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

Elective intracardiac repair by the Mustard operation is recommented in patients with transposition of the great arteries and intact ventricular septum in the first year of life (Fig. 1). In patients with associated ventricular septal defect in the first three months of life, early banding followed by early debanding before the first year of life is recommended. When the left ventricular outflow tract obstruction is discrete at valvular or subvalvular level, Mustard operation, closure of the ventricular septal defect and direct relief of out-flow obstruction is acceptable, but in patients with an unfavorable left ventricular outflow tract anatomy, a preliminary shunt followed by a Rastelli operation after the age of four years will probably result in a greater salvage. The utilization of surface induced profound hypothermia and circulatory arrest allows for more precise and rapid surgery and is shown to be a definite advantage in the very young infant.
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PMID:Review: surgery for transposition of the great arteries in the first year of life. 7 16

Of a consecutive series of 91 babies aged less than 2 years, operated on for closure of a ventricular septal defect during the last four years, the 61 cases with a minimum post operative follow up period of 18 months were retained for review. Closure of the ventricular septal defect was carried out directly 41 times, and after pulmonary artery banding in the other 20 cases, using deep hypothermia with a short period of circulatory arrest and cardiopulmonary bypass.
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PMID:[Results of surgical correction of ventricular septal defects in infants]. 11 1

During a 10 year period, January, 1965, through January, 1975, 5 patients with interruption of the aortic arch (IAA) underwent operation at the Texas Heart Institute. The mortality rate was 60 per cent; 2 patients survived the operation. One 11-day-old infant with IAA, type A, a ventricular septal defect (VSD), and a patent ductus arteriosus (PDA) underwent successful two-stage treatment. A left subclavian-ductus anastomosis, closure of the PDA, and banding of the pulmonary artery were done initially. The VSD was closed later. The second survivor, a 3-year-old girl, had IAA, type B, with a PDA and VSD. Total correction was done with the aid of cardiopulmonary bypass and hypothermia. Considerations include palliative and staged procedures versus total correction with either conventional cardiopulmonary bypass or deep hypothermia and circulatory arrest. Survival rate is improved if associated lesions are totally repaired or palliated at the time of reconstruction of IAA.
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PMID:Interruption of the aortic arch. Surgical considerations. 13 80

Between April 1970 and December 1977, 134 infants aged 2 days to 12 months underwent open heart surgery using profound hypothermia and total circulatory arrest. The technique of bypass (core) cooling is described. Results are reviewed for 4 principal diagnoses: 'simple' transposition of the great vessels, total anomalous pulmonary venous connection, ventricular septal defect, and Fallot's tetralogy. A mortality of 44 per cent in 32 cases during the first 3-year period has been reduced to 22 per cent in 102 cases during the subsequent 5 years. The overall mortality for the entire period was 28 per cent. The policy for the management of each diagnostic group is outlined.
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PMID:Open heart surgery in first year of life using profound hypothermia (core cooling) and circulatory arrest. Experience with 134 consecutive cases. 42 79

Thirty consecutive infants undergoing hypothermia and circulatory arrest for repair of ventricular septal defect, transposition of the great vessels, or atrioventricular canal defects were alternately selected for conventional high flow nonpulsatile perfusion or pulsatile perfusion during core cooling and rewarming. All received morphine anesthesia, 30 mg/kg of Solu-Medrol, and 10 to 15 mcg/kg of phentolamine. Those receiving nonpulsatile flow were perfused at a rate of 160 to 180 cc/kg/min with a roller pump and oxygenator with arterial pressure of 50 to 55 mm Hg. In the pulsatile flow group, a roller pump and oxygenator were used, and an especially constructed Datascope PAD (pulsatile assist device) was interposed in the arterial line to provide pulsatile perfusion with 75/40 mm Hg pressure at slightly reduced flow (150 cc/kg/min). The average rectal, esophageal, and tympanic membrane temperatures were reduced to approximately 16 degrees C prior to circulatory arrest. Following repair, perfusion was resumed until these temperatures returned to 37 degrees C. Cooling and rewarming were enhanced by pulsatile perfusion, with over 30% reduction in total pump time. Additionally, the larger patients in the pulsatile group cooled almost as rapidly as the smaller. The rates of decline and subsequent rise of rectal, esophageal, and tympanic membrane temperatures were equal in the pulsatile group, but the rectal temperature lagged far behind in the nonpulsatile group. Urine production during bypass was 100% greater in the pulsatile group. The plasma free hemoglobin was similar in both groups. The average postrewarming pH was 7.31 in the nonpulsatile group and 7.42 in the pulsatile group. Infants receiving pulsatile flow awakened more quickly, were more alert, and required less postoperative mechanical ventilation. We suggest that pulsatile perfusion for core cooling and rewarming of infants is safe and is more rapid and physiological than conventional high-flow nonpulsatile perfusion.
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PMID:Pulsatile perfusion versus conventional high-flow nonpulsatile perfusion for rapid core cooling and rewarming of infants for circulatory arrest in cardiac operation. 49 21

Type A interrupted aortic arch with a ventricular septal defect (VSD) in a 3-month-old infant was successfully corrected with the aid of profound hypothermia, limited cardiopulmonary bypass, and total circulatory arrest. The aortic arch was reconstructed by side-to-side anastomosis of the ascending aorta and the main pulmonary artery and then creation of a tube from the anastomotic orifice to the patent ductus arteriosus (PDA) by using a superabundant flap of the anterior wall of the main pulmonary artery. The pulmonary arteriotomy and VSD then were closed. The operative field can be approached easily through a median sternotomy with minimum dissection. Cardiac catheterization and angiocardiography 2 months later demonstrated a satisfactory reconstruction of both the aortic arch and the pulmonary artery.
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PMID:Simplified method for total correction of interrupted aortic arch with ventricular septal defect in infancy. 49 28

Infants with ventricular septal defect (VSD) who are symptomatic despite intensive medical therapy require surgical intervention. Choice of treatment depends upon the cumulative mortality and morbidity rates of the two-stage approach of initial pulmonary artery banding followed by debanding and VSD closure as compared to the risk of primary intracardiac repair in infancy. Sixteen infants underwent pulmonary artery banding at Columbia-Presbyterian Medical Center between 1967 and 1976, with one operative death but with a significant incidence of morbidity and late death. Forty patients underwent pulmonary artery debanding and closure of VSD with three operative deaths. This second-stage procedure was frequently complicated by repair of acquired lesions. During the same 10 year period 37 infants underwent primary closure of VSD with eight operative deaths. The morbidity related to this procedure is low. With the use of profound hypothermia and circulatory arrest, results have significantly improved and the risk of early correction now compares favorably with the cumulative mortality rate of the two-stage approach. Primary intracardiac repair is the procedure of choice.
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PMID:Surgical management of ventricular septal defects in infants. 63 32

The technique of surface-induced hypothermia, circulatory arrest and limited extracorporeal circulation was used in the surgical correction of congenital heart defects in 125 young children. Hospital mortality was 18% and no death could be attributed to the surgical technique. An analysis of risk factors demonstrated that successful corrective surgery was not significantly related to age, body weight or pulmonary vascular obstructive disease. In transposition of the great arteries, the presence of a ventricular septal defect was associated with an increased mortality. Emergency operations performed because of severe hypoxaemia carried a high mortality, especially in patients with tetralogy of Fallot.
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PMID:Risk factors in surgical correction of congenital heart defects in early childhood. 65 69

A variety of surgical approaches have been used for repair of cardiac lesions associated with corrected transposition of the great vessels. These techniques have met with variable success and generally high surgical mortality rates. In an effort to simplify the surgical approach to repair of ventricular septal defect and replacement of left atrioventricular valve in a 4-year-old youngster, we chose to correct the defects through a left posterolateral thoracotomy and through the left atrium utilizing profound hypothermia and circulatory arrest. Ease of intracardiac assessment and repair and postoperative results to date have been most gratifying.
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PMID:Corrected transposition. Another approach for repair of associated intracardiac malformations. 66 50

The authors discuss their clinical experience in the use of deep hypothermia in combination with auxiliary extracorporeal circulation. Operations were performed on 124 children (total mortality 23.4%). Lowest mortality was noted in correction of ventricular septal defect; 12 out of 82 patients died, which accounts for approximately 14.6%. A follow-up of the remote results shows that the method has no harmful effect on the central nervous system.
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PMID:[Heart operations on young children under deep hypothermia]. 68 8


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