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

Strong experimental evidence links ventricular fibrillation to an increased temporal dispersion of the recovery of excitability. The effect of an overall prolongation of repolarization and an increased basic dispersion of repolarization on premature dispersion was studied on ventricular surface in 10 dogs. Our observations reveal the operation of several fundamental electrophysiologic mechanisms controlling the conduction and the refractoriness in the ventricular myocardium in vivo. Action potential (AP) duration was influenced by the heart rate, the duration of the preceding AP and the proximity to the repolarization of the preceding AP. These effects can both slow, or enhance ventricular conduction, during propagation of premature impulses. This model may be applicable to several clinical situations where APs are prolonged (hypothermia, drug effects, changes in electrolytes) or when dispersion of refractoriness is increased (long QT-time syndrome, neural imbalance of the heart with and without heart disease.
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PMID:Effect of uniformly prolonged, and increased basic dispersion of repolarization on premature dispersion on ventricular surface in dogs: role of action potential duration and activation time differences. 241 50

A successful case of simultaneous modified Bentall' procedure, MVR and sternoplasty was presented for a 42 years old man of Marfan's syndrome who had funnel chest, combined with mitral regurgitation, aortic regurgitation and annuloaortic ectasia. A few reports of one stage operation for the combination of funnel chest and heart disease in Marfan's syndrome has been published. A median sternotomy was made, with total cardiopulmonary bypass, heart was arrest and cor cooling hypothermia with crystalloid cardioplegic solution. Mitral valve was replaced with #31 B-S prosthetic valve. The ascending aorta proximal to the innominate artery and the aortic valve were replaced en-bloc with composite graft made of a vascular graft and aortic valve prostheses. Coronary artery orifices cut to the button-shaped, were sutured to the composite graft. Finally, sternoplasty was completed through modified Ravitch sterno-elevation. This is the first report in Japanese journals.
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PMID:[Simultaneous corrections Bentall procedure, mitral valve replacement and sternoplasty for a patient with Marfan's syndrome]. 261 23

This study investigates the influence of inadequate oxygen supply on CK and CK-MB release rate in congenital cyanotic heart disease in fourteen patients. Eleven patients had Tetralogy of Fallot and 3 Transposition of great vessels. Their age ranged between 10 days and 10 years (mean 50.48 +/- 31.82 months). The corrective repair was carried out under CPB with systemic hypothermia (20 degrees-25 degrees C) and intermittent St. Thomas Cardioplegia perfusion in the aortic root until the septal temperature was below 16 degrees C. Three blood samples were taken before, during and 10 minutes after CPB to quantitate the CK and CK-MB. In 6 cases of Fallot, two simultaneous biopsies, one from the right and another from the left ventricular walls were taken at the end of the 10 first minutes of reperfusion to evaluate the ATP, CP and glycogen contents. CK and CK-MB levels showed an increasing evolution; the CK-MB per cent increased sharply after aortic clamp release and then fell abruptly to low values at the 10th minute after CPB arrest. Comparative evaluation between the 3 values for C K showed significant differences (P less than 0.001) in all, except when the first values were compared to the second (P greater than 0.05) and for CK-MB an overall significant differences were found at P less than 0.025 and P less than 0.001. On the other hand, quantification of ATP, CP and glycogen contents from simultaneous biopsies from the left and the right ventricular walls did not demonstrate significant differences between the two ventricles after the ischemic period.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Profile of creatine phosphokinase (CK) and its isoenzyme MB (CK-MB) during corrective procedures of congenital cyanotic heart disease. 274 16

Infant orthotopic cardiac transplantation has been recently applied to various forms of congenital heart disease with encouraging short-term results. Between June 1986 and September 1987 we evaluated 16 infants for orthotopic cardiac transplantation. Fourteen had hypoplastic left heart syndrome, one had endocardial fibroelastosis with aortic atresia, and one had anomalous pulmonary arterial origin of the left main coronary. Eight families accepted the treatment program and eight families refused (two because of associated anomalies and six on philosophical grounds). Of the eight patients who were candidates for orthotopic cardiac transplantation, one died 6 hours after diagnosis, one was allowed to die after 60 days because of acquired neurologic complications, and another had congenital cytomegalic virus infection. The remaining five patients (four with hypoplastic left heart syndrome, one with anomalous pulmonary arterial origin of the left main coronary) had orthotopic cardiac transplantation. The operation was performed with absorbable polydioxanone suture with deep hypothermia and circulatory arrest in four neonates for hypoplastic left heart syndrome (average time 47 minutes) and bicaval cannulation and continuous bypass in one 11-month-old infant for anomalous origin of the left main coronary. In-house retrieval was used in all. One neonate died of complications as a result of pretransplant donor heart dysfunction and size discrepancy, whereas the remaining three neonates and one infant survived and are home 23 months, 12 months, and 8 months (the patients with hypoplastic left heart syndrome) and 17 months (the patient with anomalous origin of the left main coronary) postoperatively. Triple-drug immunosuppression included cyclosporine, azathioprine, and prednisone. Rejection was diagnosed by clinical evaluation of child activity and monocyte cell cycle analysis from peripheral blood samples without myocardial biopsies. Routine echocardiograms, electrocardiograms, and chest x-ray films were not helpful. Six episodes of rejection were successfully treated in four patients. Twelve-month postoperative catherization in one patient (hypoplastic left heart syndrome) showed appropriate graft growth, no aortic or pulmonary anastomotic strictures, normal right and left ventricular function, and no coronary artery disease. We conclude that infant orthotopic cardiac transplantation is an acceptable procedure for severe forms of untreatable congenital heart disease. The excellent short-term results warrant continued application of orthotopic cardiac transplantation.
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PMID:Infant orthotopic cardiac transplantation. 247 96

Anesthesia and surgery have a wide range of effects on the cardiovascular system. Even in healthy patients having minor operations, anesthetic agents can cause significant cardiac depression and hemodynamic instability. Virtually all anesthetic agents have intrinsic myocardial depressant properties, although some may mask this with sympathetic stimulation. The vasodilatory effects of the volatile agents can result in serious hypotension when combined with this negative inotropy. In the patient with pre-existing cardiac disease, these cardiovascular anesthetic effects become much more serious. These patients will not tolerate wide swings of hemodynamic variables, and the cardiodepressant effects of anesthetics are more pronounced in them. The stress of anesthesia and surgery frequently unmasks previously undiagnosed heart disease. Surgery itself provides many insults to the cardiovascular system, and these may be additive with the effects of anesthesia. These include loss of blood and other volume shifts, release of various substances into the circulation, hypothermia, sudden changes in cardiac preload and afterload, myocardial ischemia, and effects of drugs or blood products given for surgical reasons. The signs and symptoms of these surgical stresses to the cardiovascular system are often masked by anesthesia.
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PMID:Cardiovascular effects of anesthesia and operation. 333 99

Ten children who had had transposition of the great vessels (TGV) repaired, deep hypothermia, and cardiac arrest were examined. Seven children with acyanotic heart disease and 12 unaffected siblings were tested for comparison. Their intelligence, academic achievement, and behaviour was studied. The group with TGV had lower performance subscores on the intelligence test, an increase in somatic complaints, and aggressive behaviour.
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PMID:Cognitive development in transposition of the great vessels. 334 69

A series is presented of 83 patients surgically explored for massive bowel infarction. Old men with previous heart disease and symptoms of peripheral atherosclerosis were primarily affected. Clinical presenting features were abdominal pain (100 per cent), peritonitis (57 per cent), shock (34 per cent) and hypothermia (26 per cent). A third-space syndrome with metabolic acidosis and uraemia was the most common physiological derangement. Age was the only factor that appeared to have influenced the surgeon's decision to perform massive bowel resection (71 years in non-resected versus 64 years in resected patients, P less than 0.006). The overall mortality rate was 71 per cent. Forty-four patients underwent massive bowel resection (mean length of remaining small bowel 60 +/- 40 cm) and twenty-four (54 per cent) survived the procedure. Axillary temperature was higher in survivors (36.7 degrees C versus 36.1 degrees C, P less than 0.03). Early postoperative total plasma protein and albumin concentrations were also higher in survivors (57 versus 46 g/l, P less than 0.005; 27 versus 22 g/l, P less than 0.02). Patients with previous symptoms of atherosclerotic disease and high pre-operative blood urea levels also had a bad prognosis. Survivors had a mean hospital stay of 57 days and parenteral nutrition had to be maintained for a mean of 34 days. The survival rate achieved with massive resection justifies this surgical approach in selected patients with massive bowel infarction.
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PMID:Mesenteric infarction: an analysis of 83 patients with prognostic studies in 44 cases undergoing a massive small-bowel resection. 339 20

This study examined anatomic differences between the adult and the newborn heart as they relate to myocardial preservation and compared standard techniques of myocardial preservation used in operations for congenital heart disease. The biventricular endocardial surface area/ventricular mass ratios were calculated in 10 neonatal (2.5 +/- 0.2:1) and 10 adult (0.6 +/- 0.1:1) pigs (p less than 0.001). Three groups of neonatal pigs underwent 1 hour of global myocardial ischemia while being supported by cardiopulmonary bypass. Myocardial protection was by deep systemic hypothermia (group 1), moderate systemic hypothermia and cardioplegia (group 2), or by deep systemic hypothermia and cardioplegia (group 3). Left ventricular end-systolic pressure-dimension and end-diastolic pressure-dimension relationships were measured before and after cardiopulmonary bypass. Septal temperatures remained below 20 degrees C in groups 1 and 3 but rose above 20 degrees C in group 2. Groups 1 and 2 had moderate and mild ventricular stiffening, respectively, whereas group 3 showed no diastolic dysfunction. Ventricular contractility was increased (p less than 0.05) in group 3. Techniques for myocardial preservation used during operations for congenital heart disease must consider the large endocardial surface area/mass ratio and the rewarming effects of systemic blood. The combination of deep systemic hypothermia and cardioplegia provided superior myocardial protection compared with the other techniques tested.
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PMID:Myocardial preservation in the neonate. Beneficial effects of cardioplegia and systemic hypothermia on piglets undergoing cardiopulmonary bypass and myocardial ischemia. 341 86

During the past 10-15 years, a better understanding of the anatomy and physiology of congenital heart disease, improved pre- and postoperative care, deep hypothermia and circulatory arrest, and miniaturization of equipment, among other factors, have contributed to the greatly increased safety of open-heart surgery in neonates and infants. Consequently a trend towards early correction has developed, which prompts the question: 'In which congenital heart anomalies presenting early in life should primary repair be preferred to initial palliation followed by late repair?' It is imperative to weigh the advantages and disadvantages of a two-stage 'palliative + corrective' procedure against primary correction. The latter is generally preferred for 'simpler' malformations such as ventricular septal defect, tetralogy of Fallot, simple transposition and atrioventricular canal malformation, where repair can be achieved with low risk. On the other hand, palliation by pulmonary artery banding, atrial septectomy or a systemic-pulmonary shunt is still preferable in those conditions in which total correction in infancy carries a high risk or is not feasible. In an underdeveloped population group the decision may be influenced by the prevalent socio-economic factors affecting the physical condition of the patient. Palliative procedures may constitute a very satisfactory method of selecting those patients in whom eventual complete correction would be justified.
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PMID:Current status of surgery for congenital heart disease in infancy. 388 19

We review 109 patients with congenital heart disease under (two year of life, surgically treated between June 1978 and October 1981; 44% were under six months and 71% were under one year. Fifty six patients were operated under cardio-pulmonary by-pass, in 41 we used deep hypothermia with total cardio-respiratory arrest, 21% of them were under three months of life an 53% under one year. We present the morbidity and mortality together with the pulmonary management. Eighty five percent of the cases remained intubated postoperative by for less than 12 hours. The postoperative pulmonary evolution was quite similar for different types of congenital heart disease, such as T. Fallot, A-V canal, transposition, etc., and there was no statistically significant difference between them in terms of respiratory assistance and pulmonary complications. Eleven patients died (19%), all of them under six months of life. In 53 patients operated, without extracorporeal circulation, 38 had total correction and 15 palliative procedures. The mortality in this group was 9% (5 cases), all of the under one month of life. The global mortality was 14%. We discuss our present surgical indications in view of our results.
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PMID:[Our experience in heart surgery in early childhood (children less than 2 years old)]. 619 41


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