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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

Potential morbidity remains substantial in aortic root replacement. The tissues are often fragile, contributing to the risk of haemorrhage and postoperative complications. In the past surgery has been directed towards minimising haemorrhage by wraparound techniques and the right atrial fistula method of Cabrol. However, recent use of aortic homografts, collagen-impregnated grafts and tissue glues have reduced bleeding and simplified operative technique. Profound hypothermia and total circulatory arrest allows aneurysm resection to extend into the aortic arch. Between 1986 and 1991 25 aortic root replacements were carried out at the Oxford Heart Centre in 21- to 76-year-olds, 13 for aorto-annular ectasia (4 due to Marfan's syndrome), 7 for aortic dissection (2 Marfan's syndrome) and 2 for complications of previous aortic valve replacement. Three patients had homograft root replacement for aortic root endocarditis. We implanted 14 Medtronic composite grafts, 1 St Jude conduit and 7 collagen-coated Dacron grafts (Hemashield, Meadox) into which a Starr-Edwards valve was sewn, as well as 3 homografts. One patient with a massive chronic dissection following previous aortic valve replacement required an interposition graft to the coronary ostia. In the others, the coronary ostia were mobilised from the native aorta and directly implanted into the conduit. In dissections a ring of pericardium or GoreTex was used to buttress the coronary anastomoses. Six patients also required coronary artery grafting. Native aorta was excised and not wrapped around the conduit. Coagulation defects were corrected aggressively with platelets, fresh frozen plasma and cryoprecipitate.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Aortic root replacement: modifications of technique with improvements in technology. 138 78

Twenty-nine patients underwent closure of patent ductus arteriosus (PDA) via pulmonary arteriotomy under low-flow extracorporeal circulation combined with profound hypothermia. No complications from air embolism or hemorrhage were encountered during the operation. The early and late results were satisfactory. This technique was used as a safe method for PDA complicated by severe pulmonary hypertension, infective endocarditis, recurrence of ductal patency and for PDA in adults or coexistence of intracardiac anomaly.
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PMID:[Closure of patent ductus arteriosus under extracorporeal circulation through pulmonary arteriotomy]. 181 5

An experimental model using surface-induced (20 degrees C) deep hypothermia and total circulatory arrest instead of cardiopulmonary bypass was developed for the study of growth of the transplanted heart. Autotransplantation of the heart was performed in 42 young dogs weighing from 4.4 to 9.0 kg (mean, 6.9 kg). Time of ischemia ranged from 26.0 to 60 minutes (mean, 43.4 minutes). Return of satisfactory cardiac function occurred in all but one animal. An early high mortality rate was due primarily to pulmonary complications, but with modifications to the technique, long-term survival increased to 70%. Early deaths (5 days to 13 weeks) of five dogs during preliminary trials were due to pleural effusion (2), sepsis (1), endocarditis (1), and ascites (1). There have been 14 long-term survivors (range, 194 to 498 days; mean, 264 days). Long-term survivors appear well, are active, and show satisfactory growth. This experimental model eliminates the need for heparinization and reduces the potential for complications associated with cardiopulmonary bypass in the dog. It avoids cannulations that might impinge on anastomotic sites. This model appears to be suited for studying growth of the transplanted heart.
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PMID:Cardiac transplantation without cardiopulmonary bypass: experimental model to study growth of the transplanted heart. 304 27

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

Verrucous endocarditis of the aortic valves was diagnosed postmortem in a Persian cat that died after showing clinical signs of dyspnoea, hypothermia and anorexia. Bacterial colonies were evident on Giemsa-stained sections of the valves and Escherichia coli was isolated from the endocarditis lesions.
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PMID:Verrucous endocarditis due to Escherichia coli in a Persian cat. 978 48

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 28-year-old man with active aortic valve endocarditis underwent emergency surgery. Because he had progressive congestive heart failure and uncontrolled infection. Aortic root replacement for Ross procedure was required because of complete debridment of infective tissue. His operation were performed under extracorporeal circulation and moderate hypothermia, the operation procedure was following, (1) taking off auto-pulmonary artery valve, (2) removing dysfunctional aortic valve and auto-transplantation of pulmonary valve on aortic root, (3) putting a pulmonary Freestyle Aortic Valve to rebuild right ventricular outflow tract. Follow-up showed heart function was in class I (New York Heart Association) , aortic and pulmonary valve function was very well. Streptococcus milleri group was isolated from his blood and infectious aortic valve postoperatively. We believed that a Ross operation with Freestyle Aortic Valve is more resistant to infection, therefore, it might be an option for infective endocarditis with aortic valve endocarditis.
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PMID:[Freestyle valve for right ventricular reconstruction in Ross operation; report of a case]. 1826 57

The incidence of bacterial endocarditis (BE) during pregnancy is about 0.01%, while maternal and fetal mortality rates due to BE are 22% and 15%, respectively. Fetal survival is <15% until week 25 of gestation, and cesarean delivery is recommended before cardiopulmonary bypass in the third trimester. The case is described of a 24-year-old woman (a known drug addict), gravida 1, para 0, at week 22 of gestation, with an acute mitral valve endocarditis caused by Staphylococcus aureus. Following urgent mitral valve replacement, the strategy for fetal survival involved reducing the hemodilution and scavenging the cardioplegia solution from the right atrium, avoiding deep hypothermia to minimize rewarming, and maintaining a high pump flow rate (>2.5 l/min/m2) with a mean perfusion pressure of 70 mmHg, using pulsatile perfusion. The patient had an uneventful postoperative course, and at 34 weeks' gestation a normal newborn of 1780 g was delivered by cesarean section. No controlled clinical trials using extracorporeal circulation during pregnancy have been conducted, and reports are limited to single cases. A strategy was proposed to manage the present case of uncontrolled maternal BE at an early gestational age, by addressing several factors that would influence the outcome for both mother and baby.
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PMID:Mitral valve replacement in pregnancy: a successful strategy for fetal survival. 2121 6


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