Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0020672 (hypothermia)
 17,327 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Two cases of delayed non-mycotic false aneurysm arising from ascending aortic cannulation site, presenting one-and-a-hald years and seven years after cardiopulmonary bypass, are described. These two cases represent an incidence of 0.12% of this complication. Repair using profound hypothermia and circulatory arrest with femoral artery and femoral vein cannulation for cardiopulmonary bypass is recommended. The advantages and complications of aortic cannulation are discussed and recommendations to minimise the complications of cannulation are made. The clinical presentation and diagnosis of non-mycotic false aneurysms arising from the aortic cannulation site are described. In addition one delayed and two early cases of non-mycotic cannulation site false aneurysms previously published are analysed. Surgeons should be alert to the possibility of this complication in all patients who have had aortic cannulation for cardiopulmonary bypass even in the distant past. Unexpected symptoms such as constant anterior chest pain, dysphagia, hoarseness, and increasing widening of the superior mediastinum on the chest radiograph warrant prompt investigation.
Thorax 1977 Dec
PMID:Delayed non-mycotic false aneurysm of ascending aortic cannulation site. 60 39

Between March 1970 and October 1977, 36 patients underwent correction of total anomalous pulmonary venous connection. The ages ranged from 5 days to 16 years; 27 (75%) were under 1 year and 19 were under 3 months of age at the time of surgery. The overall mortality was 33%. Supracardiac connection was the commonest type and was associated with the lowest hospital mortality (30%). The highest mortality occurred in the mixed and infracardiac types and was related in part to the presence of associated intracardiac anomalies. The use of hypothermia and circulatory arrest in infancy has resulted in a considerably lower hospital mortality compared with cases operated on under conventional cardiopulmonary bypass. The mortality in 23 infants (under 1 year of age) was 26% using circulatory arrest and was lowest when correction was performed within the first three months of life (18%). All four infants operated on with standard cardiopulmonary bypass died, whereas this technique was found to be safe in older children. The surgical technique using a left anterolateral thoractomy with a trans-sternal extension is described. This technique gives an excellent exposure for fashioning a long anastomosis and has been associated with a low incidence of postoperative pulmonary complications. There have been no late deaths and all survivors, who are in excellent condition up to seven years after correction, have a normal exercise tolerance.
Thorax 1978 Jun
PMID:Total anomalous pulmonary venous connection (surgical technique, early and late results). 68 63

Penetrating injuries of the thoracic aorta are usually rapidly lethal. Few patients survive for long enough to undergo surgical treatment. When penetrating injuries of the thoracic aorta are complicated by arteriovenous fistula a correct preoperative diagnosis is important for adequate planning of the surgical repair, and so selective angiography is essential. The best approach is through a median sternotomy with the use of total cardiopulmonary bypass with or without deep hypothermia and circulatory arrest. Fistulae between aorta and innominate vein invariably lead to congestive cardiac failure. A review of the literature suggests that signs of cardiac failure rarely appear early. Congestive failure developed within 30 days of the initial trauma in only two of the 12 reported cases. In our case, the early onset of cardac failure refractory to therapy and the appearance of an expanding pulsatile mass at the base of the neck, threatening rupture, necessitated emergency surgical treatment.
Thorax 1976 Dec
PMID:Repair of traumatic aortic arch to innominate vein fistula under deep hypothermia and circulatory arrest. 79 45

The results of 28 Potts' aortopulmonary shunts created for the relief of cyanotic heart disease are reviewed in this study. The shunt gave excellent symptomatic relief, but the incidence of immediate and late complications is high. Regular follow-up of patients is mandatory to detect evidence of increasing pulmonary vascular disease and to under take corrective surgery whenever feasible before its occurrence. Although Potts' anastomosis has been largely replaced by alternative shunt procedures, there may still be a place for its application in selected situations. Only a few problems were encountered at the time of closure of the shunt in 11 patients during corrective surgery using a transpulmonary technique and hypothermia with circulatory arrest.
Thorax 1976 Aug
PMID:An evaluation of Potts' aortopulmonary shunt for palliation of cyanotic heart disease. 96 95

Twenty-two patients with congenital valvular aortic stenosis were surgically treated between 1967 and July 1975. Five (23%) were under 1 year of age (group I) and 17 (77%) were between 2 and 24 years (group II). All infants exhibited severe congestive heart failure and electrocardiographi (ECG) evidence of left ventricular hypertrophy (LVH) with strain pattern. In group II, angina was present in three cases, syncope and fatigue in two; the ECG indicated LVH in 10 cases (59%) with strain pattern in five (29%). A bicuspid aortic valve was present in 77% (17/22) of the cases; 32% had other cardiac anomalies. Aortic valvotomy was performed on cardiopulmonary bypass in 20 cases, and with deep hypothermia and circulatory arrest in two. Three infants under 1 month of age with associated anomalies died (hospital mortality 14%). Intraoperative average peak left ventricular-aortic systolic pressure gradient decreased from 86 to 21 mmHg (P less than 0.001). Late clinical (in all cases) and haemodynamic (26%) follow-up showed severe restenosis in two patients of group II; one of them had a second operation, the other one died three and a half years postoperatively. Results assessed on the basis of symptoms, ECG changes, aortic valve function, and/or haemodynamic findings were fair in the two surviving infants. Results in group II were excellent in three, satisfactory in seven, fair in four, and poor in two cases. In infants, aortic valvotomy is a palliative procedure which carries a high risk. In the older age group, early and late results are more gratifying.
Thorax 1976 Aug
PMID:Surgical treatment of congenital valvular aortic stenosis. 96 96

Rapid uniform cooling of the heart is the most important requirement of any method using local hypothermia for protection of the myocardium during open intracardiac surgery. We report the construction and operation of a recirculation cooling circuit comprising a reservoir, pump, and heat-exchanger for this purpose. It is operated by the perfusionist and can deliver up to 1 litre of fluid per minute at 4 degrees C into the pericardium or interior of the heart. Advantages of the system include rapid cooling of the myocardium, simplicity of operation, and applicability to all routine cardiac surgical procedures.
Thorax 1976 Oct
PMID:A simple cooling circuit for topical cardiac hypothermia. 99 18

Open heart surgery was performed without perfusion under deep hypothermia in 343 patients with congenital heart defects aged from 1 year 3 months to 44 years. Cooling to a temperature of 26-25 degrees C in the oesophagus was achieved by covering the body with crushed ice. The patients were maintained under superficial ether narcosis and they were given morphine (0.5 mg/kg) and tubocurarine (0.5-1.0 mg/kg). The duration of circulatory arrest was 30 minutes in 190 and longer in 153 patients--60-77 minutes in 10 patients. It took an average of 7.6 minutes for resumption of normal cardiac activity after circulatory arrest prolonged beyond 60 minutes. Of the 343 patients operated on 32 (9.3%) died. Analysis of the mortality pattern showed that patients with acute cardiac insufficiency contributed most to the total number of deaths (19 patients, 5.5%); those with pulmonary oedema ranked second (4 patients, 1.2%) and those with brain oedema third (3 patients, 0.9%). Neurological complications were observed in 13 patients (3.8%). Their frequency was significantly related to the duration of circulatory arrest. Circulatory inadequacy in patients with poor myocardial function who had undergone extensive repair appeared to be a contributory factor. The results obtained without perfusion under deep (26-25 degrees C) hypothermic protection suggest that 75 minutes is a safe time, in terms of brain damage, for circulatory arrest. Under these conditions complex cardiac defects can be repaired.
Thorax 1988 Mar
PMID:Hypothermic protection (26-25 degrees C) without perfusion cooling for surgery of congenital cardiac defects using prolonged occlusion. 340 6

Two hundred and twenty-five consecutive patients with interventricular septal defect and associated pulmonary hypertension have undergone corrective surgery at the Christian Medical College Hospital. The mean preoperative systolic pulmonary artery pressure was 70.5 (range 31-136) mm Hg and the calculated pulmonary vascular resistance ranged from 300 to 1680 dyn/s cm-5. A paracoronary right ventriculotomy was the approach of choice. Profound hypothermia and circulatory arrest were not used, even in 12 patients weighing under 10 kg. Among the older children and young adolescents there were 27 who had a calculated pulmonary vascular resistance of over 800 dyn/s cm-1 and their mortality was 22%, which is good when compared with that of other series. It is evident that both the early and the late death rate after surgery increase with the age of the patient, especially in those with associated pulmonary hypertension. In 69 patients studied after repair recatheterisation showed no residual defect by oximetry. The fall in the pulmonary artery pressures after surgery has been striking in most patients. The late death rate was 2.5%. The surviving patients are leading normal, active lives.
Thorax 1983 Apr
PMID:Results of surgical treatment of ventricular septal defects with pulmonary hypertension. 686 81

Two cases of closed traumatic rupture of the innominate artery are described. Both patients underwent surgical reconstruction, for which one patient was cooled to 15 degrees C on cardiopulmonary bypass. In the management of these rare and severe injuries, which almost invariably need surgical repair, protection of the cerebral circulation is vital; cerebral blood flow and function should be monitored during the operation, for which cardiopulmonary bypass, hypothermia, or local shunting should be available. Failure to recognise the features of these injuries lead to a high death rate, and aortography should be performed whenever there is clinical or radiological suspicion.
Thorax 1982 May
PMID:Management of closed injuries of the innominate artery. 705 5