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

We present a surgical case of a 63-year-old male with distal aortic arch aneurysm combined with mitral regurgitation. Through a median sternotomy, a mitral valvuloplasty was performed with McGoon's procedure and Carpentier's ring. Then with the aid of deep hypothermia and circulatory arrest, the aortic arch was opened. A long woven velour graft was anastomosed only proximally to the distal end of the aortic arch and was allowed to float down the descending aorta ("Elephant Trunk" technique). Anti-coagulant therapy was continued only for 4 weeks after the operation. Postoperative left ventriculogram showed no residual regurgitation. The aneurysm was confirmed fully thrombosed around the graft on computed tomogram. It is concluded that "Elephant Trunk" technique for distal arch aneurysm is useful when combined other cardiac surgery without anti-coagulant therapy, such as mitral valvuloplasty, is needed.
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PMID:[Surgical treatment of distal aortic arch aneurysm combined with mitral regurgitation--a case using "elephant trunk" technique and concomitant mitral valvuloplasty]. 808 72

We have previously shown that chronic mitral regurgitation (MR) increases the rate of left ventricular early diastolic filling. These changes in chamber diastolic function were felt to be secondary to alterations in left ventricular loading conditions. Therefore, cellular diastolic function measured in cardiac muscle cells (cardiocytes) isolated from animals with chronic MR (absent alterations in loading conditions) was expected to be normal. However, chronic MR caused a decrease in sarcomere lengthening rate. The purpose of the current study was to define the mechanisms causing this decreased sarcomere lengthening rate in chronic MR cardiocytes and to explain the apparent dichotomy between chamber and cellular diastolic properties. Accordingly, sarcomere motion was measured using laser diffraction techniques in enzymatically isolated cardiocytes from seven control dogs and 11 dogs with chronic MR (produced by closed-chest transection of the mitral chordae). In the MR cardiocytes, there were abnormalities in cellular systolic function (decreased extent and velocity of shortening) and in cellular diastolic function (decreased velocity of sarcomere lengthening). Because studies in papillary muscles have shown that there is a direct relation between abnormal diastolic function (decreased velocity of muscle lengthening) and abnormal systolic function (decreased extent of muscle shortening), it was unclear whether the changes in cellular relaxation rate observed in chronic MR merely reflected a concomitant decrease in the extent of shortening or instead reflected an impairment in intrinsic relaxation properties. To make this distinction, the relation between relaxation velocity (measured as peak sarcomere lengthening rate) and sarcomere shortening extent was examined in MR cardiocytes and compared with that in control cardiocytes. There was a direct relation between sarcomere relaxation velocity and sarcomere shortening extent in both control and MR cardiocytes. Over a wide range of shortening extent, the slopes and y intercepts of this relation were similar in control and MR cardiocytes (slope, 27.7 sec-1 in control cells versus 28.1 sec-1 in MR cells; y intercept, -1.1 microns/sec in control cells versus -1.7 microns/sec in MR cells; p = NS). At any common shortening extent, relaxation velocity was the same in control and MR cardiocytes. To prove that this relation could detect abnormalities in the intrinsic myocardial relaxation process, interventions known to produce primary alterations in the intrinsic myocardial relaxation process were examined: the effects of hypothermia (30 degrees C) and isoproterenol (10(-6) M) on the relaxation velocity-shortening extent relation were studied in normal and MR cardiocytes.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Effects of chronic mitral regurgitation on diastolic function in isolated cardiocytes. 847 23

Valve repair is preferred over replacement in the management of mitral regurgitation when technically possible. Central to the achievement of a durable result is precise assessment of the anatomic abnormality present before repair, as well as accurate intraoperative evaluation of the adequacy of repair accomplished. Cardioplegic techniques commonly employed permit inspection of the valve in a flaccid, arrested state, which may not accurately reflect its function in the contractile heart. The repair can be tested under normal loading conditions only after separation from cardiopulmonary bypass. An alternative technique of myocardial management employing mild hypothermia, continuous aortic root perfusion, and intermittent fibrillation is described that provides an opportunity to directly examine the valve under physiologic conditions before, during, and after completion of the repair.
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PMID:Alternative technique for assessment and repair of the mitral valve. 863 87

The chief benefits of small skin incisions are reduced patient discomfort, accelerated recovery, and cosmetic satisfaction without compromising the quality of surgery. Since April 1997, the lower ministernotomy approach without femoral cannulation has been performed in 43 patients in the authors' institutions. The indications for this approach were initial single valve surgery and secundum-type atrial septal defect. Cases of aortic valve regurgitation that could be repaired, and aortic stenosis that necessitated annular enlargement were excluded. Among patients with mitral valve disease, those with chronic atrial fibrillation were excluded frpm undergoing the Maze procedure and those reguiring chordal reconstruction for anterior leaflet were also excluded. Mitral valve repair for mitral regurgitation was performed in 8 patients, and open mitral commissurotomy in 2. Mitral valve replacement was performed in 3 patients and aortic valve replacement in 13. Closure of an atrial septal defect was carried out in 18 cases. An approximately 10-cm median skin incision was made, and a ministernotomy with a lower semitransverse division (inverted L-shape) was carried out. Cardiopulmonary bypass was initiated with ascending aortic cannulation and right-angled venous cannulae in the superior and inferior vena cava for mitral valve disease. Single venous cannulae from the right atrial appendage was used for aortic valve disease. Surgery was performed with mild hypothermia and intermittent tepid blood cardioplegia with diltiazem. A rigid 30-degree angle scope held by a videoscope holder with a flexible arm was used for mitral valve surgery. There were one hospital death due to perioperative myocardial infarction and pulmonary embolism. There was one reopening for bleeding which resulted in methicillin-resistant Staphylococcus aureus mediastinitis. However, the patients was discharged after rectal muscle flap repair. There was one reoperation for mitral valve repair due to hemolysis. The improvement of surgical instruments and materials will further facilitate this procedure.
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PMID:[Indications for and limitations of minimally invasive cardiac surgery with the lower ministernotomy approach]. 1006 95

Twenty-seven consecutive patients underwent surgery for ischemic mitral regurgitation (MR): papillary muscle rupture (1), papillary muscle dysfunction (11) and annular dilatation (15). The grade of MR was moderate or severe, and the ejection fraction (EF) was less than 30% in 8 patients (mean, 43%). Three cases were reoperation and 3 were emergencies. Under ventricular fibrillation (VF) and intermittent aortic cross-clamping at moderate hypothermia, coronary artery bypass grafting (CABG) was performed first, followed by the mitral procedure through a right-sided left atriotomy (repair 21, replacement 6) performed under VF with the heart perfused through the native coronary arteries and CABG grafts. Concomitant procedures were CABG (23), Dor's procedure (5), and tricuspid annuloplasty (3). In one reoperative case with cardiogenic shock, CABG was impossible because of dense adhesions and the patient died just after surgery (hospital mortality, 3.7%). Five patients required intra-aortic balloon pump (IABP) support intraoperatively, but none required prolonged (> or =7 days) inotropic support or IABP use, although the serum concentrations of creatine kinase and its myocardial fraction were elevated remarkably. Other morbid events were refractory ventricular arrhythmia in one case and stroke in another. Median duration of mechanical ventilation and intensive care unit stay was 8 h and 3 days, respectively. Mean EF at hospital discharge was 48%. The extended period of VF was not associated with unfavorable clinical outcomes. Noncardioplegic surgery for ischemic MR was carried out with acceptable mortality and morbidity, and can be a good alternative, especially when clamping the aorta is undesirable.
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PMID:Noncardioplegic surgery for ischemic mitral regurgitation. 1252 Jan 48

Between August 2004 and May 2006, 124 patients undergoing coronary artery bypass grafting with ejection fractions <or= 35% were randomly assigned to off-pump or conventional procedures. Preoperative characteristics were the same in both groups, except for age and degree of mitral regurgitation. Off-pump coronary artery grafting was carried out using a tissue stabilizer and a single-suture technique; conventional coronary bypass employed cardiopulmonary bypass, moderate hypothermia, and antegrade-retrograde cold blood cardioplegic arrest. There were significantly fewer vessels grafted (3.09 +/- 0.41) in the off-pump group than in those who had a conventional procedure (3.42 +/- 0.86). The rates of mortality, morbidity, balloon pump support, inotropic usage, gastrointestinal bleeding, renal dysfunction, reintubation, as well as intensive care and hospital stay, were significantly lower in the off-pump group. The incidence of perioperative myocardial infarction did not differ significantly between groups. The results of this study indicate that beating-heart coronary bypass is safe and effective in patients with left ventricular dysfunction.
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PMID:Off-pump coronary artery bypass grafting in left ventricular dysfunction. 1824 99

We successfully treated a case of a 2-year-old male with aortic coarctation coexisting with severe mitral regurgitation via left posteriolateral thoracotomy at one stage. After a mitral valve replacement under perfused ventricular fibrillation with moderate hypothermia, we repaired the aortic coarctation with coarctation resection and end-to-end anastamosis with the aid of deep hypothermic circulatory arrest and selective low-flow cerebral perfusion. The patient had an uneventful hospital course and remains well.
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PMID:One-stage correction of aortic coarctation and severe mitral regurgitation via left posteriolateral thoracotomy in a 2-year-old child. 1859 26

A 53-year-old male patient developed severe mitral regurgitation 6 years after coronary artery bypass grafting (CABG) with a left internal thoracic artery and 2 saphenous veins. The left ventriculography showed severe mitral regurgitation and slight decrease in left ventricular function. The coronary arteriography showed all grafts being patent. The median re-sternotomy was avoided because of the risk for injury of bypass grafts, and the right anterolateral thoracotomy was chosen. Mitral valve replacement was performed under moderate hypothermia and ventricular fibrillation without aortic cross clamping. The postoperative course was uneventful. Right anterolateral thoracotomy is considered to be a superior approach to the mitral valve surgery in the patients with previous CABG.
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PMID:[Reoperation through right thoracotomy for mitral regurgitation after coronary artery bypass grafting; report of a case]. 1976

A 79-year-old woman with Bland-White-Garland syndrome was admitted to our institution for surgical treatment of severe mitral regurgitation (MR). She had previously undergone mitral valve repair and coronary artery bypass grafting for both mitral insufficiency and a coronary artery anomaly 14 years earlier. However, the degree of residual MR had gradually worsened, and redo mitral valve surgery was scheduled. Multidetector row computed tomography revealed that the right coronary artery (RCA) was dilated and located just behind the sternum, and saphenous vein graft bypassed to the left anterior descending artery was occluded. This meant that the RCA was the only vessel supplying coronary blood flow. We successfully performed port-access mitral valve replacement under mild hypothermia with fibrillatory arrest to prevent damage to the RCA. We propose that port-access surgery is a safe and effective treatment for redo cardiac surgery after initial surgical correction of a congenital heart anomaly.
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PMID:Port-access mitral valve replacement after surgical correction for Bland-White-Garland syndrome. 2144 99

A 51-year-old man developed severe mitral regurgitation 10 years after previous mitral valve repair; the echocardiographic images showed a remarkable eccentric jet toward posterior wall of left atrium associated with a high degree of pulmonary vein retrograde flow. The coronary arteriography pointed out no pathologic lesions but a coronary fistula from the proximal right coronary to the right atrium. The standard approach was avoided, and a right anterolateral minithoracotomy was chosen, providing an excellent view. Under cardiopulmonary bypass and mild hypothermia, the mitral valve was re-repaired, and a new ring was implanted. After aortic cross-clamp release, the right coronary fistula was closed through the right atrium. The postoperative course was uneventful, and the patient was discharged on the fourth postoperative day. In such a high-risk reintervention and concomitant procedure, we think that this different approach may represent a feasible and reliable alternative.
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PMID:Mitral re-repair and right coronary fistula closure: advantage of minimally invasive approach. 2243 44


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