Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This study reports on the frequency and clinical significance of false-positive thallium studies in the interventricular septum in patients with left bundle branch block. In a 3-year period, 93 studies were performed on patients with complete left bundle branch block and sinus rhythm. Of these, 29 had a reversible septal defect; 17 are scored false-positive although only six had angiographic proof of normal left anterior descending coronary arteries. We conclude that thallium scintigraphy is indicated in patients with left bundle branch block, but caution is justified when reversible ischemia is demonstrated scintigraphically.
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PMID:False-positive Tl-201 SPECT studies in patients with left bundle branch block. Frequency and clinical significance. 161 54

In this work the clinical features, diagnostic methods, surgical procedures and postoperative follow-up are reviewed in 19 cases of atrioventricular septal defect with associated tetralogy of Fallot. The clinical situation was always related to the degree of pulmonary ischemia, that pointed out the urgency and need for a palliative surgical procedure before corrective surgery. There was no data in the ECG for the differential diagnosis of isolated forms of atrioventricular septal defect. In 50% of the cases the cardio-thoracic index was increased by right atrial enlargement. The diagnosis of the malformation was made in every case by means of 2D echocardiography. In 16 cases palliative surgery was done (aortic-pulmonary shunts), with one death (6.2%) due to facts unrelated to the technique. Of the 6 cases with corrective surgery (5 cases with previous shunts), one needed a mitral valve replacement (St Jude prosthesis). There was no mortality in this group and the functional status in the long-term follow-up was: 3 cases were in the functional class I and 3 cases in class II. The overall mortality for all surgical procedures carried out was 4.3%. In conclusion, we consider the use of the corrective surgery adequate to the clinical stability of the patients with atrioventricular septal defect with associated Fallot's tetralogy.
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PMID:[Atrioventricular septal defect with associated tetralogy of Fallot. Clinico-morphological aspects and surgical considerations]. 261 44

In a patient with a prior history of cerebral abscess and cerebral ischemia, an unsuccessful perfusion lung scan led to a radionuclide angiocardiogram using an arm vein injection. This showed a total right-to-left (R-L) shunt from the superior vena cava (SVC) to the left atrium. Repeat radionuclide study, through a leg vein, demonstrated a moderate R-L shunt and an interpretable lung scan could be obtained. Catheterization and contrast cineangiogram did not provide the exact diagnosis, the preoperative conclusion being anomalous drainage of the SVC into the left atrium, with atrial septal defect (ASD) and partial anomalous pulmonary venous connection to the SVC. The operative diagnosis was high atrial (sinus venosus) septal defect. This example of major but clinically unsuspected R-L shunt emphasizes the value of performing a perfusion lung scan, preferably in conjunction with radionuclide angiocardiography in patients with a prior history of unexplained cerebral abscess or systemic ischemia. Implications of the site of an ASD on quantitation of L-R shunts by radionuclide methods are also discussed.
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PMID:Unsuccessful lung scan due to major right-to-left shunt through a sinus venosus septal defect. 403 43

A 37-year-old man with atypical chest pain and complete left bundle branch block showed a marked exercise induced septal defect on Tc-99m sestamibi stress testing. A repeat examination at rest the next day revealed complete reversal of the previous septal defect. Coronary angiography two days later showed a normal coronary artery system. Left bundle branch block has been associated with false-positive results of exercise (and more recently, dipyridamole) TI-201 examinations for septal ischemia. The case presented here may be the first reported example of a false positive Tc-99m sestamibi examination for septal ischemia in the presence of left bundle block.
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PMID:False-positive Tc-99m sestamibi SPECT in a patient with left bundle branch block. 842 18

Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, which is most commonly caused by acute myocardial infarction. The pathophysiology of cardiogenic shock is characterized by a downward spiral: ischemia causes myocardial dysfunction, which, in turn, augments the ischemic damage and the energetical imbalance. With conservative therapy, mortality rates for patients with cardiogenic shock are frustratingly high reaching more than 80%. Additional thrombolytic therapy has not been shown to significantly improve survival in such patients. Emergency cardiac catheterization and coronary angioplasty, however, seem to improve the outcome in shock-patients, which most probably is due to rapid and complete revascularization generally reached by angioplasty. In addition to interventional therapy with rapid coronary revascularization, the use of mechanical circulatory support may interrupt the vicious cycle in cardiogenic shock by stabilizing hemodynamics and the metabolic situation. Different cardiac assist devices are available for cardiologists and cardiac surgeons: 1. intraaortic balloon counterpulsation (IABP), 2. implantable turbine-pump (Hemopump), 3. percutaneous cardiopulmonary bypass support (CPS), 4. right heart, left heart, or biventricular assist devices placed by thoracotomy, and 5. intra- and extrathoracic total artificial hearts. Since percutaneous application is possible with IABP, Hemopump and CPS, these devices are currently used in interventional cardiology. The basic goals of the less invasive intraaortic balloon counterpulsation (IABP; Figure 1) are to stabilize circulatory collapse, to increase coronary perfusion and myocardial oxygen supply, and to decrease left ventricular workload and myocardial oxygen demand (Figure 2). Since the advent of percutaneous placement, IABP has been used by an increasing number of institutions (Figure 3). In addition to cardiogenic shock, the system may be of use in a variety of other indications in the catheterization laboratory and intensive care unit, including weaning from percutaneous cardiopulmonary bypass, in ischaemic left ventricular failure, in unstable angina, in high risk PTCA, and in prophylactic support in patients with myocardial infarction and successful revascularization. Animal experimental data showed that IABP may improve success of thrombolysis and recent clinical data suggest that survival is enhanced and transfer for revascularization is facilitated when patients with myocardial infarction and cardiogenic shock undergo thrombolysis and IABP rather than thrombolysis alone. A lot of studies had demonstrated before, that combined use of counterpulsation and revascularization therapy (i.e. coronary bypass surgery or angioplasty) may improve prognosis in patients with myocardial infarction complicated by cardiogenic shock (Table 1). In such patients, early treatment with IABP is most important: Multivariate analysis identified early IABP-support with a duration of shock to IABP-treatment of > or = 4 hours as an independent predictor of a positive short-term outcome. In shock-patients with postinfarction ventricular septal defect, IABP provides a marked hemodynamic improvement, and a significant decrease in shunt-flow (Figure 5). However, despite initial stabilization with IABP, such patients need immediate surgical repair of the septal defect to avoid hemodynamic deterioration. The rate of complications related to percutaneous IABP was significantly attenuated by employing catheters of reduced size. Using 9.5-F catheters, a long duration of counterpulsation emerged as the most significant factor associated with complications. In our hospital, those patients with 9.5-F catheters in whom counterpulsation did not exceed 48 hours had a low complication rate of 3.9%. The Hemopump is a catheter-mounted transvalvular left ventricular assist device intended for surgical placement via the femoral artery (Figures 6 and 7). (ABSTRACT TRUNCATED)
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PMID:[Reperfusion therapy and mechanical circulatory support in patients in cardiogenic shock]. 1054 49

We report acute thromboembolic events in a 14-year-old boy with Down syndrome and repaired atrioventricular septal defect. He presented with sudden onset of bilateral lower limb ischemia. Transesophageal echocardiography detected a thrombus in the right atrium. An arterial saddle embolus was removed following bilateral iliac embolectomy. Despite anticoagulation, he presented again with sudden bilateral lower limb ischemia and respiratory distress. Multiple pulmonary emboli and a thrombus in the right atrium were noted on imaging studies. An arterial embolus was removed from the abdominal aorta at the bifurcation. To our knowledge, this is the first report of a child or adolescent with a repaired congenital heart lesion and arterial embolism requiring embolectomy. This association and possible etiological factors are discussed.
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PMID:Saddle arterial embolus in a patient with Down syndrome. 1640 56

A new technique to repair tetralogy of Fallot or double-outlet right ventricle with an anomalous right coronary artery arising from the left anterior descending coronary artery and crossing the right ventricular outflow tract is described. The right coronary artery was mobilized, transected, and re-implanted into the ascending aorta. The right ventricular outflow tract and ventricle septal defect were repaired through a ventriculotomy and pulmonary arteriotomy. The right ventricular outflow tract and pulmonary annulus were reconstructed with a pericardial patch. Five consecutive patients underwent this technique between August 2007 and October 2008. The indications of the electrocardiograms were no heart ischemia in all patients at mean follow-ups conducted at 5 to 19 months. All the patients were in New York Heart Association functional class I at the time of last follow-up.
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PMID:Right ventricular outflow tract patch reconstruction in anomalous origin of right coronary artery. 2033 75

Cardiac hydatid cysts are rarely seen. The presentation of an acute lower limb ischemia secondary to embolization from an interventricular hydatic cyst is also rare. We describe a case of a 30-year-old-man who presented with acute lower limb ischemia revealing hydatid cyst of the interventricular septum and septal defect, and who was operated on successfully.
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PMID:Interventricular septum hydatid cyst presenting with acute lower limb ischemia: a case report. 2613 Apr 58

Cardiac hydatid cysts are rarely seen. The presentation of an acute lower limb ischemia secondary to embolization from an interventricular hydatic cyst is also rare. We describe a case of a 30-year-old-man who presented with acute lower limb ischemia revealing hydatid cyst of the interventricular septum and septal defect, and who was operated on successfully.
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PMID:Interventricular septum hydatid cyst presenting with acute lower limb ischemia: a case report. 2834 10