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

A 25-year-old with a history of childhood rheumatic fever and resultant mild aortic insufficiency presented for routine prenatal care during her sixth pregnancy. At 14 weeks' gestation; a significant diastolic murmur was identified. Further evaluation revealed a massively dilated, aneurysmal aortic root, moderate to severe aortic insufficiency, and mild left ventricular hypertrophy. Because of the risk of sudden aneurysm rupture and the high mortality associated with this lesion, the patient was advised to undergo therapeutic abortion and aortic valve replacement with arch repair. The patient refused abortion but desired repair during pregnancy in spite of the increased fetal risk. At 17 weeks' gestation, aortic valve replacement and ascending aortic aneurysm excision were performed under pulsatile cardiopulmonary bypass and mild hypothermia. The patient's postoperative course and pregnancy proceeded uneventfully except for one episode of postpericardiotomy syndrome. A healthy, full-term male infant was delivered by spontaneous vaginal delivery. The carefully coordinated combination of obstetric and cardiovascular anesthesia contributed to this successful outcome for mother and child. The principles for fetal preservation and anesthetic considerations for pregnant women undergoing open heart surgery are reviewed.
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PMID:Aortic valve repair and arch replacement during pregnancy: a case report. 909 96

From January 1989 through June 1996, 29 patients underwent surgical repair of type A acute aortic dissection. Mean age was 59 +/- 13.5 years (range 25-76 yrs) and 21 patients (72.4%) were male. Nineteen patients (65.5%) had systemic hypertension and 3 (10.3%) Marfan syndrome. One patient (3.4%) had prior surgical repair of descending aortic dissection and CABG. Six patients (20.7%) were operated on in shock. The dissection was limited to the ascending aorta (DeBakey type II) in 12 patients (41.4%). Eleven patients (37.9%) had severe aortic regurgitation. Replacement of the ascending aorta was performed in all cases and extended to include the transverse arch in one. Twenty-three patients (79.3%) were operated upon using a tubular graft (sacron-21, homograft-2) with aortic valve resuspension. In the remaining 6 (20.7%) the aortic valve and root were replaced using a Bentall procedure, modified with a homograft in 3 cases. Five patients (17.2%) had associated surgery: CABG (4) and closure of aortic-atrial fistula (1). Mean cardiopulmonary bypass time was 134 minutes (range 70 to 285 min) and aortic cross-clamp time was 58 minutes (range 23 to 93 min). Hypothermic circulatory arrest for open distal anastomosis was used in 26 patients (89.7%) (mean time 22 min; range 10 to 32 min), with retrograde cerebral perfusion in the last 4 years (18 cases; 62.1%). Hospital mortality was 17.2% (5 patients). Eight patients (27.6%) had hospital morbidity: reexploration for bleeding (4 cases), CVA (3), A-V block necessitating permanent pacemaker (1). The mean time of hospitalization was 18 days (range 9 to 81 days). In the follow-up period (mean 38 mths; range 4 to 94 mths), 2 patients died (CVA and gastrointestinal bleeding) and 4 required hospitalization (perforated duodenal ulcer, peritonitis, suspected endocarditis, supraventricular tachyarrhythmia-1 patient each). All 22 survivors (75.9%) returned to the functional status they had prior to the dissection and 18 of them (81.8%) are in NYHA functional class I. Type A acute aortic dissection is a complex pathology and the postoperative mortality remains significant, but surgery permits good functional recovery and an active life for the survivors.
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PMID:[Surgery for acute type-A aortic dissection]. 930 6

A retrospective study was conducted for the surgical treatment on acute aortic dissection among the cardiovascular services of 5 affiliated hospital of medical school. The total of 74 cases were operated for the last 5 years period from Jan., 1991 to Dec., 1995, in which 64 cases were classified as Type A and 10 for Type B. The average age for Type A was 58.4 years old and 10% of patients were consisted of Marfan syndrome. The most frequent complications associated with dissection was aortic regurgitation (37.5%), followed by cardiac tamponade (23.4%). The surgeries were undertaken in less than 24 hours from the onset of symptom in 45.3% of patients. The localization of initial tear as was proved by intraoperative finding was at ascending aorta in 64.0%, whereas it was found at aortic arch in 21.8% of patients. The most frequent application of operative procedure was simultaneous graft replacement of ascending aorta and aortic arch (68.7%) with the use of profound hypothermia and antegrade selective cerebral perfusion (85.4%). The overall mortality rate was 25.0%, however when compared as ascending only vs ascending + arch replacement, the later group demonstrated higher mortality rate (16.6% vs 28.9%). The majority of surgical indication for Type B was hemorrhage from the dissection and 20.0% of mortality was recorded in this group of patients.
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PMID:[The surgical treatment for acute aortic dissection--a retrospective study from the statistics of affiliated hospitals of a medical school]. 958 77

We report a rare case of hemolysis after coil occlusion of a patent ductus arteriosus (PDA), which was treated by surgical removal of the coil and closure of PDA. A 65-year-old woman was admitted to our hospital with congestive heart failure due to severe aortic regurgitation associated with PDA. Before undergoing open heart surgery she underwent closure of the PDA using a Jackson coil as an adjunct of treatment to improve her hemodynamic state. However, a small residual shunt resulted in severe hemolysis. Two weeks after the intervention she underwent aortic valve replacement and PDA closure after removal of the coil through the main pulmonary artery under moderate hypothermia and temporary circulatory arrest. Hemolysis is always secondary to a residual leak and several methods have been reported to manage this complication. Our report suggests that early surgical retrieval of the coil before the organized thrombus is formed, can be safely performed even in an elderly patient whose ductus is usually fragile.
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PMID:Persistent hemolysis after coil occlusion of a patent ductus arteriosus in a patient with aortic regurgitation. 968 33

A case of Takayasu's arteritis resulting in extensive fusiform aneurysmal dilatation of the entire aorta extending from the aortic root to the abdominal bifurcation associated with aortic regurgitation is described. She underwent successful radical replacement of the aortic root, ascending, transverse arch and proximal part of the descending aorta employing simultaneous modified Bentall and Elephant trunk techniques. During aortic arch replacement the brain was protected by selective antegrade innominate perfusion under moderate hypothermia. A pattern to the best of our knowledge, has not been reported earlier.
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PMID:Radical aortic replacement employing simultaneous modified Bentall and elephant trunk procedure in Takayasu's arteritis. 1083 36

An infected pseudoaneurysm of the ascending aorta after heart surgery is a fatal disease due to its rapid progress, worsening of the systemic condition and a tendency of recurrence. We report a 53-year-old man with this condition who presented with fever and an aortic regurgitation due to compression of the ascending aortic root 2 months after mitral valve replacement for infective endocarditis. We performed an aneurysmectomy with a cardiopulmonary bypass using groin cannulation and moderate systemic hypothermia. A pseudoaneurysm developed 5 mm proximally of the previous aortotomy. There was no dehiscence of the former aortic suture line. After debridement of the ascending aorta involving the previous aortotomy and pseudoaneurysm, we elected to directly close the aortic defect using Teflon felt strips to avoid a prosthetic graft. The aortic valve had no infective endocarditis and other abnormality. Postoperatively, there was no aortic regurgitation, and the cause of the previous aortic regurgitation was believed to be due to a compression of the aortic root from outside. The postoperative course has been good.
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PMID:Ascending aortic infected pseudoaneurysm with aortic insufficiency following cardiac operation for infective endocarditis. 1117 43

Lesions of the ascending aorta associated with aortic valve disease are usually treated by implanting a prosthetic valved conduit (Bentall procedure). In this report, we present our experience in which a valved homograft conduit was used for the procedure. Six patients underwent a Bentall procedure with the use of a cryopreserved valved homograft conduit. Two of the patients had annuloaortic ectasia, 2 had Marfan syndrome, and 1 had an atherosclerotic aneurysm of the aorta. One patient had severe aortic stenosis due to a bicuspid aortic valve, along with an aneurysm and localized dissection of the ascending aorta. In all of the patients, the aortic annulus was substantially dilated, with accompanying moderate-to-severe aortic regurgitation. A standard procedure was performed with moderate hypothermia, cardiopulmonary bypass, and aortic and bicaval cannulation. The ascending aorta and the aortic valve were replaced with a cryopreserved valved homograft conduit (aortic in 5 patients and pulmonary in 1). The native coronary ostia were anastomosed directly to the homograft. Echocardiography, which was performed intraoperatively, before discharge from the hospital, and at follow-up visits (1 to 36 months), revealed good valve function without dilatation of the homograft conduits. There was 1 late death due to Aspergillus fumigatus endocarditis, 6 months postoperatively. In 1 patient, magnetic resonance imaging performed at 24 months revealed normal caliber of the homograft conduit. We conclude that the Bentall procedure can be performed, safely and with excellent results, using cryopreserved homograft conduits.
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PMID:Bentall operation with valved homograft conduit. 1119 10

A 78-year-old woman with an aortic root aneurysm and aortic regurgitation developing acute type A dissection successfully underwent aortic root replacement using a stentless xenograft during core cooling, followed by total aortic arch replacement under selective cerebral perfusion with deep hypothermia. This bioprosthesis can be used in the same way as a free-hand homograft and potentially provides an aggressive, safe option for acute aortic dissection requiring aortic root reconstruction in elderly patients.
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PMID:Concomitant aortic arch and root replacement using a stentless xenograft for acute type A dissection. 1148 39

A-37-year-old woman in shock condition was transferred to our hospital after cardiopulmonary resuscitation for ventricular fibrillation. She was unconscious and suspected of suffering ischemic brain damage, with pathologic reflexes and weak brain stem reflexes. Brain CT scan showed cerebral edema without hemorrhage or infarction and an electroencephalograph revealed slow alpha-theta waves. Chest CT scan and echocardiogram showed ascending aortic aneurysm with sever aortic regurgitation. An emergent operation was performed for progression of heart failure. There were no distortion or dilatation of the sinus of Valsalva and annuloaortic ectasia and aortic valve leaflets were almost normal. We considered that the aortic valve dysfunction was cause by dilatation of the sinotubular junction. Ascending aortic and aortic valve replacement were carried out to shorten cardiopulmonary bypass time and to prevent the progression of brain damage. Mild hypothermia was employed as a neuroprotective procedure for three days after surgery. The patient's neurological symptoms, which were right hemiparesis, facial apraxia and motor aphasia, improved and she was discharged from the hospital on foot without any neurological complications on the 47th postoperative day and returned to work after two months.
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PMID:[An unconscious patients with ascending aortic aneurysm accompanied by aortic regurgitation successfully treated by emergency operation after cardiopulmonary resuscitation]. 1159 40

A 78-year-old woman presented with acute pulmonary edema, a blood pressure of 250/160 mmHg, and a 4/6 diastolic murmur of probable aortic origin. Aortography revealed 4+ aortic regurgitation, left ventricular dysfunction, a right coronary artery with good distal run-off but complete proximal occlusion, a fusiform aneurysm of the ascending and transverse aorta (with a transverse dissection in the left anterolateral wall of the upper ascending aorta, but no evidence of intramural lumen), and milder, isolated dilatation of the descending thoracic aorta. Upon operation, on 8 September 1987, I discovered an incompetent aortic valve, advanced atherosclerosis in the ascending and transverse aorta, and a loose intimal flap--but no false lumen--in the upper ascending aorta. After valve replacement and construction of a vein graft to the distal right coronary artery, I decided against replacement of the diseased segment of the ascending and transverse aorta and chose, instead, aortic endarterectomy reinforced by external grafting, as a simpler, quicker, and safer procedure for this patient. Safety was further enhanced by use of profound hypothermia (16 degrees C) to induce total circulatory arrest during the brief period (15 minutes) required for endarterectomy of the arch and approximation of the flap. The patient was discharged 19 days after surgery and continues well and asymptomatic to the present, 21 months after surgery; her milder dilatation of the descending thoracic aorta, which was not treated, is stable and is being monitored.
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PMID:Endarterectomy and external prosthetic grafting of the ascending and transverse aorta under hypothermic circulatory arrest. 1522 17


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