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

A 25-year-old with a history of childhood rheumatic fever and resultant mild aortic insufficiency presented for routine prenatal care during her sixth pregnancy. At 14 weeks' gestation; a significant diastolic murmur was identified. Further evaluation revealed a massively dilated, aneurysmal aortic root, moderate to severe aortic insufficiency, and mild left ventricular hypertrophy. Because of the risk of sudden aneurysm rupture and the high mortality associated with this lesion, the patient was advised to undergo therapeutic abortion and aortic valve replacement with arch repair. The patient refused abortion but desired repair during pregnancy in spite of the increased fetal risk. At 17 weeks' gestation, aortic valve replacement and ascending aortic aneurysm excision were performed under pulsatile cardiopulmonary bypass and mild hypothermia. The patient's postoperative course and pregnancy proceeded uneventfully except for one episode of postpericardiotomy syndrome. A healthy, full-term male infant was delivered by spontaneous vaginal delivery. The carefully coordinated combination of obstetric and cardiovascular anesthesia contributed to this successful outcome for mother and child. The principles for fetal preservation and anesthetic considerations for pregnant women undergoing open heart surgery are reviewed.
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PMID:Aortic valve repair and arch replacement during pregnancy: a case report. 909 96

Pulmonary thromboendarterectomy is an accepted operative procedure for treatment of pulmonary hypertension due to chronic embolism. Despite its proven value this procedure has been established at very few centers worldwide. In this paper we report our actual operative concept and operative results. Between 8'89 and 4'96 127 patients were operated with use of extracorporeal circulation, deep hypothermia and circulatory arrest. After analysis of the initial high perioperative mortality (26%, 29/108) our operative and postoperative concept changed since 11'94: 1. central incision of both pulmonary arteries, 2. endarterectomy exclusively during circulatory arrest, 3. prolonged reperfusion to 37 degrees C, 4. pressure controlled ventilation, NO-inhalation, early extubation, and 5. modified vasopressor therapy. Preoperatively 12 of the 19 patients were in NYHA class III and 6 in class IV. Mean pulmonary artery pressure was 52(17) mmHg with a calculated pulmonary resistance of 1013(579) dynes.s.cm-5. Mean circulatory arrest time was 37 min (19-57 min) (bypass time 345 min, (240-430 min)). Perioperatively two patients (11%) died (multiorgan failure; rethrombosis of pulmonary artery/right heart failure), all other patients survived (89%). Perioperative complications included reversible renal failure, delirium and postcardiotomy syndrome (1/2/1). Mean pulmonary resistance was postoperatively significantly reduced (362(124) dynes.s.cm-5) (p < 0.01). Early results of pulmonary thromboendarterectomy can be improved by consequent modifications of the intra- and postoperative concept.
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PMID:[Surgical aspects of pulmonary thrombendarterectomy]. 941 95