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

Rabbit pups are completely dependent on a maternal pheromone for the release of suckling behavior. However, if the mother is perfumed prior to nursing, pups will learn to respond to the novel odor with the characteristic nipple-search behavior in just one 3-4 min nursing episode. In a first investigation of the processes underlying this recently developed learning paradigm, time-dependent effects of hypothermia on retention of the task could be demonstrated. Thus pups whose whole body was cooled to a mouth temperature of 7 degrees C immediately after conditioning (n = 10) and tested 24 h later for 3 min on a perfumed fur did not differ significantly in their search response from naive, untreated controls (n = 10). In contrast, pups cooled 4 h after conditioning (n = 10) demonstrated clear retention of the learned response and searched as vigorously as conditioned but uncooled animals (n = 10). As pups of all groups demonstrated normal nipple-search behavior when tested on a lactating doe, the deficits associated with immediate cooling appear to have been specific to the learning task and time of treatment.
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PMID:Rapid odor conditioning in newborn rabbits: amnesic effect of hypothermia. 174 94

To assess the results of operative therapy for permanent junctional reciprocating tachycardia, a type of incessant tachycardia, the clinical and electrophysiologic data of 8 such patients referred for management of tachycardia were reviewed. The duration of incessant tachycardia was 14 +/- 10 years (range 2 to 30). The heart rate at rest during tachycardia ranged from 120 to 150 beats/min. Four of 8 patients had cardiomegaly or depressed ejection fraction (16 +/- 10%, range 5 to 27) at presentation and, of these, 2 had symptoms of congestive heart failure. Exertional dyspnea despite normal left ventricular function was noted in 1 patient, 2 had chronic palpitations and 3 were asymptomatic. Electrophysiologic data confirmed the presence of a posteroseptal pathway with atrioventricular node-like properties conducting slowly in the retrograde direction only. Seven patients underwent successful surgical ablation of the accessory pathway. Hypothermic cardiopulmonary bypass was used in 2 and a closed heart technique without cardiopulmonary bypass in the other 5. Three of 4 patients with reduced left ventricular function showed an improvement in ejection fraction to 34 +/- 20% (range 16 to 63) after control of dysrhythmia. Three patients had no evidence of cardiomegaly despite equivalent periods of incessant tachycardia. Another patient with normal left ventricular function despite incessant tachycardia for over 30 years underwent spontaneous remission to sinus rhythm and did not undergo surgery. These data suggest that permanent junctional reciprocating tachycardia has a variable presentation and that congestive heart failure is not an infrequent presenting symptom. The substrate is invariably an accessory atrioventricular pathway with a long conduction time and decremental properties conducting only in the retrograde direction.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Results of operative therapy in the permanent form of junctional reciprocating tachycardia. 270 78

Filling the pericardial sac with ice and saline during open heart surgery protects the myocardium during periods of ischemic arrest. Bilateral diaphragmatic paralysis complicated intense local hypothermia in five patients undergoing coronary artery bypass surgery. All complained of severe orthopnea, exertional dyspnea, insomnia, and excessive daytime somnolence. All exhibited paradoxic inward movement of the abdominal wall with inspiration. The diagnosis of bilateral diaphragmatic paralysis was confirmed with upright and supine spirometry and, in one patient, with transdiaphragmatic pressure measurements. Although paralysis has resolved in four patients, all experienced months of disabling impairment. One patient required four months of mechanical ventilatory support prior to her recovery. Alternative methods of intraoperative myocardial preservation that avoid this complication should be developed.
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PMID:Bilateral diaphragmatic paralysis complicating local cardiac hypothermia during open heart surgery. 633 67

Since 1969, 15 patients, ranging in age from 21 to 67 years, with pulmonary hypertension associated with chronic thrombotic obstruction of major pulmonary arteries have had pulmonary thromboendarterectomy. Symptoms compatible with embolism antedated surgery for periods of 8 months to 18 years; several alternative diagnoses were maintained for months to years. Only 2 of 15 were treated for the initial embolic episode. All patients had dyspnea on exertion and were in New York Heart Association class III-IV before surgery. Resting arterial hypoxemia was common. Resting preoperative mean pulmonary artery pressures ranged from 25 to 66 mm Hg; pulmonary vascular resistances, 420 to 1869 dynes/sec X cm-5. Partial or complete thromboendarterectomy was possible in patients using cardiopulmonary bypass with hypothermia and cardioplegia. All patients showed a fall in pulmonary vascular resistance. All developed some degree of "reperfusion" lung edema and arterial hypoxemia that lasted for a few days to several months. Two patients died during hospitalization. The 13 survivors have been followed for 8 to 144 months (mean, 38.3 months). All patients improved after surgery. One patient died of nonembolic causes; none had recurrent embolism.
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PMID:Chronic thrombotic obstruction of major pulmonary arteries. Results of thromboendarterectomy in 15 patients. 661 79

A 63-year-old patient had been diagnosed with angina pectoris for 5 months and came to us complaining of progressive exertional dyspnea. Echo cardiography showed remarkable pulmonary hypertension and we were prompted to do cardiac catheterization. The catheterization showed the pressure of the main pulmonary artery (PA) as 84/14 (36) mmHg and PA angiography showed a massive embolus in the right main PA. Chest computed tomography and lung perfusion scintigraphy were also compatible with pulmonary embolism. The patient had been treated with anticoagulant for 1 month, but he was not doing well. We decided to remove the embolus surgically. In a median sternotomy, a cardiopulmonary bypass was established with ascending aortic and two caval cannulae. During cooling, the right PA was mobilized within the pericardial reflection. An incision was made in the right PA. An organized thrombus was located at the central PA and extended to the distal segmental PA. Thromboendarterectomy was carried out carefully. To obtain a better operative view, circulatory arrest was introduced intermittently. The left PA was opened and the organized thrombus, located at the bifurcation between the upper and lower branch, was removed. Post-operative PA angiography showed remaining thrombus in the right lower PA, but the pressure of the main PA fell to 27/12 (18) mmHg. Pulmonary thromboendarterectomy by median sternotomy with the aid of deep hypothermia and circulatory arrest was useful to remove the thrombus in the bilateral PA, and to obtain good hemodynamic and symptomatic results.
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PMID:[Successful pulmonary thromboendarterectomy in a patient with chronic pulmonary thromboembolism]. 907 Nov 34

A 21-year-old male patient had suffered from palpitation and exertional dyspnea since October, 1997. He was admitted to our hospital, and a series of examinations were performed. Chest computed tomography (CT) revealed marked dilatation of the ascending aorta (about 7.5 cm at the proximal portion) and aortic annulus, an intimal flap in the ascending aorta and aortic arch was also noted. Cardiac catheterization revealed the pulmonary capillary wedge pressure was 33 mmHg, pulmonary artery pressure was 47/38 mmHg with a mean of 35.4. The cardiac index was 1.01 l/min/m2. Poor left ventricular contractility was shown by a left ventricular ejection fraction (LVEF) of 13.8% and a right ventricular ejection fraction (RVEF) of 5.13% by a radionuclide angiogram (RNA) study. Under the diagnosis of dilated cardiomyopathy and dissecting aortic aneurysm of the ascending aorta and aortic arch, he was put on a waiting list for heart transplantation. On November 11, 1997 he received heart transplantation. Resection of the dissecting aneurysm of the ascending aorta and the aortic arch and replacement with a 26 mm Vascutek graft were performed first under deep hypothermia and retrograde cerebral perfusion. Then while he was rewarming up, heart implantation was performed. He was discharged 30 days after surgery and has been doing well since then. As far as we know, no literature regarding combined heart transplantation and resection of a dissecting aneurysm of the ascending aorta and aortic arch has been reported.
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PMID:Combined heart transplantation and resection of dissecting aneurysm of ascending aorta and aortic arch: a case report. 1074 63

Although the results of surgical repair for congenital pulmonary stenosis are generally good, some patients develop progressive symptoms related to pulmonary regurgitation and right ventricular dilation. Pulmonary homograft implantation may have a beneficial effect on these symptoms, due to a reduction in the volume overload of the right ventricle and hemodynamic improvement. We describe our experience of one patient with severe pulmonary regurgitation following pulmonary valvotomy performed with the Brock technique during childhood because of pulmonary valve stenosis. The patient was admitted to our Institution because of dyspnea on exertion (NYHA functional class II-III) and paroxysmal episodes of supraventricular arrhythmias. Echocardiography showed severe pulmonary regurgitation, an important right ventricular dilation associated with severe tricuspid insufficiency and a patent foramen ovale without any significant shunts. Surgical repair was performed through a median sternotomy with cardiopulmonary bypass and moderate hypothermia. The right ventricular infundibulum was opened and a cryopreserved pulmonary homograft was implanted with continuous sutures. De Vega annuloplasty was performed on the tricuspid valve and the patent foramen ovale was closed with a running suture. Postoperative course was uneventful and the patient was discharged on the seventh postoperative day. Three months after surgery the patient is asymptomatic and echocardiographic evaluation shows no evidence of pulmonary or tricuspid regurgitation, a decrease in right ventricular dilation and a significant improvement in biventricular systolic and diastolic function. In conclusion, pulmonary regurgitation after surgical valvotomy can be treated with the implantation of a cryopreserved pulmonary homograft with satisfactory results. It would appear advisable to perform surgical repair of concomitant right heart anomalies, such as secondary tricuspid insufficiency, to obtain both a decrease in right ventricular overload and a regression of its preoperative dilation.
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PMID:[The correction of pulmonary insufficiency with a cryopreserved homograft: an optimal solution to a postoperative problem not rare]. 1083 30

Bilateral pulmonary thromboendarterectomy has been recognized as the first-choice therapeutic option for patients with chronic thromboembolic pulmonary hypertension. With careful patient selection, meticulous surgical technique and careful postoperative management the surgical procedure has proven potentially curative for these often severely incapacitated patients in whom prognosis is otherwise poor. By means of pulmonary angiography and multislice CT correct diagnosis is established and the crucial question of operability determined.In the presence of significant exertional dyspnea and/or elevation of pulmonary vascular resistance surgery is indicated when the thromboembolic obstructions are determined accessible to surgical removal. Suboptimal surgical results may be obtained in patients with solely peripheral location of lesions, i. e., beginning at the bronchopulmonary segmental arteries, and correct patient selection becomes crucial especially in advanced stages of disease of very high pulmonary vascular resistance and presence of right heart failure.The surgical techniques are standardized with use of median sternotomy with cardiopulmonary bypass, deep hypothermia and periods of circulatory arrest and consist of complete dissection of the intimal layer of the pulmonary branches containing the thromboembolic lesions as a true endarterectomy technique.The reported operative mortality for pulmonary thromboendarterectomy differs in the literature between 4.5% and 23.5% and probably reflects not only the various experiences with this patient group but most likely also the disparate policies in patient selection. The authors' experience comprises 250 surgically treated patients with an operative mortality of 14.4%. The immediate hemodynamic and functional improvement of patients following successful thromboendarterectomy is excellent with further improvement during the first year. Pulmonary hypertension recurs over time in a few patients because of embolism, thrombosis or progression of reactive vasculopathy. However, the functional improvement and decrease of right ventricular afterload are persistent in the vast majority.Given the poor results of lung transplantation, this is not an alternative, and patients with chronic thromboembolic pulmonary hypertension should undergo thromboendarterectomy, preferably in the most early stage of their disease.
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PMID:[Pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension]. 1596 3

Coronary arteries originating from the opposite coronary cusp and crossing the path between the aorta and the pulmonary artery are associated with ischemia and sudden cardiac death. An increased prevalence of these cases may be attributed to diagnostic advances in computed tomographic angiography (CTA). We report a retrospective review of ten patients referred for surgical intervention from March 2008 to present. Nine patients were diagnosed with right coronary arteries arising from the left coronary cusp and one patient with a left coronary artery arising from the right coronary cusp. Seven patients were male and the median age was 40 years (range, 21 to 51). Symptoms included atypical chest pain, tachy-arrythmias, diaphoresis, and dyspnea on exertion. CTA demonstrated anomalous coronary arteries arising from the opposite coronary cusp and traveling between the aorta and the pulmonary artery. Surgical intervention was performed on all ten patients with no mortality and only one re-operation requiring bypass grafting. The sixth patient in the series had concomitant atherosclerotic disease, requiring left internal mammary artery grafting to the left anterior descending coronary artery. Cardiopulmonary bypass (CPB) was utilized with moderate hypothermia in all ten patients, with retrograde and/or coronary ostial cardioplegia administration. At routine surgical follow-up, all patients were without original presenting symptoms. Patients with anomalous coronary arteries arising from the opposite coronary cusp are at risk of acute myocardial infarction and sudden cardiac death. Surgical unroofing is a viable option for this patient population and avoids coronary artery bypass grafting. Since March 2008, we have operated on ten patients presenting with this anomaly and have had excellent short-term results. Further long-term follow-up is necessary.
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PMID:Surgical intervention utilizing cardiopulmonary bypass for coronary unroofing of anomalous coronary artery. 2051 83

The patient was a 41-year-old female with chronic thromboembolism. She was admitted to an affiliated hospital with exertional dyspnea, leg swelling, and hemoptysis, and she was treated medically with tissue plasminogen activator and warfarin therapy. When transferred to our hospital, she was oxygen-dependent with severe dyspnea. A pulmonary arteriogram showed occlusion and stenosis of the pulmonary arteries. Cardiac catheterization revealed marked pulmonary hypertension. The lung perfusion scintigram showedmultiple defects in the right and left lungs. Preoperative laboratory data showed a markedly decreased protein C antigen level. Magnetic resonance angiography showed that a myoma uteri compressed the pelvic vein and that she had deep vein occlusion of the left leg. After the administration of an epoprostenol infusion and the insertion of an inferior vena cava filter, she underwent an operation. Under deep hypothermia, the bilateral pulmonary artery was opened and an endarterectomy was performed during intermittent circulatory arrest. After surgery, her pulmonary vascular resistance was in the normal range. Her New York Heart Association functional classification changed from class IV to class I. She has been in good condition for 7 years since the surgery.
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PMID:A case report of pulmonary thromboendarterectomy for chronic thromboembolism in a patient with protein C deficiency. 2390 11


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