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

The interrelation between the energy and nitrogenous metabolism of the myocardium during cardioplegia has been studied in patients with congenital valvular heart disease (tetralogy of Fallot--12 patients, ventricular septal defect--5 patients). Whole body hypothermia with repeated heart reperfusion with cold cardioplegic blood perfusate was used for the protection of the myocardium. However, ATP level of the myocardium of some patients decreased by 20% and more of the baseline. This loss was accompanied by a reduction in glutamate and aspartate levels and a rise in ammonium and alanine levels in the myocardium (by 17.7 +/- 3.8; 17.6 +/- 5.9; 61.4 +/- 12.5 and 92.4 +/- 26.3% of the baseline, respectively).
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PMID:[Effect of cardioplegia on nitrogen and energy metabolism of the human heart]. 366 4

During a 7 year period, 64 consecutive neonates (less than 30 days of age) underwent surgical repair of coarctation of the aorta. There were no intraoperative deaths, four (6%) postoperative deaths, and seven (12%) late deaths. Improvement in the survival rate in this study can be attributed to improved perioperative care, avoidance of hypothermia during the operation, use of prostaglandin E1 to stabilize the patient's condition before the operation, emergency cardiac catheterization and operations, adequate relief of the aortic obstruction, and appropriate use of pulmonary artery banding. The last of these factors may further reduce the mortality. Banding of the pulmonary artery in patients with complex cardiac lesions associated with a ventricular septal defect has significantly lowered the mortality compared with the mortality of those without pulmonary artery banding. In contrast, the absence of pulmonary artery banding in those with a large ventricular septal defect did not affect the mortality or postoperative ventilator requirements as compared to patients having banding and coarctation repair. One late death was related to complications of the pulmonary artery band.
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PMID:Results of surgical treatment of coarctation of the aorta in the critically ill neonate. Including the influence of pulmonary artery banding. 370 79

In two cases of interrupted aortic arch (IAA) of type A, one associated with a ventricular septal defect (VSD) and one with an aortopulmonary window, and two of type B, both associated with a VSD, total anatomic repair was performed at respective ages of 6 months and 24, 8 and 3 days. All four operations were performed through a median sternotomy, using profound hypothermia and circulatory arrest. The repair included resection of the patent ductus arteriosus, direct end-to-side anastomosis of the descending to the ascending aorta and closure of the VSD or, in one case, of the aortopulmonary window. The two oldest infants (with type A IAA) survived. Reexamination two years postoperatively demonstrated good width of the aortic anastomosis with no gradient. In the child who had had an aortopulmonary window there was a proximal tight stenosis of the right pulmonary artery, which was corrected at reoperation. Total anatomic correction of IAA through an anterior approach is technically feasible and the aortic anastomosis seems to grow satisfactorily. The management of very sick neonates with IAA remains a great challenge.
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PMID:Total anatomic correction of interrupted aortic arch complex. Experience in 4 infants. 370 96

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

Interruption of the aortic arch is practically always associated with intracardiac malformations of variable complexity, at the least, a ventricular septal defect. Surgery is usually performed in two stages: aortic repair and pulmonary artery banding after intravenous prostaglandin administration. The second stage comprises debanding and repair of the intracardiac lesions under cardiopulmonary bypass. However, in some cases, interruption of the aortic arch is associated with intracardiac lesions which necessitate correction under cardiopulmonary bypass from the onset, this was the situation in two of the three cases described by the authors: aorto-pulmonary window, a lesion which can only be corrected under circulatory arrest and deep hypothermia. One of these two children, operated in the neonatal period, did not survive: the other, operated at 6 weeks, had an excellent result. In the third case, the association of tricuspid atresia and a restrictive ventricular septal defect necessitated enlargement of the septal defect and therefore, open heart surgery under circulatory arrest; the results were favourable.
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PMID:[Interruption of the aortic arch and malformative cardiac lesions requiring repair under extracorporeal circulation. Apropos of 3 cases]. 392 15

Primary aortic arch reconstruction was undertaken in three neonates with interrupted aortic arch and ventricular septal defect. Total ascending aortic occlusion without cardiopulmonary bypass or profound hypothermia permitted, in each case, a rapid tension-free end-to-side descending-to-ascending aortic anastomosis without resulting neurologic or cardiac sequelae. This technique offers distinct advantages over previously described methods and should be considered whenever interrupted aortic arch is present with a ventricular septal defect.
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PMID:Primary reconstruction of interrupted aortic arch by total aortic outflow obstruction. 394 87

A ventricular septal defect was repaired in a 3 1/2-year-old child on cardiopulmonary bypass. Because of excessive pulmonary venous return, a period of circulatory arrest under deep hypothermia was used. A large volume of air was found in the arterial line and the ascending aorta before perfusion was reinstituted. The air probably entered the arterial system through a large aortopulmonary collateral artery during circulatory arrest. This artery was not visualized on angiocardiography and could have caused excessive pulmonary venous return during perfusion. Air was successfully expelled by reversed perfusion. There were no neurological sequelae.
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PMID:Air in the aorta: treatment by reversed perfusion. 395 9

Clinical interventions for repair of congenital heart defects, such as hypothermia and cardiopulmonary bypass, may cause changes in pulmonary vascular resistance (PVR) and systemic vascular resistance (SVR) leading to deleterious alterations in blood flow. Since the relationship between the pulmonary and systemic circulations in patients with ventricular septal defects (VSDs) is dynamic and susceptible to stimuli, we directly measured hemodynamic variables and blood flow distribution in infant pigs with VSDs during surface cooling. In 12 piglets (aged 4 weeks and weighing 4 kg), VSDs were created by caval occlusion, right ventriculotomy, and septal perforation, resulting in a 2.2 +/- 0.4:1 shunt. SVR and PVR were derived by both the flow probe (FP) and microsphere (microseconds) techniques. Systemic and pulmonary blood flow distribution were measured (microseconds). Qp/Qs ratios were derived by oximetry, FP, and microseconds techniques. Pigs were surface cooled in 28 degrees C while measurements were made at 37 degrees, 32 degrees, and 28 degrees C. SVR increased by FP (4034 +/- 55.4 to 10450 +/- 2132 dynes-sec/cm5 [p less than 0.05]) and by microseconds (3097 +/- 497 to 1022 +/- 2583 dynes-sec/cm5 [p less than 0.05]), while PVR remained unchanged. Qp/Qs ratios increased during hypothermia by FP (2.4 +/- 0.4:1 to 6.3 +/- 1.4:1 [p less than 0.05]), by microseconds (2.2 +/- 0.4:1 to 3.5 +/- 0.8:1 [p less than 0.05]), and by oximetry (1.4 +/- 0.1:1 to 2.6 +/- 0.3:1 [p less than 0.05]). Visceral flow (34.8 +/- 5 to 17.5 +/- 4 ml/100 gm/min [p less than 0.05]) and renal flow (127 +/- 21 to 53 +/- 11 ml/100 gm/min) [p less than 0.05]) both decreased during hypothermia. Systemic surface cooling-induced hypothermia in pigs with VSD causes an increase in SVR but no change in PVR resulting in an increased left to right intracardiac shunt confirmed by three measurement techniques. Redistribution of blood flow favors the lungs while lowering renal and visceral flow. Surface cooling-induced hypothermia and circulatory arrest in infants with VSDs may cause circulatory alterations leading to increased left to right shunt and decreased renal and visceral flow even before cardiopulmonary bypass and intracardiac repair.
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PMID:Hemodynamic effects of surface cooling-induced hypothermia on immature pigs with ventricular septal defects. 403 72

Results of repair of the interrupted arch complex have remained poor despite advances in operative technique. Palliative prosthetic grafts to form a transverse arch through the lateral approach have been advocated, but a need for both subsequent closure of the ventricular septal defect and replacement of the prosthetic conduit makes this approach undesirable. The total experience with this lesion at the University of California San Francisco (29 patients) is presented. Since January 1982, 10 patients, eight with type B and two with type A interrupted arch, underwent total repair. Ages ranged from 3 to 150 days (median 11 days). An anterior approach to total repair with single atrial-to-ascending aortic and transductal descending aortic bypass was used. Deep hypothermia to less than 18 degrees C was used, and during total circulatory arrest the cannula was removed from the descending aorta and direct anastomosis of the descending and ascending aorta was performed. Total circulatory arrest time was a mean of 12 min. During rewarming of the infant, the ventricular septal defect was closed. Mean pump time was 52 min. Operative mortality was 20% (two of 10 patients) at 17 and 32 days after surgery. Our results demonstrate that the anterior approach to total repair of interrupted arch complex in early infancy can be achieved with a lower mortality than palliation followed by subsequent closure of ventricular septal defect and also obviates the need for prosthetic replacement of the transverse arch. The anterior approach is the method of choice for repair of interrupted arch complex.
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PMID:The total repair of interrupted arch complex in infants: the anterior approach. 620 91

Myocardial protection was evaluated in 2 groups of 5 infants each undergoing correction of either tetralogy of Fallot (TOF) or subcristal ventricular septal defect (VSD). In group A, profound hypothermia and total circulatory arrest (PHTCA) was utilized. In group B, profound hypothermia and total circulatory arrest combined with potassium cardioplegia (PHTCA + K) was the method of protection used. The analysis was carried out by sequential measurements of clinical, electrocardiographic, enzymatic (CK-MB) and ultrastructural parameters. There were no operative deaths. One infant had a second operation for recurrent VSD. The average anoxic time was 35.4 min in group A (PHTCA) and 32.6 min in group B (PHTCA + K). Analysis of our data demonstrated that when potassium cardioplegia was added to PHTCA, there was less intraoperative myocardial damage according to physiological, ultrastructural and biochemical parameters than when profound hypothermia and total circulatory arrest was applied alone.
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PMID:Myocardial protection in infant open heart surgery. 661 54


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