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Query: UMLS:C0022116 (ischemia)
 91,303 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Eighty-eight operations for correction of intracardiac congenital heart defects were performed using local cardiac hypothermia for protection of the ischemic myocardium. Twenty-six patients underwent repair of tetralogy of Fallot, 23 had patch closure of ventricular septal defect, 24 had correction of various types of congenital aortic stenosis, and 15 were operated upon for other complex lesions. The overall operative mortality was 5.6%. Ischemia times ranged from 9 to 119 minutes (mean, 48 minutes). Ischemic arrest protected by local cardiac hypothermia provides an optimal operative field, permitting repair of uncomplicated intracardiac defects in a precise, unhurried manner. No hemodynamic abnormalities attributable to the technique were encountered.
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PMID:Local cardiac hypothermia for myocardial protection during correction of congenital heart disease. 118 May 98

During a 5-year period (1979 to 1983), 50 consecutive patients undergoing continuous intraaortic balloon (IAB) pumping were transferred from Evanston Hospital to Northwestern Memorial Hospital (16 miles), where they underwent cardiac operation. All patients had cardiac catheterization before transfer. Indications for IAB were cardiogenic shock (9 patients), postinfarction angina (18 patients), unstable angina (9 patients), evolving myocardial infarction (3 patients), accelerating angina or hemodynamic instability during cardiac catheterization (9 patients) and prophylactic insertion for high-grade left main stenosis (2 patients). Transportation after stabilization was uneventful in all patients. All patients underwent operative coronary revascularization. There was concomitant mitral valve replacement in 3 patients, acute ventricular septal defect repair in 1 patient, aortic valve replacement in 1, and ventricular aneurysmectomy in 1. Three patients (5%) died postoperatively. Nine patients (20%) had complications directly related to IAB insertion. One patient required femoral-femoral arterial bypass preoperatively, 4 patients had postoperative lower limb ischemia treated by IAB removal or thrombectomy and 1 patient had thrombocytopenia (less than 60,000/mm3), 1 false aneurysm, 1 anterior compartment syndrome and 1 prolonged bleeding at the insertion site. Interhospital transfer with IAB pumping in progress should not be restricted to patients with cardiogenic shock, but can be effectively used for all patients who require preoperative IAB insertion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Interhospital transport of patients with ongoing intraaortic balloon pumping. 387 35

Between December 1975 and February 1984 five patients with Transposition of the great arteries and large ventricular septal defect underwent repair by arterial switching with reimplantation of the coronary arteries. They ranged in age from 2 to 28 months and weighted between 3.2 and 10 kg. The oldest patient had underwent banding of the pulmonary artery together with a Blalock-Hanlon septectomy at 6 months of age. Direct reconstruction of the "new" pulmonary artery was achieved in 4 patients. The first of these patients operated upon on December 1975 died of acute left ventricular ischemia due to compression of the main left coronary artery caused by the newly reconstructed pulmonary artery. This death appears to be technically avoidable by using the method recently reported by Lecompte. One patient who was in good hemodynamic status died of mediastinitis 2 months after the repair. At necropsy the repair was found intact and the woven dacron conduit used to reestablish the continuity to pulmonary artery was found grossly infected. The remaining three patients continue to be asymptomatic 48, 40 and two months respectively after repair. Our small experience supports the anatomic correction as the procedure of choice for the surgical treatment of most of the patients with Transposition of the great arteries and large ventricular septal defect.
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PMID:[Anatomical correction of transposition of the great arteries associated with a large interventricular defect]. 400 70

A 48 year old man, victim of a serious road traffic accident (multiple limb fractures, closed trauma of the left hemithorax) was immediately diagnosed as having a systolic regurgitant murmur. The initial ECG recordings showed anterior subepicardial ischemia, and later, a low antero-septal and apical infarction. The hemodynamic status progressively deteriorated, leading to catheterisation 7 months after the accident showing an inferiorly situated VSD (oxymetry and dye dilution techniques). Angiography visualised the traumatic rupture of the lower part of the septum and an inferior posterior left ventricular aneurysm. AT surgery, the septal rupture was repaired by a Dacron patch and a false aneurysm was plicated. The patient was asymptomatic after surgery, and control catheterisation and angiography one year later showed the absence of a residual shunt and good movement of the inferior posterior left ventricular wall. The lesional mechanisms associated instantaneous septal rupture by deceleration, contusion of the apex and progressive development of an inferior posterior wall false aneurysm.
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PMID:[Acquired interventricular communication and false left ventricular aneurysm caused by non-penetrating trauma of the thorax]. 641 17

The main and most attractive surgical measure in acute coronary disease is emergency revascularisation of acute ischemia. As far as unstable angina is concerned, the recommendations of the National Cooperative Study Group are more or less universally accepted, which means that emergency revascularisation is reserved for patients in whom stabilisation of angina with vigorous medical treatment is unsuccessful. On the other hand, it has been shown that a large proportion of patients in whom unstable angina had been successfully stabilized subsequently suffered from severe chronic angina. The author therefore recommends performing coronarography in all younger patients within a few days. If left main stem or three-vessel disease is documented by this investigation, aortocoronary bypass should be performed during the same hospitalisation. In cases with isolated proximal stenosis of the left anterior descending artery, transluminal dilatation should be considered. The author's own results confirm the general experience that revascularisation for unstable angina does not involve elevated risk. After established acute infarction, the role of surgery is confined to treatment of severe mechanical complications of infarction (acute aneurysm, ventricular septal defect, subvalvular mitral insufficiency) and aortocoronary bypass for postinfarction angina. The author's results show that early and late mortality are rather high, though a good late result can be achieved in about 50% of the cases. However, in view of the poor prognosis under conservative treatment, even this modest rate of success seems acceptable.
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PMID:[Surgical treatment of acute coronary heart disease]. 661 Sep 37

Short-term ischemia (up to 10 minutes) induced by clamping of the aorta in correction of a ventricular septal defect causes no essential ultrastructural, metabolic or functional changes in the myocardium. In much longer period of ischemia (of up to 40 minutes) during operation for congenital heart diseases, the use of deep hypothermia is effective. Cold cardioplegia is a sufficiently reliable method for myocardial protection when the aorta is clamped for up to 60 minutes in operations for acquired heart diseases. Changes in the structure and metabolism of the myocardium are reparable, their degree depends on the initial condition of the heart muscle and proper fulfilment of the methodical conditions of this type of protection. Pharmacological cardioplegia combined with external cooling of the heart makes it safe to disconnect the heart from circulation for a loger period (up to 120 minutes).
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PMID:[Ultrastructural and histochemical criteria of myocardial hypoxia and a morphological assessment of the various methods for its protection (based on biopsy data of the human heart)]. 735 99

A case is reported of double-outlet right ventricle (DORV) with restrictive subaortic ventricular septal defect (VSD) in which enlargement of the defect at the time of surgical repair was associated with the late postoperative development of a false aneurysm of the left ventricle. The enlarging fale aneurysm caused extrinsic compression of the dominant left circumflex coronary artery, with subsequent ischemia and infarction of the posterolateral left ventricle. The anatomy and surgical implications of restrictive VSD are discussed.
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PMID:Postoperative false aneurysm of left ventricle and obstruction of left circumflex coronary artery complicating enlargement of restrictive ventricular septal defect in double-outlet right ventricle. 738 28

This is a summary of relative indications for the selection of patients for coronary angiography. Coronary angiography is an important part of clinical evaluation of patients with ischemic heart disease, valve heart disease, cardiomyopathies. Main groups of patients with ischemic heart disease are: angina pectoris after low levels of effort despite a good medical treatment, unstable angina, variant angina, angina with high risk of acute coronary syndromes from noninvasive exercise testing. In addition coronary angiography is indicated in patients with unexplained congestive heart failure, in patients with acute myocardial infarction with mechanical complication requiring cardiac surgery such as hemodynamically important mitral insufficiency, large ventricular septal defect or a large aneurysm leading to heart failure. Also in patients with sudden death syndrome unrelated to acute myocardial infarction. Patients with silent ischemia with known coronary artery disease and with known risk factors should undergo coronary angiography. Indication for coronary angiography is also in patients with hemodynamically important valvular, subvalvular or supravalvular heart disease in whom corrective surgery is contemplated.
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PMID:[Indications for cornary angiography]. 835 58

Acute dyspnea in a post-myocardial infarction patient may prompt the physician to use further diagnostic testing to evaluate apparent worsening left ventricular function, ischemia, mitral valve dysfunction, chordae or valvular rupture, or a ventricular septal defect producing a left to right shunt. We present a case of a 62-year-old woman with an unrecognized myocardial infarction at home who presented to the emergency department (ED) acutely dyspneic and free of chest pain. Prompt evaluation in the ED with echocardiography and Doppler imaging proved time-efficient and allowed early lifesaving surgery to be performed. We propose that access to emergent echocardiography in select cases should be a standard service in every ED.
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PMID:Emergent use of echocardiography in a post-myocardial infarction patient with acute dyspnea. 863 Jan 51

The oxygen free radicals and the interaction between neutrophils and endothelium have been implicated in the pathogenesis of lung injury associated with cardiopulmonary bypass (CPB), and in the setting of total CPB, the ischemia-reperfusion injury has been suspected as the mechanism of lung injury. To prevent this reperfusion induced lung injury, we performed continuous pulmonary perfusion during total CPB. We studied 26 infants less than 1 year of age who underwent patch closure of ventricular septal defect. Intermittent mechanical ventilation (5/min) and continuous perfusion of pulmonary artery (30 ml/kg/min) were performed during total CPB in 7 infants (Group P). Whereas 19 infants underwent ordinary CPB (Group N). PaO2/FiO2 ratio was employed for the predictor of lung injury and was calculated before and after CPB. PaO2/FiO2 ratio decreased from 3 to 12 hours after CPB and then increased by 24 hours after CPB in both groups. The lowest PaO2/FiO2 ratio measured at 12 hours after CPB correlated with age and body weight at operation (Spearman's correlation coefficient, 0.59; p = 0.01 and 0.61; p = 0.009, respectively) and strongly correlated with preoperative Rp/Rs ratio (-0.73; p = 0.003). PaO2/FiO2 ratio, however, did not correlate with duration of CPB and aortic cross clamping, preoperative Pp/Ps and Qp/Qs ratio in group N. PaO2/FiO2 ratio of group P at 3, 6, and 12 hours after CPB were higher than those of group N, although there were no significant difference When analysis was made on the infants with high pulmonary vascular resistance (preoperative Rp/Rs ratio > or = 0.1), PaO2/FiO2 ratio of group P (n = 6) at 3, 6 and 12 hours after CPB were higher than those of group N (n = 11), and the difference was statistically significant at 12 hours after CPB (291.1 +/- 15.5 versus 199.6 +/- 27.0, p = 0.027. These results implicate that young age, low body weight and especially high pulmonary vascular resistance were incremental risk factor of lung injury after CPB and, furthermore, ischemia reperfusion injury can be the initiating factor of lung injury. The results also suggest that continuous pulmonary perfusion during total CPB is an effective mean to prevent lung injury particularly for the infants with high pulmonary vascular resistance.
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PMID:[Effectiveness of continuous pulmonary perfusion during total cardiopulmonary bypass to prevent lung reperfusion injury]. 902 20


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