Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1956 and 1967, 34 patients, aged 2 months to 40 years, underwent aortic valvulotomy under hypothermia for congenital aortic stenosis. There were two early and five late deaths. Twenty-seven patients were followed up for a mean of 15 years. Thirteen patients had no subsequent operation: 11 are asymptomatic, seven with mild aortic insufficiency. Ten patients have had aortic valve replacement (AVR), one revalvulotomy, three will require AVR. Three late deaths were sudden. The literature has been reviewed for data on mortality, endocarditis, aortic insufficiency, and reoperation. Operation improves longevity, but does not restore it to normal. Aortic valve replacement in children carries a poor prognosis, possibly reflecting severity of disease. The chances of reoperation after ten years are 20% to 40%. Valvulotomy must, therefore, be regarded as the first in a possibly lifelong series of operations.
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PMID:Congenital aortic stenosis: ten to 22 years after valvulotomy. 70 45

From 1974 to 1976 104 infants (under 1 year of age) underwent intracardiac correction for congenital heart diseases. Mean age and body weight were 6.6 +/- 3.6 months resp. 5.66 +/- 1.4 kgs. The diagnoses and mortality rates were: transposition of the great arteries (TGA) with intact ventricular septum 27 (0), TGA plus associated anomalies 9 (0), ventricular septal defect (VSD) 20 (1), VSD plus associated anomalies 6 (1), total anomalous pulmonary venous drainage 9 (5), pulmonary stenosis and pulmonary atresia with intact ventricular septum 9 (2), aortic stenosis 7 (3), ASD I or II 7 (0), and miscellaneous 10 (3). Intracardiac correction was performed either on cardiopulmonary bypass and moderate hypothermia or in deep hypothermia with or without total circulatory arrest. The early mortality in the first group was 7% (6 out of 90), in the second group 64% (9 out of 14). With increasing experience, cardiopulmonary bypass has proven to be a save method for intracardiac correction of congenital heart anomalies in infancy even in the youngest age group under three months of age and under emergency conditions.
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PMID:[Intracardiac correction of congenital heart anomalies in 104 infants (author's transl)]. 92 69

In this report, the development of false aneurysm of the ascending aorta 8 years following the repair of congenital aortic stenosis is described. A 14-year-old male patient was found to have congenital aortic stenosis in 1966 after medical check-up and subsequently operated upon. In the postoperative period, he was complicated by remittent fever of 1 month's duration, which was finally controlled by antibiotics. Arterial blood cultures taken on a few occasions were negative. Eight years and 5 months after surgery, he was noticed to have a mediastinal mass around the base of the heart and the presence of false aneurysm was confirmed by aortography. Aneurysmectomy was carried out almost 9 years after the previous operation, and it was found that aneurysm was arising from the suture line of the aortotomy with communication to the aorta at the bottom of the aneurysm. Postoperatively, patient's recovery was uneventful and was discharged on the 23rd postoperative day. Etiology, timing of operation and techniques utilizing hypothermia and/or circulatory arrest are discussed.
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PMID:Non-infected false aneurysm of the ascending aorta eight years after aortic valve surgery. 94 42

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.
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PMID:Surgical treatment of congenital valvular aortic stenosis. 96 96

In 39 patients aged from 2 1/2 to 35 years the results of surgical treatment of congenital aortic stenosis are analyzed. Electro-, phonocardiographic and roentgenological findings along with those obtained through catheterization of the left cardiac chambers prior to surgery are described in detail. All these patients were divided into 3 groups, depending upon extent of deranged hemodynamics. The 1st group included 10 persons with a moderate aortic stenosis. The systolic gradient between the left ventricle and the aorta did not exceed in them 30 mm Hg. The 2nd group counted 20 patients with a well-marked aortic stenosis and a systolic pressure gradient between 30 and 80 mm HG. The 3d group embraced 9 patients with an acute aortic stenosis. Here the systolic gradient was in excess of 80 mm Hg. Surgery was performed in 35 patients under a moderate hypothermia and with extracorporeal circulation. Thirteen (33.3 per cent) patients died during surgery and in the post-operative period.
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PMID:[Clinical course, diagnosis and surgical treatment of congenital aortic stenosis]. 102 37

A total of 47 infants (2,7 to 9,6 kg in weight, 3 days to 21 months of age, 89% under one year) underwent early total correction of severe congenital heart defects in profound hypothermia of about 22degreesC and circulatory arrest (11 to 64 minutes). 8 patients were operated upon without extracorporeal circulation (ECC) (mortality 63%). 37 infants were additionally cooled and rewarmed with ECC (mortality 22%). The most common diagnosis were: Total atrioventricular canal (11), aortic stenosis with and without combined lesions (8), tetralogy of Fallot (7), ventricular septum defect (7) and transposition of the great arteries (4).
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PMID:[Open-heart surgery during deep hypothermia in infancy]. 108 24

Eighty-eight operations for correction of intracardiac congenital heart defects were performed using local cardiac hypothermia for protection of the ischemic myocardium. Twenty-six patients underwent repair of tetralogy of Fallot, 23 had patch closure of ventricular septal defect, 24 had correction of various types of congenital aortic stenosis, and 15 were operated upon for other complex lesions. The overall operative mortality was 5.6%. Ischemia times ranged from 9 to 119 minutes (mean, 48 minutes). Ischemic arrest protected by local cardiac hypothermia provides an optimal operative field, permitting repair of uncomplicated intracardiac defects in a precise, unhurried manner. No hemodynamic abnormalities attributable to the technique were encountered.
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PMID:Local cardiac hypothermia for myocardial protection during correction of congenital heart disease. 118 May 98

During the past seven years, 102 patients with TGA have been operated on using the switch operation. Overall early mortality was 5.9%, late mortality 2.%. Sixty-three newborns had an intact septum and were corrected between the 3th and 35th day after birth, 39 had a ventricular septal defect and/or associated anomalies. All operations were carried out under ECC and deep hypothermia. Myocardial function was recorded intraoperatively by using sonomicrometry. The data demonstrate that adaptation of the left ventricle to the new load conditions should be supported by drugs providing inotropic stimulation and afterload reduction. Mean follow-up time is 32.5 months, no rhythm problems have been recorded during that period, a few children revealed trivial pulmonary or aortic valve stenosis and/or incompetence. The switch operation permits good early results for newborns with TGA and intact septum and TGA with VSD. A decade has to pass in order to judge the long-term results.
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PMID:Experience with anatomical correction of transposition of the great arteries (TGA). 178 50

Open commissurotomy for critical aortic stenosis has been performed in a consecutive series of 28 neonates and infants below 3 months of age (average age 1 month) including 5 patients with severe organic mitral valve disease in need of concomitant correction. In the majority of cases, aortic stenosis was due not only to fused commissures but also to excessive immature valve tissue protruding into the valve area. Therefore a technique of extended commissurotomy has been adopted resecting such nodules responsible for a secondary level stenosis. All operations were done under deep hypothermia (17 degrees C), circulatory arrest (33 +/- 11 min) and cardioplegia using the Bretschneider solution (35-50 ml/kg). Hospital mortality was 18% (5) including 1 infant dying at 2 months of thrombosed mitral prosthesis inserted at a secondary operation. Severe organic mitral valve disease proved to be the only significant risk factor for early mortality. During the follow-up period of up to 10 years (average 5 years), 1 child with a hypoplastic left heart died and 2 children had to undergo reoperation for residual and recurrent stenosis, respectively. Actuarial survival for the present series is 78% at 10 years while reoperation free survival for the aortic valve is 64%. It is concluded that careful and if necessary extended open commissurotomy still represents the method of choice in this age group. Alternative methods such as transventricular or percutaneous dilatation did not show a lower risk until now and long-term results are not convincing as yet.
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PMID:Surgery for critical congenital aortic stenosis during the first three months of life. 189 68

Similarly as in all war-ravaged countries of Europe, in Czechoslovakia, too, cardiosurgery did not begin being systematically developed until after 1945. Patent ductus arteriosus was first treated surgically in this country in 1947, the year 1951 saw the launching of surgical therapy for mitral stenosis (commissurotomy on the closed heart), 1955 - the introduction into clinical practice of open-heart surgery for simple heart defects (DSS, pulmonary artery stenosis and aortic stenosis) with the patient in 28 degrees C hypothermia and with the blood circulation arrested for brief periods of time. In the years 1958-1959, four Czechoslovak cardiosurgical centres began to provide surgical treatment for congenital and acquired heart defects in extracorporeal circulation. Considering the war-inflicted material and personnel shortcomings prevailing in those times, Czechoslovak cardiosurgery managed relatively soon to attain the standard of cardiosurgery of the western countries, thus testifying to the viability of the country's post-war health care services. At present, there are six cardiosurgical centres in this country systematically engaged in the surgical treatment of congenital and acquired heart defects and providing the diagnosis and surgical correction of heart defects on a professional scale equal to that in countries with advanced health care systems. While the care provided at Czechoslovak cardiosurgical centres is comparable in terms of quality, the productivity of those centres leaves much to be desired. Ways and means of coping early with this inadequacy are looked for with the help of the Ministry of Health.
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PMID:Czechoslovak cardiosurgery. 207 Jun 91


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