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

A case of aorticopulmonary fistula secondary to thoracic aortic aneurysm of syphilitic origin has been presented. Aneurysm involved the first portion of the ascending aorta and ruptured into the main pulmonary artery a few cm above the pulmonic valve. Two weeks after onset, the patient successfully operated upon under profound hypothermia with perfusion. Thirteen cases of this disease since 1943 were reviewed and we discussed briefly profound hypothermia as a useful technic for surgical correction of this condition.
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PMID:Aorticopulmonary fistula. A case of successful repair with review of literature since 1943. 99 45

After extensive experimental evaluation, heparin-coated perfusion equipment was clinically evaluated with low or no systemic heparinization in three different groups of patients (n = 47). In group 1, resection of descending thoracic aortic aneurysms (n = 24) was performed with heparin-coated equipment used for left heart bypass (n = 12) or partial cardiopulmonary bypass (n = 12) for proximal unloading and distal protection (heparin 5000 IU, autotransfusion). All devices remained functional throughout the procedures and no systemic emboli were detected. The sole death (1 of 24, 4%) occurred in a patient with ruptured thoracoabdominal aortic aneurysm requiring operation in extremis. Paraparesis with spontaneous recovery occurred in one patient (1 of 24, 4%). In group 2, coronary artery revascularization randomized for low (activated clotting time greater than 180 seconds) versus full (activated clotting time greater than 480 seconds) systemic heparinization was prospectively analyzed in 22 patients. All patients recovered without sequelae, and no myocardial infarction was diagnosed. Low dose of heparin (8041 +/- 1270 IU versus 52,500 +/- 17,100 IU; p less than 0.0005) resulted in reduced protamine requirements (7875 +/- 1918 IU versus 31,400 +/- 14,000 IU; p less than 0.0005), reduced blood loss (831 +/- 373 ml versus 2345 +/- 1815 ml; p less than 0.01), reduced transfusion requirements of homologous blood products (281 +/- 415 ml versus 2731 +/- 2258 ml; p less than 0.001), and less patients transfused (5 of 12 versus 10 of 10; p less than 0.05). Lower D-dimer levels in the group perfused with low systemic heparinization (0.50 +/- 0.43 mg/L versus 1.08 +/- 0.59 mg/L; p less than 0.05) were attributed to the absence of cardiotomy suction in this group. In group 3, rewarming in accidental hypothermia by cardiopulmonary bypass was successfully performed without systemic heparinization in a patient with hypothermic cardiac arrest (23.3 degrees C) and intracranial trauma. We conclude that systemic heparinization for clinical cardiopulmonary bypass can be reduced and eliminated in selected patients if perfusion equipment with improved biocompatibility is used. Bypass-induced morbidity can be reduced.
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PMID:Reduction and elimination of systemic heparinization during cardiopulmonary bypass. 154 23

From 1980 to January 1991, 130 patients (89 men and 41 women, aged 22 to 76 years; mean age, 52 years) underwent 133 interventions on the aortic arch. Aneurysm was diagnosed in 57 patients, whereas 29 had chronic and 44 acute aortic dissection. In 67 instances a partial and in 35 instances a total arch replacement was performed. The distal arch was approached through a left thoracotomy in 14 patients. Local interventions (n = 17) included surgical reconstruction and glue procedures. Additionally, 55 patients required aortic valve replacement, preferably with composite grafts (n = 46), whereas the valve was reconstructed in 14. Procedures were performed using hypothermia (nasopharyngeal temperature, 11 degrees to 25 degrees C) and circulatory arrest (mean time, 27 minutes). Early mortality was 13.9% at the first operation on the aortic arch. Early deaths included 7 of 57 patients with aortic aneurysm (12.3%), 2 of 29 patients with chronic dissection (6.9%), and 9 of 44 patients with acute dissection (20.5%). Neurological (n = 6) and cardiac events (n = 5) were the most common causes of early death. Since 1987, 7 of 88 patients have died for an overall mortality of 8.0%. With growing experience, proper indication, and adequate operative strategy including the use of circulatory arrest in hypothermia, operation on the aortic arch can be performed with an acceptable risk.
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PMID:Advances in aortic arch surgery. 173 61

Twenty patients (Group 1) with a mean age of 38.5 +/- 16 years and an admission Trauma Score of 7.26 +/- 5.9, suffered 27 vascular injuries and were resuscitated with the Infuser 37 (IN-37) with an integral heat exchanger. Admission systolic BP averaged 46.47 mmHg (seven with absent vital signs). A mean of 7,030 ml of blood, 3,313 ml of colloid and 13,630 ml of crystalloid per patient was given in less than 24 hours, mostly through the IN-37. Twelve thoracotomies, nine laparotomies, and one extremity exploration were performed. Twelve patients, seven with a Trauma Score less than 3, died in less than 24 hours of exsanguination. The survival rate was 40% at 24 hours and 25% at 30 days. Six patients (Group 2) with a mean age of 70.33 +/- 8.3 years underwent operation for ruptured aortic aneurysm (5 pts), and elective aortic aneurysm (1 pt) with a 66% survival at 24 hours. Admission systolic blood pressure averaged 84 mmHg. A mean of 3,895 ml of blood, 1,900 ml of colloid and 7,733 ml of crystalloid per patient was administered in less than 24 hours, mostly through the IN-37. The IN-37 provides a safe and simple means of normothermic, rapid volume replacement in hemorrhagic shock. Its use in critically ill but potentially salvageable patients with vascular injuries and aortic aneurysm may avoid the consequences of prolonged hypoperfusion and hypothermia.
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PMID:Normothermic rapid volume replacement in vascular catastrophes using the Infuser 37. 322 36

Our experience (January 1982-May 1987) concerns 41 patients, operated upon for aortic dissection (30 patients) or aneurysm (11 patients) using circulatory arrest with deep hypothermia. There were 24 male and 17 female patients (mean age: 55 years 9 months, range 32-73 years). The mean circulatory arrest time in minutes was 41 +/- 3 (mean rectal temperature before circulatory arrest was 18.4 degrees C +/- 0.3 degrees C). Total (24 patients) or partial (16 patients) replacement of the aortic arch was performed. One patient with a sacciform aneurysm had the aortic wall defect closed. Hospital mortality was 22% +/- 7% (9 patients): 8 of 30 patients with aortic dissection (26.6%) and 1 of 11 patients with aortic aneurysm (9%). Neurological complications occurred in 3 patients. These data lead us to prefer circulatory arrest with deep hypothermia as the method of choice for aortic arch surgery. However, when a short circulatory arrest time (less than 30 min) for the repair is foreseeable, mild hypothermia (20 degrees C-24 degrees C) may be preferred. In patients who will not tolerate excessive cardiopulmonary bypass times, expected difficulties with the repair should suggest mild hypothermia and short circulatory arrest in easier cases or moderate hypothermia with brachiocephalic perfusion in the others.
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PMID:Should circulatory arrest with deep hypothermia be revised in aortic arch surgery? 327 20

Profound hypothermia and circulatory arrest is a well worked out technique for total repair of congenital defects in infants. Recently, it has been popularized for the repair of aneurysms of the transverse aortic arch. We have applied this technique of profound hypothermia and circulatory arrest in three other adult patients in whom conventional techniques would not allow safe and adequate complete repair of acquired intra-cardiac defects. The first patient, a 76-year-old female, had a large chronic ascending aortic aneurysm involving the aortic valve, as well as the innominate and left common carotid arteries. Resuspension of the aortic valve, resection of the ascending aneurysm, and reconstruction of the ascending and transverse aorta were performed under profound circulatory arrest. In addition, multi-dose hypothermic blood K+ cardioplegia was utilized to protect the myocardium. The second patient underwent valve replacement during a period of circulatory arrest because of extensive calcification of the entire ascending aorta and transverse aortic arch. Arrest time was 56 minutes. The third patient was a 54-year-old female and had a large patent ductus arteriosus with a 3:1 left-to-right shunt as well as significant aortic and mitral valve disease. The ductus was closed through an incision in the pulmonary artery during a 13-minute period of profound hypothermia and circulatory arrest. Aortic valve replacement and mitral repair were also performed at the same time, utilizing conventional techniques. All three patients recovered uneventfully with no evidence of any significant neurologic defect. Long-term follow-up has shown improvement in functional classification in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Use of profound hypothermia and circulatory arrest in complex intra-cardiac repair in adults. 359 26

From 1982 until October 1985 we operated 9 cases of aortic aneurysm involving the transverse aortic arch (5 male and 4 female, from 26 to 69 years). Two patients had an acute dissecting aortic aneurysm, the others had an aneurysm of the aortic arch involving also the ascending aorta in 5 cases and the descending aorta in 1. Three patients underwent aortic valve replacement and implantation of coronary orifices. Two patients had previously had AVR. The operation was carried out under cardiopulmonary by-pass. After obtaining 25 degrees C hypothermia the bypass was discontinued and the cerebral vessels were cannulated from inside of the opened aneurysm and perfused at a flow rate of 250 ml/min. The myocardium was protected by cold cardioplegia and topical cooling. During total circulatory arrest the distal aortic arch anastomoses were completed in 28-56 minutes. Then the by-pass was restarted and the rest of the operation was carried out as usual. One patient with an acute dissecting aortic aneurysm died on the 2 post-operative day due to brain damage and rupture of abdominal aorta. The other patients recovered well. There were no permanent neurological or myocardial complications. Three patients had a transient renal failure, one needing dialysis. The 8 survivors have done well 4-46 months after the operation.
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PMID:Hypothermia and circulatory arrest in reconstruction of aortic arch. A report of nine cases. 361 37

Total aortic replacement including aortic valve was performed successfully in the two patients in whom this method of treatment was utilized to correct a chronic dissecting aortic aneurysm. Both patients had moderately severe aortic insufficiency producing increasing heart strain and progressive enlargement of the false lumen of aortic dissection involving the entire aorta despite ideal blood pressure control. In addition, one patient had Marfan's syndrome. The surgical treatment for both patients was performed in two stages. At the first operation, cardiopulmonary bypass, profound hypothermia, and circulatory arrest were employed while the aortic valve and the ascending and transverse aortic arch were replaced and the coronary and brachiocephalic vessels were reattached to the composite valve-graft used for replacement. At the second operation, the entire descending thoracic and abdominal aortic segments were replaced with a graft and the intercostal, lumbar, and visceral arteries reattached thereto. Left vocal cord paralysis occurred in both patients and transient mild paraparesis occurred in only one. Both patients are alive and well, one at 13 months and one at 6 weeks. This experience suggests an additional treatment modality for selected patients with complications of chronic aortic dissection.
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PMID:Total aortic replacement for chronic aortic dissection occurring in patients with and without Marfan's syndrome. 623 Oct 6

The operative management of aneurysms of the ascending aorta continues to present a technical challenge to the surgeon, and the results obtained provide a useful clinical assessment of the means of myocardial protection. We present a series of 35 consecutive patients who underwent operations for aneurysms of the ascending aorta during which myocardial protection was achieved with hypothermia and potassium cardioplegia. Twenty-three patients underwent aortic valve replacement and resection and grafting of a chronic ascending aortic aneurysm. Aortic valve replacement and aneurysmorrhaphy of a chronic ascending aneurysm were performed in five patients. Four patients underwent resection and grafting of a chronic ascending aortic aneurysm and three patients resection and grafting of acute aortic aneurysms. Aortic cross-clamp times varied from 48 minutes to 2 hours, 32 minutes, with a mean cross-clamp time of 1 hour, 29 minutes. There was one death in the hospital in this series of 35 patients for a mortality rate of 2.8%. Of the 34 survivors, there has been one late death from recurrent sternal wound infection. This clinical series documents the efficacy and safety of hypothermic potassium cardioplegia for protection of the myocardium during extended periods of ischemia attending operative correction of ascending aortic aneurysms.
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PMID:Myocardial protection with hypothermia and potassium cardioplegia during operation for ascending aortic aneurysms. 736 37

We studied the non-invasive method of monitoring of cerebral metabolism and oxygenation of patients mainly with thoracic aortic aneurysm during Cardio-pulmonary bypass (CPB) by Near-infrared Spectrophotometry (NIRS) to establish the safety limits of cerebral perfusion. NIRS monitoring of all 12 patients showed that cerebral oxygenation levels were maintained within the pre-CPB range when mean arterial perfusion pressure (MAPP) was above 60 mmHg. With considering rectal temperature, the cerebral oxygenation levels were maintained above the pre-perfusion baseline when MAPP was above 50 mmHg at rectal temp. < or = 25 degrees C, and 73 mmHg at > or = 25 degrees C. It was suspected that cerebral autoregulatory mechanism could exist even in hypothermia (< or = 25 degrees C) because cerebral oxy-Hb and blood volume was significantly declined when MAPP was reduced to 40 mmHg or less. In 5 patients who underwent selective cerebral perfusion, the base line level of blood volume was preserved when the perfusion flow rates were above 0.5l/min, and the desirable oxy-Hb levels were obtained when the flow rates were above 0.4l/min. During deep hypothermic circulatory arrest (18 degrees C), cerebral oxy-Hb level was gradually reduced from baseline, reflecting proceeding metabolic activity even in profound hypothermia. These findings led us to conclude that non-invasive, continuous, and direct monitoring of cerebral oxygenation using NIRS can provide valuable data to prevent cerebral injury after CPB. It is hoped that the safety limits of cerebral perfusion and circulatory arrest can be established in the future using multiple analysis of pressure, flow, temperature, Hb concentration and so far by NIRS.
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PMID:[Clinical study on measurement of cerebral metabolism and oxygenation during cardio-pulmonary bypass by near-infrared spectrophotometry]. 759 43


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