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)

To avoid damage of myocardial ischemia, myocardial hypoxia and reperfusion injury, we designed mitral valve replacement in beating heart under extracorporeal circulation with low dose temperature of 31 degrees C to 35 degrees C in 137 cases of rheumatic heart disease, congenital heart disease mitral stenosis and mitral insufficiency, or concurrent aortic insufficiency. The patients were rept in unblocking aorta, unfilling cardiac arrest perfusion, idle pulse and dradycardia of 40-50 times/min, nose temperature of 32 +/- 1 degrees C. Patients with concurrent aortic insufficiency should first undergo replacement of aorta under cold cardiac arrest and then replacement mitral valve under beating heart to reduce the time of cold heart ischemia. Plastic surgery for tricuspid valve was done under beating heart. Good postoperative prognosis was nated: an average arterial pressure of 9.5-10.5 kPa (70 to 80 mmHg), dose of dopamine was obviously reduced. No low cardiac output syndrome, acute renal failure and severe arrythmia were observed in 137 cases, except 4 deaths due to infection and blood coagulation (2.9%). A left cardiac chamber no-level air removal device and aorta perfusioner leading flow device were designed for exsufflation of left pneumatocardia.
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PMID:[Mitral valve replacement under beating heart in 137 cases]. 959 Jul 59

Dynamic mitral regurgitation (MR) is typically associated with either severe systolic left ventricular dysfunction or episodes of acute myocardial ischemia. We report three patients with mild combined mitral stenosis and regurgitation and normal global left ventricular systolic function who presented with severe exertional dyspnea. Upright bicycle exercise echocardiography revealed development of severe dynamic MR in all three cases with Doppler evidence of severe pulmonary hypertension. There was no echocardiographic or electrocardiographic evidence of ischemia. Exercise echocardiography is an established tool for assessing dynamic changes in transvalvar pressure gradients. These results suggest that exercise echocardiography may also be useful for evaluating changes in severity of MR and for the assessment of dynamic changes in pulmonary artery systolic pressures.
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PMID:Exercise echocardiography in combined mild mitral valve stenosis and regurgitation. 1014 21

Between January 1990 and December 1999, 20 patients underwent the valve surgery concomitant with coronary artery bypass grafting. There were 16 males and 4 females, their mean age was 66.5 years. Of the 20 patients, aortic stenosis was noted in 7, aortic regurgitation in 3, mitral stenosis in one, and mitral regurgitation in 9 patients. The cause of mitral regurgitation was considered to be an ischemic change in six patients, including ruptured papillary muscle due to myocardial infarction in two patients. On the contrary, LMT lesion was recognized in 5, LAD lesion in 17, LCX in 16, and RCA in 12 patients. Seven patients had preoperative myocardial infarction, three patients were required preoperative IABP support. AVR was performed in 10, MVR in 5, and MAP in 5 patients. The number of bypass was 1.9 +/- 0.85. Four patients died of LOS and MOF. The remaining 16 patients have been doing well. The significant difference between the survived and the not survived patients was recognized in the factor of emergency, preoperative IABP, papillary muscle rupture due to myocardial infarction, history of PTCA, LAD lesion, and the time of CPB. The factors regarding coronary artery had the influence on the outcome of a patients of valve surgery concomitant with CABG. Therefore, an appropriate myocardial protection and perioperative management for ischemia were mandatory.
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PMID:[Perioperative risk factors in valve surgery concomitant with coronary artery bypass grafting]. 1093 83

Aortic atresia is the most severe variant of hypoplastic left heart syndrome (HLHS), and has been associated with significant mortality after stage I palliation. Coronary artery abnormalities are more prominent in this group of patients, especially in the presence of a patent mitral valve. Herein, we describe a case of isolated left ventricular ischemia after the Norwood procedure in a neonate with hypoplastic left heart syndrome, left ventricular hypertrophy, mitral stenosis, aortic atresia, and anomalous left coronary artery.
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PMID:Isolated left ventricular ischemia after the Norwood procedure. 1184 98

This article will provide an overview of real time 3-dimensional (3D) echocardiography (RT-3D) in evaluation of patients with heart disease. We will briefly describe the technique and our experience in its clinical applications in patients with coronary artery disease, left ventricular apical thrombi, mitral stenosis and its role in guiding intracardiac catheter placement. Our extensive experience with application of RT-3D during dobutamine stress and during supine bicycle exercise indicates the technique is sensitive in detection of ischemia. RT-3D has been valuable in clearly identifying left ventricular apical thrombi in patients in whom 2-dimensional (2D) echo cannot firmly establish their presence or absence. We have utilized RT-3D in guiding myocardial biopsy in heart transplant patients and in precisely measuring mitral valve area before and after balloon valvuloplasty. RT-3D technique continues to evolve and should play an important role in assessment of patients with heart disease.
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PMID:Real-time 3-dimensional echocardiography. Technique and clinical applications. 1467 48

Although the majority of recent scientific advances developed in the field of myocardial preservation have improved surgery procedures, it seems that during cardiothoracic surgery ischemia-reperfusion continues triggering clinical postoperative problems. This report focused on the changes human capillary endothelial cells and nerve endings suffer after cardiopulmonary bypass. The study involved four patients who received Bretschneider solution for cardioplegia during mitral stenosis surgery. Biopsies of right atrium were taken prior to and after CPB to be analyzed under electron microscopy. Samples taken after CPB showed detachment of myocardial capillary basal membrane, endothelial edema, and widespread nerve-ending destruction. Nevertheless, the shelter provided by the most advanced cardioplegic solutions, myocardial endothelial edema, and nerve-ending destruction cannot be completely prevented. Thus, it is possible to suggest that low interstitial concentration of Na(+), which activates Na(+)/Ca(++) exchanger, and inflow of Ca(++), present during ischemia-reperfusion, may lead to endothelial and neuronal cell damage, triggering cardiac contraction dysfunction. This mechanism would explain at least in part some of the problems patients face during the postoperative state.
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PMID:[Ultrastructural findings during human myocardial preservation with HTK solution]. 1508 50

Accompanying the clear benefits, there are certain risks of tachyarrhythmias in percutaneous coronary interventions (PCI), including serious ventricular arrhythmias and atrial fibrillation (AF). Ventricular arrhythmias may result from excess catheter manipulation, intracoronary dye injection, new ischemic events, or reperfusion. In patients with heart failure such kind of arrhythmias can occur more frequently. Atrial dysfunction, sino-atrial and nodal ischemia, congestive heart failure, sympathetic stimulation, iatrogenic factors are the possible causes of AF especially in patients undergoing primary PCI. Atrial fibrillation, on the other hand, can cause clinical squeal in the setting of a rapid ventricular response or if the loss of atrial systole results in hypotension, as in a patient with mitral stenosis or diastolic ventricular dysfunction. Majority of the ventricular arrhythmias and AF tend to revert spontaneously. However, the special treatment must be given, when necessary.
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PMID:Tachyarrhythmias in percutaneous coronary interventions. 1669 2

Although bicuspid aortic valve occurs in an estimated 1% of adults and mitral valve prolapse in an estimated 5% of adults, occurrence of the 2 in the same patient is infrequent. During examination of operatively excised aortic and mitral valves because of dysfunction (stenosis and/or regurgitation), we encountered 16 patients who had congenitally bicuspid aortic valves associated with various types of dysfunctioning mitral valves. Eleven of the 16 patients had aortic stenosis (AS): 5 of them also had mitral stenosis, of rheumatic origin in 4 and secondary to mitral annular calcium in 1; the other 6 with aortic stenosis had pure mitral regurgitation (MR) secondary to mitral valve prolapse in 3, to ischemia in 2, and to unclear origin in 1. Of the 5 patients with pure aortic regurgitation, each also had pure mitral regurgitation: in 1 secondary to mitral valve prolapse and in 4 secondary to infective endocarditis. In conclusion, various types of mitral dysfunction severe enough to warrant mitral valve replacement occur in patients with bicuspid aortic valves. A proper search for mitral valve dysfunction in patients with bicuspid aortic valves appears warranted.
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PMID:Presence of a congenitally bicuspid aortic valve among patients having combined mitral and aortic valve replacement. 2201 39

We describe a successful perioperative management of a case of 38-year-old male, presented with chronic jaundice with severe mitral stenosis and moderate tricuspid regurgitation; upon evaluation, he was found to have severe glucose-6-phosphate dehydrogenase (G6PD) deficiency. Usually, patients deficient in G6PD exhibit increased hemolysis and therefore increased need for blood transfusion after cardiac surgery as well as impaired oxygenation in the postoperative period leading to prolonged ventilation. On reperfusion after a period of ischemia, the antioxidant system recruits all of its components in an attempt to neutralize the overwhelming oxidative stress of free radicals, as the free radical scavenging system is deficient in these patients, the chances of free-radical-induced injury is more. Our patient underwent mitral valve replacement and tricuspid annuloplasty under cardiopulmonary bypass with necessary precautions to reduce the formation of free radicals. Treatment was targeted toward the prevention of free radical injury in the G6PD-deficient patient. He had an uneventful intraoperative and postoperative course.
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PMID:Perioperative challenges in a patient of severe G6PD deficiency undergoing open heart surgery. 2223 23

Severe mitral regurgitation (MR) following balloon mitral valvotomy (BMV) needing emergent mitral valve replacement is a rare complication. The unrelieved mitral stenosis is compounded by severe MR leading to acute rise in pulmonary hypertension and right ventricular afterload, decreased coronary perfusion, ischemia and right ventricular failure. Associated septal shift and falling left ventricular preload leads to a vicious cycle of myocardial ischemia and hemodynamic collapse and needs to be addressed emergently before the onset of end organ damage. In this report, we describe the pathophysiology of hemodynamic collapse and peri-operative management issues in a case of mitral valve replacement for acute severe MR following BMV.
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PMID:Emergency mitral valve replacement for acute severe mitral regurgitation following balloon mitral valvotomy: pathophysiology of hemodynamic collapse and peri-operative management issues. 2440 4


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