors that may be implicated in the pathogenesis of pulmonary edema, such as increased pulmonary blood flow and relative lymphatic insufficiency in infants, cannot be excluded.
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PMID:Extravascular lung water in children immediately after operative closure of either isolated atrial septal defect or ventricular septal defect. 403 40

The appropriate time for surgical intervention in congenital cardiopathies is chosen as a function of several imperatives; psychological and family reasons militate in favour of an early intervention. In particular, in cardiopathies accompanied by pulmonary arterial hypertension (serious VSD, arterial transpositions with VSD, etc.) there is a risk of irreversible obstructive pulmonary arterial disease in the first months of life in some cases. This risk, added to those of cardiac insufficiency, prompts early intervention. The progressive risks of cyanotic cardiopathies: risks of intravascular thrombosis and of cerebral abscess have contributed to these cardiopathies being operated upon earlier than was done some years ago. The decision to be taken remains difficult for complex cardiopathies. Coarctations of the aorta are usually operated upon before the age of 4 years in order to avoid the risk of permanently fixed arterial hypertension and premature vascular degeneration. The operative indications in aortic stenoses are now guided not only by clinical data but also by an assessment of the haemodynamic tolerance by ultrasonography and exertion tests.
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PMID:[Date of surgery in congenital cardiopathies]. 409 99

Since 1981 the authors have performed 14 orthotopic heart transplantations and one heart-lung transplantation, using cyclosporine and prednisone as immunosuppressants. Eight of the recipients had terminal congestive cardiomyopathy and six had ischemic cardiac dysfunction. The combined heart-lung transplantation was performed on a patient with a congenital ventricular septal defect with Eisenmenger's syndrome. Twelve of the patients were alive and well at follow-up 9 to 34 months (mean 17.4 months) after transplantation. One patient died of acute rejection and one of acute pancreatitis and secondary peritonitis. The third death, due to acute right ventricular failure, occurred immediately after transplantation. Rejection was diagnosed histologically on seven other occasions in four patients and was treated successfully. Infection was not a major problem. Cyclosporine -induced reversible nephrotoxicity was evident in 12 patients, 2 of whom required dialysis. Other side effects of cyclosporine seen in these patients included hypertension, gastrointestinal upset, headaches and hirsutism. This experience suggests that cyclosporine is a potent immunosuppressive agent that has greatly reduced the hazards of rejection and infection. However, the frequency of nephrotoxicity is high; careful monitoring of cyclosporine blood levels and renal function is essential.
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PMID:Cyclosporine in cardiac transplantation. 623 93

A successful operation in a 22-month-old baby with the Taussig-Bing anomaly is reported. The operation consisted of a intraventricular rerouting of the left ventricular blood through the ventricular septal defect to the aorta via an intraventricular dacron conduit sutured to the sub-pulmonary conus posteriorly. The patient was recatheterized 3 months after surgery and there was no sub-aortic or sub-pulmonary obstruction. There was residual pulmonary artery hypertension and a residual shunt that was successfully closed at reoperation. Among 41 surgical cases of TB anomaly reported in the literature, 6 only have had this kind of repair with 3 deaths. The present case is the youngest patient successfully operated upon by this technique. The three basic surgical options in the Taussig-Bing anomaly are discussed, along with the anatomic conditions that permit intraventricular conduit repair, which appears to be theoretically the best surgical approach.
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PMID:[Taussig-Bing anomaly. Intraventricular correction in an infant. Review of the literature]. 642 54

Four hundred seventy-five patients underwent repair of tetralogy of Fallot from 1955 to 1964; 396 of these were hospital survivors and were followed up for 12 to 22 years. An excellent late clinical result was maintained by 87 percent of the 396 hospital survivors. A less than excellent result in the remaining 13 percent of hospital survivors was caused by late mortality in 7 percent (sudden death in 3 percent, death due to cardiac causes in 2 percnt and death due to noncardiac causes in 2 percent), required reoperation in 4 percent (mainly because of residual ventricular septal defect) and development of symptoms in 2 percent. Postoperative cardiomegaly (cardiothoracic ratio greater than 0.55) was observed in 60 (25 percent) of 246 patients who had a follow-up chest roentgenogram, and was more common among those who died late or remained symptomatic. Among the few patients with inadequate surgical relief of right ventricular hypertension who did not have transanular patch repair, the hypertension did not tend to decrease progressively, whereas it did decrease in patients who had patch repair. No late sudden deaths were encountered in 20 patients shown to have postoperative right bundle branch block plus left axis deviation (bifascicular block pattern). Pulmonary valve incompetence appeared to have relatively little harmful influence on the late result, causng cardiac disability in 1 percent of the patients and appeared to be the main contributing factor of postoperative cardiomegaly in 13 (5 percent) of the 246 patients who had a follow-up chest roentgenogram. Most late deaths and complicatins appeared within 2 years of operation, and accelerating deterioration in late results did not occur as the follow-up extended beyond 2 decades.
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PMID:Long-term evaluation (12 to 22 years) of open heart surgery for tetralogy of Fallot. 644 95

Lung biopsies obtained during operation from 175 patients with isolated or combined ventricular septal defect were examined histologically. The degree of the pulmonary hypertensive vasculopathy was classified according to the Heath and Edwards-grading. These morphological findings were compared to the hemodynamic data (pulmonary/systemic ratios of systolic pressure, resistance, and flow as well as mean pulmonary artery pressure). Pressure and resistance showed a good correlation to the histological changes. The combination of both variables, however, did not further improve the prediction of the severity of the vascular lesions. No relation was found between flow and pulmonary vasculopathy. Higher grades of the vasculopathy were associated with systolic pressure ratios exceeding at least 0.65, in most patients with even marked higher ratios. On the other hand an elevation of pulmonary blood pressure of pulmonary arterial resistance does not mean a more severe vasculopathy implicitly, since there were some patients with a considerable hemodynamic hypertension without at least severe histological changes. We conclude that patients with a systolic pulmonary pressure not exceeding about 75% of systemic pressure have a very low risk of a morphologically fixed hypertension. Therefore an urgent operation of such patients to prevent fixation of the pulmonary hypertension seems not to be necessary.
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PMID:[Hemodynamics and histology of the lung in 175 ventricular septal defects]. 648 4


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