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

During aortic clamping, drug protection of the myocardium, far from supplanting hypothermia, complements it, particularly in the case of left ventricular hypertrophy. Ultramicroscopy and new techniques of histobiological exploration of the myocite have enabled one to distinguish the lessions provoked by anoxia from those induced by reperfusion. At present, drug protection, extended to energetic solutions and electrolytes, aim at preserving energy metabolism by stocking of the substrate and at avoiding interferences which precipitate exhaustion of the adenosine triphosphate and phosphocreatinine reserves. In order to do this, hemodilution in particular is limited in subjects with decompensated cardiopathy; choice of anesthetics is orientated towards neuroleptanalgesia or fluothane, and it is attempted to neutralize the adrenergic reaction by the use of beta-blocking substances. Furthermore, it is preferred to interrupt electrogenesis at the stage of polarization: depolarizing cardioplegic solutions rich in potassium and sodium are rejected and in preference membrane stabilizers are used (procaine, magnesium, tetrodoxine...) The ultramicroscopic analysis of the structural modifications leads to sparing of the integrity of the lysosomial membrane by corticoids and alkalines. The use of calcium is deferred, anti-calcium techniques are even proposed (washing poor in calcium, verapamil). Cellular edema is prevented and treated by solution (mannitol - sorbitol) whose osmolarity must be less than 300 M osm/l. A conditioning of the biochemical and physicial structures and of cardiac work is being more and more thought of which leads to the classification of beta stimulating substances as negative, and their indications must be seriously thought of and used with reserve.
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PMID:[Drug protection of the myocardium during cardiac surgery]. 1 31

In 81 operations for correction of infants's cardiopathies, authors used, associated with E.C.C., a deep hypothermia allowing a circulatory arrest of an average duration of 52 minutes, according to the technics described by BARRAT-BOYES in 1971. From this experience, authors study the modifications brought to the organism by this hypothermia, and discuss the technical aspects in pre, per and post-operative periods. Mortality of this series is of 13,5 p. 100. It is in relation with the cardiopathy or it's correction, without anu possibility or directly charge the technique of hypothermia in its determinism. The early mortality includes a bilateral phrenic paralysis, an air embolism, three septic complications and two neurologic complications probably related to a poor thermic repartition. Advantages of this technique concern the possibility to operate in a bloodless field and a diminution of E.C.C. time.
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PMID:[Deep hypothermia on the infant: physiopathology and technics of ECC]. 1 34

Sixty-five infants were submitted to complete repairment of a congenital cardiopathy under profound hypothermia and ECC. Description of the preparation of the young surgical patient, of the anesthesia, of the technique of ECC. The overall mortality was 35.5 p. 100. The hypothermia induced by ECC, does not introduce any supplementary risks as long as strict technical rules are respected.
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PMID:[Technics of anesthesia and hypothermia for the infant. Choice of replacement fluid for the circuit]. 1 39

Effects on hemostasis of deep hypothermia on infant has been studied on 29 infants operated upon for a cardiopathy under deep hypothermia. Results of this study show a diminution of the coagulation factors rate, an augmentation of the fibrinolytic activity and an unforeseable variability of the residual heparin leading in all cases to a complement of the heparin neutralization by Protamine.
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PMID:[Variations in hemostasis in the infant under deep hypothermia]. 1 45

A five year experience of profound hypothermia and circulatory arrest in the operative management of severe congenital heart disease in 128 infants and children weighing 10 kg or less is reviewed. Hospital mortality was 13% for the entire series--8% in the last two years. Mortality varied with the defect present rather than with the age at operation, and appeared to decline over the five years. There was no morbidity associated particularly with this technique, and no evidence of permanent neurologic nor intellectual impairment. Total arrest time averaged 55 minutes, was related significantly to the defect being repaired, but was not related to hospital mortality. The results support the idea of definitive early cardiac repair for severely symptomatic infants and young children, rather than surgical palliation. The hypothermic arrest technique is attractive since it allows optimal operating conditions, thus permitting an accurate repair and the consequent improvement in surgical results.
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PMID:Reparative cardiac surgery in infants and small children: Five years experience with profound hypothermia and circulatory arrest. 48 18

The effects of hypothermia on auditory brain stem response (ABR) in both children with congenital heart disease undergoing cardiac surgery and cats as an animal model were investigated. The latency of the ABR waves were prolonged with decreased body temperature. The latency of the later response components were prolonged more than that of the earlier response components; all waves disappeared below 25 degrees C and during artificial cardiac arrest. When the body temperature was raised, the later component began to reappear above 25 degrees C; the latency of all components shortened with temperature until normal responses were obtained at 34 degrees C. The data from both humans and cats were comparable. The ABR seems to be a useful monitor for evaluating brain stem function during deep hypothermia.
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PMID:Effects of deep hypothermia and circulatory arrest on the auditory brain stem responses. 54 8

Local hypothermia as a procedure for myocardial protection was utilized in 50 patients; 17 had congenital and 33 aquired heart disease. On patient with diagnosis of A-V canal, previously operated on, died on the 2nd postoperative day after mitral valve replacement and closure of a residual defect. Two other valvular patients died suddenly on the 9th and 20th postoperative days from thrombosis of the prosthesis. The lengths of time of aortic clamping required for correction of these various cardiopathies were analized and correlated with the final results. In comparison with the experience of other authors, a close relationship between the duration of the myocardial ischemia and the figures of morbi-mortality was observed. It is concluded that local hypothermia constitutes an adequate procedure for myocardial protection on the condition that the length of aortic clamping times do not exceed certain limits.
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PMID:[Protection of the myocardium with local hypothermia in open heart surgery]. 55 36

Our methods of myocardial protection are demonstrated in 846 patients subjected to open heart surgery for correction of congenital heart disease. They include body hypothermia and injection cardioplegia using magnesium-asparate-procaine. The spectrum of myocardial protection reaches from normothermia without cardioplegic arrest during short periods of extracorporeal circulation to profound body hypothermia with multiple injections of the cardioplegic solution in complex cardiac malformations. The results in 586 patients with left to right shunt, 140 patients with cyanotic cardiac malformations and 120 patients with congenital valve lesions are presented. Attention is directed to possible negative sequelae of overdosage of magnesium-asparate.
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PMID:[Myocardial protection utilizing hypothermia and cardioplegin during surgical correction of congenital heart disease (author's transl)]. 65 8

The results of 28 Potts' aortopulmonary shunts created for the relief of cyanotic heart disease are reviewed in this study. The shunt gave excellent symptomatic relief, but the incidence of immediate and late complications is high. Regular follow-up of patients is mandatory to detect evidence of increasing pulmonary vascular disease and to under take corrective surgery whenever feasible before its occurrence. Although Potts' anastomosis has been largely replaced by alternative shunt procedures, there may still be a place for its application in selected situations. Only a few problems were encountered at the time of closure of the shunt in 11 patients during corrective surgery using a transpulmonary technique and hypothermia with circulatory arrest.
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PMID:An evaluation of Potts' aortopulmonary shunt for palliation of cyanotic heart disease. 96 95

New borns and babies with congenital heart disease in poor condition have been shown to have a higher risk of developing hypoglycaemia. Blood sugar levels (BSL), acid-base balance and oxygen saturation have been studies in 10 babies from 7.5 to 15 months of age, weighing less than 9kg, before, during and after open-heart surgery. Preoperative mean BSL in the anaesthetized patient was 76mg per cent. It rose slightly after the onset of surgery and further increased to an average of 205mg per cent during cardio-pulmonary bypass with the temperature stablized at 28-29 degrees C. In the early postoperative phase BSL normalized but slowly, reaching a mean value of 107mg per cent 20-24h after the end of surgery. These results demonstrate that, at least under the usual conditions of extracorporeal circulation and hypothermia at our clinic, hypoglycaemia is not a threat in babies undergoing open-heart surgery for total correction of congenital lesions. The possible mechanisms leading to the observed hyperglycaemia are discussed and the results compared with similar studies in adult patients.
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PMID:[Blood sugar levels and acid-base balance in babies before, during and after open-heart surgery with hypothermia and extracorporeal circulation (author's transl)]. 100 46


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