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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A dissecting aneurysm of the ascending and transverse aorta with heart failure due to sudden severe arotic valve insufficiency in a 47-year-old man has been treated successfully. Vasodilator therapy was done preoperatively, and then hemodynamics was improved markedly. A selective perfusion technique by using separate pumps at pre-determined flow-rates with hypothermia was utilized. The replacement of both the aortic valve and the ascending and transverse aorta involving brachiocephalic artery with a prosthetic valve and expanded polytetra-fluoroethylene coated woven Dacron grafts was performed.
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PMID:Successful surgical management of a dissecting aneurysm of the ascending and transverse aorta with heart failure due to sudden, severe aortic valve insufficiency. 68 44

Four patients are reported in whom the aortic arch and variable portions of the ascending and descending aorta were replaced with a prosthesis. In three patients the preoperative diagnosis was dissecting aneurysm of the aortic arch and in one an arteriosclerotic aneurysm of the aortic arch was present. A combination of surface cooling and cardiopulmonary bypass was utilized to produce total body hypothermia. Arch replacement was carried out during a period of total circulatory arrest. Cardiopulmonary bypass was then utilized to warm the patient and resuscitate the heart. The average duration of cerebral ischemia was 43 minutes and the average duration of myocardial ischemia was 74 minutes. The average lowest esophageal temperature was 14 degrees C., and the average lowest rectal temperature was 18 degrees C. Three patients are alive and well 4 to 13 months following surgery. One patient died 4 days postoperatively of pulmonary insufficiency. This experience indicates that by utilizing total body hypothermia and circulatory arrest aortic arch replacement can be carried out with an acceptable mortality rate. Corrective surgery could be offered to patients with life-threatening enlarging aneurysms of the aortic arch.
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PMID:Prosthetic replacement of the aortic arch. 118 83

A 57-year-old female underwent simultaneous Cabrol's operation and aortic arch replacement for aortic dissection. She was admitted with complaint of back pain. Aortography demonstrated acute dissecting aneurysm of the ascending, arch and descending aorta (DeBakey type I) as well as aortic valve regurgitation (Seller's II degree). The operation was undertaken using cardiopulmonary bypass (CPB) under hypothermia with selective cerebral perfusion. A new method to reduce the duration of ischemic cardiac arrest was applied. Initially a low-porosity woven Dacron tube graft (8 mm) was anastomosed to coronary arteries. Blood of CPB was perfused to this graft. This coronary perfusion contributed to shorten ischemic cardiac arrest time and cardiac function was favorable. This method to reduce the duration of ischemic cardiac arrest brought about good result.
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PMID:[A case report of simultaneous procedure of Cabrol's operation and aortic arch replacement: method to reduce the duration of ischemic cardiac arrest]. 140 32

Twenty nine cases of type A acute aortic dissection were subjected to a retrospective study concerning perioperative management. Two keys pointed out for the management were as follow; (1) An optimal control of blood pressure is the most important measure to avoid advance of aortic dissection or rupture of dissecting aneurysm. Both pericardiac tamponade and aortic valve insufficiency should be taken care of from their onset, since they are often complicated after aortic dissections and their onset is fatal. (2) Separated brain perfusion and profound hypothermia with total circulatory arrest might involve a high risk of inducing postoperative brain damage and mortality, especially for old patients.
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PMID:[Perioperative management for type A acute aortic dissection]. 149 84

A case of pseudocoarctation with dissecting aneurysm of the ascending aorta and arch is reported. A 49-year-old man was admitted with chest pain and loss of consciousness. Angiogram showed kinking of the aortic isthmus and dissecting aneurysm of the ascending aorta. There was no pressure gradient between arms and legs. Prosthetic graft replacement of the ascending aorta was successfully performed by the use of total cardiopulmonary bypass with moderate hypothermia. Etiology of the development of pseudocoarctation is unknown, however, hypothesis that embryological abnormality of the aortic arch is one of the contributing factors has been widely accepted. This case was accompanied by bicuspid aortic valve. It is suggested that the developmental etiology of this case seems to be similar to that of classical coarctation of the aorta. Development of the dissecting aneurysm is supposed to be due to hypertension of the upper body during exercise, even though there is no pressure gradient at rest.
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PMID:[Pseudocoarctation associated with dissecting aneurysm of the aorta: a case report]. 151 14

A successful emergency replacement of the ruptured ascending thoracic aorta by means of ringed Dacron tube graft for 69-year-old male was presented, who had been admitted to our hospital with deep cyanosis and shock. He had experienced severe chest pain one hour prior to admission followed by mental confusion and was brought by ambulant service. Emergency chest enhanced computed tomography showed a clear ruptured dissecting aneurysm (DeBakey Type I) with complicated with pericardial tamponade. Soon after this admission he developed bradycardia with hypotension and quickly went into shock. After induction of anesthesia, cardiac arrest developed. External cardiac massage was started at the same time. Partial cardiopulmonary bypass using femoral vein to artery bypass with the membrane oxygenator was instituted and the body was cooled until moderate hypothermia (25 degrees C). The pericardium was opened and blood clot was removed. The ascending aorta ruptured which was replaced with ringed Dacron tube graft (24 mm in diameter). Patient tolerated procedure well and made good postoperative recovery with temporally mild mental confusion. He discharged 2 months after the surgery without any neurological or mental complication. He has been followed up for six months in excellent condition.
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PMID:[A successful emergency surgical treatment of DeBakey type I dissecting aneurysm complicated with cardiac tamponade and bleeding shock]. 156 16

Since May 1987 to May 1988, 8 cases of dissecting aneurysms of the aortic arch were treated surgically at the Department of Cardiovascular Surgery. Justus-Liebig University. Four cases were Standford A type and 4 were Stanford B type. All the patients were operated on under deep hypothermia (20 degrees C) and circulatory arrest, and aneurysms were repaired using pre-clotting graft without clamping the aortic arch. Bleeding from anastomosis line was controlled by fibrin coagulum. In addition, the auto-blood transfusion was applied using the cell saver system. This procedure could be performed in a short circulatory arrest and cardiac ischemic time. Seven patients were alive and discharged without neurological complication. Only one patient died because of the carotid artery dissection to the aortic dissection on the 2nd. post-operative days the clinical results were almost satisfactory. It appeared that surgical repair for dissecting aneurysm of the aortic arch could be performed safely and easily by this surgical technique and the know-how.
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PMID:[Surgical treatment of dissecting aneurysms of the aortic arch]. 202 Jan 48

Gelatine-Resorcine-Formol Glue has been proposed to reinforce the tissues during surgery of type A acute aortic dissection. From January 1977 to December 1988, 105 patients were operated on in emergency. The ascending aorta was replaced in all patients and the aortic stumps were reinforced with the GRF glue before suturing a Dacron prosthesis. In 29 patients the repair extended to the aortic arch. In these cases, the distal repair was carried out under circulatory arrest and profound hypothermia (21 patients) or carotid perfusion (8 patients). The aortic valve was replaced in 20 patients (20%). Four patients died during surgery and 20 patients died during the postoperative course for an overall hospital mortality rate of 23%. Average follow-up is 51 months (range: 3 to 130 m). Three patients were lost to follow-up. Seven patients died 3 months to 10 years postoperatively. Eleven patients had to be reoperated upon for AVR (3 patients), CABG (1 patient) and recurring or evolving dissecting aneurysm (8 patients). The reoperations resulted in 2 deaths. The remaining 69 patients are in good or fair clinical condition. Postoperative angiograms, CT scans or NMR, have shown a satisfactory repair in all documented patients but a persisting dissection beyond the prosthesis in 75% of them. The GRF glue allows easier and safer repair of type A acute dissection. It has permitted the extension of the repair to the aortic arch whenever necessary.
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PMID:Surgery of type A acute aortic dissection with Gelatine-Resorcine-Formol biological glue: a twelve-year experience. 237 Feb 56

This is a case report of the successful surgical treatment of acute dissecting aneurysm of the ascending aorta. The patient was a 65-year-old female, who admitted to the hospital 3 hours after the onset of severe back pain. Enhanced CT of the chest and abdomen revealed acute dissection of the ascending aorta from its origin to the bilateral common iliac arteries. Thirteen hours initiation of the symptoms, operation was carried out using pump-oxygenator with hypothermia. Transverse incision of the ascending aorta revealed acute dissection in anterior aspect extending to two third of the circumference. The proximal small intimal tear was found 3 mm apart from the right coronary artery ostium. Upon closure of the tear resulting in obliteration of the right coronary artery, it required bypass procedure between the right coronary artery and the innominate artery using the saphenous vein graft. The aortic incision was directly closed using Dacron felt bolsters. Postoperative studies revealed disappearance of the proximal aortic dissection, patency of the bypass graft and existence of distal aortic dissection. Patient is in active life 6 months after operation.
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PMID:[A successful surgical treatment of acute dissecting aneurysm of the ascending aorta: repair of the proximal intimal tear necessitating bypass for the right coronary artery]. 267 55

Type A aortic dissection still presents an emergency situation in cardiac surgery that is associated with high morbidity and mortality rates. There has been a significant improvement in the surgical outcome since the introduction of deep hypothermia and circulatory arrest. In this study, we discuss our results after operative repair of ascending aortic dissections, using deep hypothermia and circulatory arrest. This study presents the results of 67 patients (43 men, 24 women) from 18 through 81 years of age (mean, 54 years) who underwent surgery for type A dissecting aneurysm over a period of 4 years. Type A dissection (52 acute and 15 chronic cases) was due to Marfan syndrome in 12 patients, to atherosclerotic disease of the aorta in 27 patients, and to traumatic injury in 1 patient. Hypertension as the only pathologic finding was observed in 27 patients. Deep hypothermia (confirmed by isoelectric electroencephalogram) and circulatory arrest were induced in all patients. Two patients died intraoperatively due to massive bleeding (intraoperative mortality, 3%). The 30-day mortality rate was 30% (n = 20). Causes of perioperative deaths in order of frequency were multi-organ failure (n = 11), myocardial infarction (n = 2), postoperative bleeding (n = 2), cerebrovascular insult (n = 2), and sepsis (n = 1). The mean intensive care unit stay of the surviving 47 patients (72%) was 8 days, followed by a mean of 21 additional days in the hospital. Our experience with profound hypothermia and circulatory arrest, used in combination with coated grafts, supports our conviction that this is the method of choice for the treatment of type A dissecting aneurysm.
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PMID:Surgical treatment of type A aortic dissections. Results with profound hypothermia and circulatory arrest. 868 Feb 82


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