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

Congenital absence of the pulmonary valve is usually associated with a malalignment type of ventricular septal defect as well as right ventricular outflow obstruction and aneurysmal dilatation of the pulmonary arteries. Symptomatic infants primarily have severe tracheobronchial obstruction caused by aneurysmal dilatation of the proximal pulmonary arteries; pulmonic and systemic blood flow are usually balanced. Surgical intervention to relieve the obstruction by plicating the pulmonary artery and its branches under deep hypothermia and circulatory arrest, together with patch closure of the ventricular septal defect, is advocated.
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PMID:Surgical treatment of absent pulmonary valve syndrome in infants: relief of bronchial obstruction. 662 42

Between 1974 and March 1983, 14 infants with interruption of the aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) have been operated at our institution. In the beginning of our experience only palliative operations were performed, consisting in reconstruction of the aortic arch, closure of PDA and pulmonary artery banding (PBA). According to this procedure five patients were operated. Three of them died, the two survivors underwent successful closure of the VSD subsequently. Since 1979 the primary total correction, with repair of the extra- and intracardial anomalies in deep hypothermia and circulatory arrest, is the operation of choice. A total of nine patients underwent primary correction, in this latter group we observed two deaths only.
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PMID:[Early correction of the interrupted aortic arch]. 665 9

The indications for and results of surgical closure of ventricular septal defect (VSD), uncomplicated by other congenital cardiac defects, depend on the size of the VSD and its haemodynamic consequences. In infants the timing of surgical closure is determined largely by the persistence of symptoms of congestive cardiac failure unresponsive to maximal medical treatment. There is a high incidence of spontaneous closure of VSD with age, especially in defects of small size. Accompanying aortic regurgitation is a serious complication. Progress in surgical technique (e.g. deep hypothermia, cardioplegia, identification of the conduction tissue) has substantially decreased the hospital mortality of surgical closure and the incidence of late deaths. In selected series the hospital mortality has been reduced to as low as 1-2% in patients over one year of age. Unless there is intractable cardiac failure (rarely observed beyond infancy), surgical closure can be delayed: pulmonary vascular obstructive disease develops only very exceptionally below the age of two years. Late complications include re-opening of the patch repair, arrhythmias and conduction disorders. The prognosis of post-operative left axis deviation plus right bundle branch block (left anterior hemiblock) is good in the absence of serious arrhythmias. Late deaths are rare. Operation in early childhood prevents the occurrence or persistence of abnormal right ventricular function. Exercise tolerance is normal in the absence of complications in practically all patients, who can therefore lead a normal life in all respects. There is, however, still slight doubt to what extent surgical closure is truly "curative" rather than "corrective".
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PMID:The outlook for children after cardiac surgery: ventricular septal defects. 665 3

We have successfully corrected interrupted aortic arch with ventricular septal defect by employing deep hypothermia and circulatory arrest, a median sternotomy incision, and a pulmonary arteriotomy. This simplified technique has the advantage of an abbreviated period of cerebral ischemia, with a relatively simple partitioning of the pulmonary artery.
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PMID:Pulmonary artery partition: new method for correction of interrupted aortic arch. 687 68

This is a review of 136 patients who have undergone corrective surgery for congenital heart disease with the aid of profound hypothermia in a 6-year period. Almost all patients were less than one year old and less than 10 kg. In 1979 the average age was 3.4 months and the average weight was 4.1 kg in 34 infants. The hypothermic technique consisted of surface cooling followed by cardiopulmonary bypass cooling and circulatory arrest during definitive surgery. The hospital mortality was 26% for the whole period, having decreased from 53% in 1974 to 15% in 1979. After operation 70% of patients with uncomplicated ventricular septal defect or the tetralogy of Fallot were extubated within 4 hours, 65% of all patients were extubated within 12 hours of operation.
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PMID:Corrective cardiac surgery in infants. A review of 136 patients including the contribution of postoperative ventilation. 700 40

The techniques of deep hypothermia for correction of congenital cardiac defects are well known in many cardiac centers and many cases can be treated even if there are pre-existing rhythm troubles. Our patient had the following diagnosis: left atrial isomerism, dextrocardia; left sided azygos continuation of inferior vena cava; left and right superior venae cavae, hepatic veins, pulmonary veins, all draining into a common atrium; d-loop with normally related ventricles; ventriculo-arterial concordance, small VSD. In addition complete a-v block was present. The patient, 40 days old and 3.4 kg., in heart failure, was paced with a temporary transvenous catheter at 130/min and, afterwards, catheterized. Surgery was undertaken three days post-catheterization using surface deep hypothermia. A Mustard operation, including enlargement of the new left atrium with PTFE (Goretex), was performed during total circulatory arrest. At the end, a permanent pacemaker was positioned in the abdomen and epicardial wires were left on the right ventricle. The postoperative period was uneventful and the patient is doing well 3 months latter. The interest of the case is that even in a complex congenital cardiac malformation with complete a-v block, the technique of surface deep hypothermia can be used because all the physiological parameters remain stable during the procedure in spite of the very low heart rate.
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PMID:[Deep hypothermia for the correction of a congenital cardiac defect complete with atrioventricular block]. 718 63

Since March, 1974, eight patients, aged 7 days to 5 months, with type B interrupted aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) were treated at the Columbus-Presbyterian Medical Center and the University of Maryland Hospital. Six of these patients underwent definitive repair utilizing deep hypothermia and circulatory arrest. Correction involved resection of all ductal tissue, primary anastomosis of the aortic arch, closure of the foramen ovale, and patch closure of the VSD. In five patients, all arch vessels were preserved and no prosthetic material was used to reconstruct the aortic arch. One patient died 48 hours postoperatively of a coagulopathy. All others survived more than 30 days. One patient, 3 1/2 months old at repair, had undergone pulmonary artery banding at another institution at 11 days of age; he died of recurrent respiratory infections 8 months after correction. Three patients are alive and well 3 to 6 years after repair. Two have undergone repeat cardiac catheterization which demonstrated good growth of the anastomosis and no residual gradient. Primary definitive correction of type B IAA with VSD and PDA provides distinct advantages over palliative or other surgical procedures with excellent long-term results.
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PMID:Primary definitive repair of type B interrupted aortic arch, ventricular septal defect, and patient ductus arteriosus. Early and late results. 727 42

Short-term ischemia (up to 10 minutes) induced by clamping of the aorta in correction of a ventricular septal defect causes no essential ultrastructural, metabolic or functional changes in the myocardium. In much longer period of ischemia (of up to 40 minutes) during operation for congenital heart diseases, the use of deep hypothermia is effective. Cold cardioplegia is a sufficiently reliable method for myocardial protection when the aorta is clamped for up to 60 minutes in operations for acquired heart diseases. Changes in the structure and metabolism of the myocardium are reparable, their degree depends on the initial condition of the heart muscle and proper fulfilment of the methodical conditions of this type of protection. Pharmacological cardioplegia combined with external cooling of the heart makes it safe to disconnect the heart from circulation for a loger period (up to 120 minutes).
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PMID:[Ultrastructural and histochemical criteria of myocardial hypoxia and a morphological assessment of the various methods for its protection (based on biopsy data of the human heart)]. 735 99

Concerning their experience between February 1973 and May 1979 about 258 infants less than 12 Kg operated up for large VSD, the authors studies the 27 deaths. Their is not statistical difference between patients under 6 Kg of weight (128 cases, 15 deaths) and patients over 6 Kg of weight (130 cases, 11 deaths). The procedure is performed under hypothermia and circulatory arrest under 5 Kg and moderate hypothermia with cardioplegic myocardial protection in other cases. The causes of deaths have been: --either post-op. complications (post-operative bleeding, catheter complication, mediastinitis), --or pre-operative error (Swiss cheese VSD, single ventricle). The indications for pulmonary artery banding remain multiples VSD, and VSD associated with other visceral malformations.
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PMID:[One stage repair of VSD in infants (author's transl)]. 740 70

High mortality rates (20% to 60%) have been reported in the repair of coarctation of the aorta in infancy. During a 4 year period, 34 infants less than 6 months of age had coarctation repair (two prior to 1976). Eleven were less than 2 weeks of age, nine were 2 weeks to 1 month, eight were 1 to 2 months, and six were 2 to 6 months. Associated lesions were patent ductus arteriosus (PDA) (82%), ventricular septal defect (VSD) (53%), and other intracardiac lesions (35%). Twenty-three patients (67%) had emergency operations; the other procedures were semielective. The indications for operation included congestive cardiac failure (91%), acidosis (32%), hypertension (29%), cardiogenic shock (26%), and cardiac arrest (18%). There was one operative death (2.9%) in a patient with severe pulmonary valve insufficiency and multiple VSDs. There was one late death a 4 months (Taussig-Bing complex). Primary repair was used in 15, patch-graft angioplasty in 19 (left subclavian artery in nine, left common carotid in one, and Dacron or pericardial patch in nine). Two (6%) required reoperation for recurrent coarctation (follow-up 3 to 36 months with a mean of 25.8). Of 15 patients with a large VSD, six had pulmonary artery banding with two deaths (one operative and one late), two had debanding plus VSD repair, and two are awaiting operation. The remaining nine patients did not have banding (no operative or late deaths), four patients required late VSD closure, two VSDs closed spontaneously, two VSDs became smaller, and one patient is awaiting VSD closure. The infrequent need for pulmonary artery banding may be partly due to "physiological banding" seen at Denver's high altitude. The VSD spontaneously closed or became smaller in 44% of nonbanded patients. The low operative mortality can be ascribed to (1) aggressive medical therapy, (2) emergency catheterization and repair, (3) avoidance of hypothermia, and (4) adequate relief of the coarctation.
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PMID:Surgical repair of coarctation of the aorta in infants less than six months of age: including the question of pulmonary artery banding. 745 26


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