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

Twenty five infants with truncus arteriosus underwent complete surgical correction in the first year of life between January 1984 and June 1990 at Marie Lannelongue Hospital. All had cardiac failure and pulmonary hypertension. Another severe cardiac malformation was present in 6 cases. Complete repair was carried out under cardiopulmonary bypass with moderate hypothermia. After closing the ventricular septal defect the continuity of the right ventricle and pulmonary artery was reestablished by a valved Dacron conduit with a bioprosthesis (13 patients), by an autologous pericardial conduit with the same type of prosthesis (5 patients), by a valveless conduit (1 patient) or by direct insertion of the pulmonary artery (6 patients). Eight children (32%) died shortly after surgery. Seventy one per cent of children operated in the first month of life died compared with only 17% of those operated after one month of life (p less than 0.05). The seventeen survivors have been followed up for an average of 21 +/- 22 months. Three secondary deaths were observed at 33 days, 2 and 10 months after surgery: the first child died of left ventricular failure and pulmonary vascular disease related to the complexity of the associated cardiac malformations; the other 2 deaths were unexpected. The one and three year survival rate is 54%. Pulmonary stenosis with a systolic pressure gradient of more than 30 mmHg was found in 7 patients of whom 6 had valved Dacron conduits (p less than 0.01). One child was successfully operated 60 months after the total correction and another child is on the waiting list for reoperation 69 months after the total correction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Immediate and mid-term results of complete repair of truncus arteriosus during the first year of life]. 189 4

Systemic hypothermia at 25 degrees-28 degrees C without chemical cardioplegia was used in 908 patients undergoing coronary artery bypass grafting. Local coronary artery flow was interrupted only during grafting of a distal anastomosis. Systemic perfusion pressure was maintained at 80-100 mmHg, hematocrit at 20%-25%, and pCO2 and pH were monitored during hypothermia according to the alpha-stat principle, while the left ventricle was vented routinely. Proximal anastomoses were performed just before extracorporeal circulation was started by only partially occluding the ascending aorta. Preoperatively 61.9% of the patients had had a myocardial infarction, and 44% had unstable angina. In 14% a severe lesion of the main stem of the left coronary artery was present. Left ventricular function was moderately depressed in 25% and severely depressed in 8% of the patients. Forty-eight patients (5.3%) were aged 70 years or older. The mean number of grafts placed per patient was 3.3. Perioperative myocardial infarction occurred in 3%. Death due to left ventricular failure occurred in 0.4%. No left ventricular assist devices were needed; an intra-aortic balloon pump was used in 1%; positive inotropic support was required in 3.8% of the patients. These results indicate that systemic hypothermia alone provides safe myocardial protection and in certain cases may be the method of choice, particularly if aortic cross clamping or administration of cardioplegic solution is contraindicated. In addition, this method provides rapid revascularization of a severely ischemic zone, as present after unsuccessful PTCA procedures.
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PMID:Myocardial protection by simple systemic hypothermia without aortic occlusion. 226 41

Comparison of 1085 patients having coronary bypass surgery without cardioplegia from Jan. 1970 to Aug. 8, 1977 with 1060 patients operated upon with cardioplegia from Aug. 9, 1977 to Dec. 31, 1980 suggests that improved myocardial protection afforded by cardioplegia combined with profound topical hypothermia has its principal impact in those patients requiring urgent or emergency operations by reducing the probability of intraoperative left ventricular failure after coronary bypass. The need for postoperative balloon pumping and the risk of intraoperative death were significantly lower in patients operated upon with hypothermia + cardioplegia myocardial protection. In patients who survived 30 days after operation there was no significant improvement in long-term survival, incidence of myocardial infarction, or recurrence of angina pectoris in the cardioplegia group despite a greater average number of grafts per patient and a smaller number of ungrafted but obstructed coronary arteries.
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PMID:Early and late results of coronary bypass surgery. Evolution and the influence of cardioplegia. 295 53

In 144 experiments carried out on dogs, the possibility was proved to use for the recipient's protection during transplantation either deep immersion hypothermia or total artificial circulation without it being filled with the donor's blood. In order to maintain cardiac activity after clinical death of a non-heparinized organism for the purpose of later heart transplantation the authors propose to use the direct mechanical cardiac massage (DMCM) which makes possible not only to restore adequate pulsating blood flow in the dead body but also to assess after restoration of the heart's pump function the suitability of using it for transplantation. Functional adaptation of a transplanted heart proceeds in 3 stages: pronounced heart failure (5-15 min), functional heart failure (4-6 hours), stabilization of cardiac activity (2-3 days). Implantation of a second heart in experimental left ventricular failure of the recipient helped to achieve an effective and prolonged reduction of excessive functional overload of the affected heart.
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PMID:Some aspects of experimental heart transplantation. 353 17

Experience with aortic valve replacement over a 9-year period is reviewed. Hospital mortality was 5.0%, with an additional late mortality of 15.0% during a mean follow-up period of 4.3 years. There was a 7.5% mortality among the 93 patients who were operated on using direct coronary perfusion. There were no early deaths among the 48 patients operated on using cold cardioplegic arrest. Paravalvular leaks developed in 20 patients, and 9 had reoperation. There were no early deaths following elective reoperations for prosthetic valve dysfunction, but urgent reoperation was associated with a 40% mortality. Eighty percent of all patients are still alive at a maximum follow-up of 9 years. Eighty-six percent of the survivors who were in New York Heart Association Functional Class III or IV before operation are now in Class I or II. Hypothermic cardioplegic arrest was found to be preferable to coronary perfusion as a method of myocardial protection during aortic valve replacement. Patients with paravalvular leaks who have a history of left ventricular failure prior to aortic valve replacement should be considered candidates for early elective reoperation, owing to the significantly greater mortality associated with urgent reoperation.
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PMID:Aortic valve replacement: a 9-year experience. 743 14

A 33-day-old girl was transferred to our hospital because of severe cyanosis and tachypnea. The diagnosis of aortopulmonary window and interrupted aortic arch was established by echocardiogram and cineangiocardiogram. Reconstruction of aortic arch by extended direct anastomosis and simple patch closure of aortopulmonary window were performed by means of profound hypothermia and circulatory arrest on 36 days of age. Her postoperative clinical course was uneventful, but at 2 months after operation, stenosis of the ascending aorta was noticed by echocardiographic examination. As her physical growth had been satisfactory, she was managed under close observation at outpatient clinic. At seven months after operations, she fell into progressive left heart failure, and emergency operation was carried out for the relief of stenosis of the ascending aorta, but she could not come off bypass. A stenosis of the ascending aorta is a fatal complication that may occur after one-stage repair of interrupted aortic arch with aortopulmonary window consisting of extended direct anastomosis and simple patch closure. We now consider that division of ascending aorta and pulmonary artery and repair of both of the defect is indispensable for the correction of aortopulmonary window, especially in neonate and small infant with this lesion associated with interrupted aortic arch.
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PMID:[Severe ascending aortic stenosis after one-stage repair of aortopulmonary window and interrupted aortic arch]. 796 44

Between 1978 and 1997 the Institute of Legal Medicine of the Hannover Medical School examined 17 fatal autoerotic deaths. The incidence for the Hannover region was 0.49 cases per million inhabitants per year. The victims included 17 men with an average age of 36.8 years; a peak in the age distribution was seen between 20 and 29 years. Twelve of the men were found by friends or family in a domestic environment, while other situations in which the victims were found included the victim's own car, a hotel room, a canal embankment, a public parking lot as well as the holding cell of the youth detention center. The men were of varying socioeconomic status and held a number of different types of jobs or still attended school. Five of the men were found completely nude, while five were only undressed below the waist. Four men wore women's clothes and two were fully clothed with exposed genitals. Besides women's clothes, other objects found at the scene included various types of sexual aids, including ropes, chains, metal bars, locks, sex magazines, condoms, plastic bags, rubber items, etc. In four cases blood alcohol levels between 0.1 and 2.5 per thousand (urine alcohol levels between 0.2 and 2.5 per thousand ) were found. Toxicologic examination revealed chloroform, ketamine, a propane-butane gas mixture in one case each, and in two cases cocaine and morphine. Causes of death included central paralysis after strangulation (seven cases), asphyxiation (4), subarachnoid hemorrhage (2), intoxication (1), hypothermia (1), left heart failure (1), and drowning (1). The history, findings at scene, and autopsy findings and, in individual cases, other investigations are of utmost importance to accurately reconstruct a fatal autoerotic accident.
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PMID:Accidental autoerotic deaths between 1978 and 1997. Institute of Legal Medicine, Medical School Hannover. 1455 Jun 12