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

This study evaluated specially designed perfluorocarbon (PFC) emulsions as blood substitutes in case of induced ischemia of the left heart ventricle in healthy farm pigs. Two hundred ml of perfluorocarbon emulsion were infused while 200 ml of blood were simultaneously drawn. Radiographic contrast media were given to aid placement of balloon catheters in the left coronary artery. Histopathological analysis showed that right heart failure caused the deaths of both pigs. Particles (up to>3 micro) of foreign body materials obstructed capillaries of all organs analyzed (heart, lung, liver, kidneys and spleen). Laboratory investigation showed severe interference between the PFC emulsion and radiographic contrast media, resulting in the deterioration of the PFC emulsion. The strongest interference occurred when PFC emulsion and Accupaque interacted; particle size started at an initial 311 nm and went up to >3 micro within seconds. Great care must be taken when PFC emulsions are used in combination with x-ray contrast media. None of the described radiographic contrast media should be used within 48 hours prior to the use of this PFC emulsion. Also, the use of these contrast media should be avoided for a certain period of time after using PFC emulsion. The mechanisms of elimination of PFC emulsions from the circulation are not completely understood and has yet to be evaluated.
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PMID:Interaction between a perfluorocarbon emulsion and radiographic contrast media. 1515 57

Pulmonary hypertension (PH) is a threatening condition that can be associated with a great variety of both pulmonary and extrapulmonary diseases. In all forms of severe PH the pulmonary vascular bed looses its physiological features of a "high flow-low pressure system", putting an increased afterload on the right ventricle (RV). Acute pulmonary hypertension in the intensive care unit often represents a clinical problem secondary to acute respiratory failure, left heart failure, pulmonary embolism, or decompensation of prior PH by concurrent pulmonary or cardiovascular disease. Right ventricular failure (acute cor pulmonale) occurs when relevant increases in pulmonary vascular resistance overwhelm its compensatory mechanisms, both abruptly on a previously normal RV, or gradually on a chronic cor pulmonale. This review addresses the main pathophysiological aspects of severe PH, focusing on the hemodynamic derangements occurring in the setting of acute cor pulmonale, and emphasizing the role of ventricular interdependence (the way right ventricular failure greatly affects diastolic and systolic function of the left ventricle), the risk of RV ischemia (the end stage of RV failure) and systemic organ hypoperfusion (caused by antegrade and retrograde heart failure). The understanding of the peculiar features of this type of cardiovascular insufficiency is necessary to both provide effective monitoring and adequate supportive therapy.
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PMID:Pathophysiology of severe pulmonary hypertension in the critically ill patient. 1517 2

Despite advances in mechanical circulatory support, cardiogenic shock continues to have a high mortality. We reviewed our experience with pulsatile versus non-pulsatile temporary mechanical support at our institution to determine optimal strategy for survival. From January 2001 to December 2003, mechanical support for cardiogenic shock was instituted in 38 patients. Non-pulsatile devices (NP group) were used in 22 patients and pulsatile devices (P group) in 16 patients. Indications for the NP group were post-cardiotomy shock (PCS) in 17, myocardial infarction in 2, and isolated post-cardiotomy right ventricular failure in 3 patients. In the P group, 9 had the device placed for PCS, 3 for viral myocarditis, 1 after myocardial infarction, and 3 for right ventricular (RV) failure. Overall, bleeding, limb ischemia, and multi-system organ failure were higher in NP group with 5 weaned and 3 surviving to discharge (14%). In the P group, survivors included 7 weaned and 3 transplanted patients (63%). With the exception of isolated RV failure, we obtained a dismal survival result with ECMO/centrifugal circuits for treatment of cardiogenic shock. For refractory pump failure, improved survival was achieved by using intermediate-term pulsatile devices with early transition to a chronic device and/or heart transplantation.
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PMID:Strategies for temporary mechanical support: contemporary experience with pulsatile and non-pulsatile support systems. 1611 32

48 year old man with chronic obstructive pulmonary disease (COPD) secondary to pulmonary hypertension with domiciliary non-invasive ventilation was seen. He came to the emergency department with acute exacerbation of COPD. The patient was admitted to the Cardiology Service with the diagnosis of congestive heart failure. Diagnostic imaging (chest X-ray, transthoracic Doppler-echocardiography, multidetector row spiral CT and myocardial perfusion imaging) revealed an enlarged right ventricle. ECG was consistent with right ventricular failure. The heart perfusion imaging (pharmacologic stress testing with dobutamine) showed cor pulmonale and right ventricle ischemia induced by drug stress with dobutamine. Although right ventricle myocardial chronic dysfunction rarely causes right ventricular failure, it can occur when cor pulmonale and ischemia heart disease are present.
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PMID:[Ischemia of right ventricle and cor pulmonale]. 1612 9

Glycine reduces ischemia-reperfusion injury after experimental liver transplantation. We hypothesized that glycine might also protect right heart function in an isovolumic cardiac transplantation model. In six domestic donor pigs 150 ml of a 300 mmol L-glycine solution were administered intravenously. The hearts were then arrested with histidine-tryptophan-ketoglutarate solution. Animals without prior glycine infusion served as controls (n = 6). After 4 h of ischemia, hearts were transplanted into recipients. An isovolumic model was used in which the right ventricular (RV) volume was controlled in vivo using an intracavitary high-compliance balloon. After 1 and 2 h of reperfusion the RV balloon volume was gradually increased and the developed pressures were recorded (P(developed) = P(systolic) - P(diastolic)). Right ventricular failure was defined as a decrease in developed intracavitary pressure. Glycine hearts could be loaded with a significantly increased volume after 1 h (glycine: 53 +/- 13.7 ml vs. control: 32 +/- 11.7 ml; P = 0.015) and after 2 h (67 +/- 18.6 ml vs. 43 +/- 8.2 ml; P = 0.018). Maximal RV developed pressures were not significantly different between groups. Postischemic RV end-diastolic compliance was significantly higher in glycine-treated animals (P = 0.04). Glycine protects early postischemic RV compliance, but has no important influence on maximal developed pressures.
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PMID:Glycine application and right heart function in a porcine heart transplantation model. 1644 71

Pulmonary thromboendarterectomy (PTE) is a complicated surgical procedure that is an effective treatment in reducing pulmonary artery pressure and pulmonary vascular resistance for chronic thromboembolic pulmonary hypertension. Chronic thromboembolic pulmonary hypertension usually results from incomplete lysis of a large organized thrombus in the main pulmonary artery and secondary branches, leading to pulmonary hypertension, right ventricular failure, and subsequent death because of heart failure. Between March 1997 and April 2005, 30 PTE operations were performed in Fuwai Hospital, Beijing, China. They were 24 men and 6 women, with an average age of 45.7 +/- 11.4 years and average disease history of 48 +/- 12.6 months. Twelve of them were in New York Heart Association (NYHA) class 4, and 18 were in class 3. Seventeen cases were found with deep venous thrombosis (DVT), and inferior vena cava filters were implanted before surgery. The mean systolic pulmonary pressure was 91.4 +/- 22.4 mmHg, mean pressure of arterial oxygen (PaO2) was 56.2 +/- 8.6 mmHg, mean cardiac index (CI) was 1.64 +/- 0.47 L/min/m2, and mean saturation of arterial oxygen (SaO2) was 0.90 +/- 0.05. All operations were performed using the PTE procedure under deep hypothermia and intermittent circulation arrest. Perfusion management consisted of myocardial, cerebral protection, lung protection, and deep hypothermia with multiple periods of circulatory arrest and reperfusion at hypothermia, ultrafiltration, and cell-saving techniques. One patient died of infective shock post-operatively. Four cases experienced complications of the central nervous system. The mean cardiopulmonary bypass time was 191.1 +/- 34.4 minutes, the mean aortic clamping time was 95.1 +/- 27.8 minutes, and mean circulation arrest time was 47.7 +/- 12.9 minutes. Improvement of hemodynamic status occurred immediately after surgery. Mean pulmonary artery pressure decreased from 91.4 +/- 22.4 to 48.3 +/- 10.7 mmHg, and CI increased from 1.64 +/- 0.47 to 2.58 +/- 0.51 L/min/ m2. PaO2 increased from 56.2 +/- 8.6 to 88.9 +/- 6.0 mmHg and SaO2 increased from 0.90 +/- 0.05 to 0.97 +/- 0.01. Twenty-six cases were followed for 36.8 months: 22 in NYHA class 1, 3 in class 2, and 1 in class 3. PTE is an effective treatment for chronic thromboembolic pulmonary hypertension. The key to success is to adopt synthesized measures to protect the vital organ under deep hypothermic circulatory arrest (DHCA) from ischemia and reperfusion injury. Appropriate patient selection, perioperative management, improved techniques, and experience can optimize outcome.
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PMID:Perfusion techniques for pulmonary thromboendarterectomy under deep hypothermia circulatory arrest: a case series. 1731

Isolated right ventricular myocardial infarction (RVMI) is a very rare complication of ischemic heart disease. Generally it accompanies infero-posterior or antero-septal myocardial infarction cases. Right ventricular myocardial infarction is a strong predictor of acute right ventricular failure, bradyarrythmia, ischemic and mechanical complications and is frequently complicated by cardiogenic shock which often leads to death. Acute right ventricular ischemia (RVI) and RVMI are big problem particularly during and early post-operative cardiosurgery procedures. Atherosclerotic changes and heart blood flow disturbances predispose to RVI or RVMI that occur more often in cardiosurgical patients, especially in early postoperative period. On the other hand early intraoperative diagnosis and longer reperfusion period result in the correction of heart function and better prognosis.
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PMID:[Isolated right ventricular myocardial infarction in cardiosurgery practice]. 1733 27

Since the advent of implantable cardioverters/defibrillators (ICD) and percutaneous ablation, surgery for the treatment of ventricular arrhythmia has decreased tremendously. Nevertheless, surgical treatment of ventricular arrhythmias is still required, especially for cases where ICD discharge occurs very frequently or in patients with other indications for surgery. The choice of surgical therapy may range from radiofrequency- or cryoablation of a single focus (identified either intra- operatively or percutaneously) to more extensive surgical procedures such as surgical ventricular reconstruction with endocardial resection or even resection of the right ventricle and the creation of a cavo-pulmonary circulation for malignant arrhythmias and right ventricular failure in patients with arrhythmogenic right ventricular dysplasia. However, the choice of surgical procedure should be made based on the pathomechanism of the arrhythmia. This is important because any incision in the left or right ventricle or percutaneous ablation may also be the cause for ventricular arrhythmia. In this short review we will describe the most common underlying substrates for ventricular arrhythmia, indications for surgery, the techniques used for treatment and the results achieved. We will conclude that for most cases of patients with ventricular arrhythmia undergoing surgery, ischemia and the presence of a scar after myocardial infarction is the underlying cause and revascularization plus surgical ventricular reconstruction with endocardial resection may be the best treatment option.
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PMID:Surgical therapy of ventricular arrhythmias. 1764 37

A 74-year-old man with a history of diabetes and arterial hypertension, presented with right ventricular failure, remarkable jugular venous distension, hepatomegaly, and swelling of the lower extremities. He was complaining of atypical chest pain and was referred for an echocardiogram and a myocardial perfusion SPECT imaging study. The echocardiogram showed normal left ventricular function with a dilated right atrium and right ventricle, severe tricuspid regurgitation, pulmonary hypertension, and an atrial septal defect with bidirectional shunt. The SPECT images showed normal left ventricular function with no areas of induced ischemia but an impressive right ventricle with severe dilatation and hypertrophy. A right ventricular "perfusion abnormality," consistent with ischemic changes, seen on stress but less evident on rest images was demonstrated on the dual isotope (Tl-201 rest/Tc-99m MIBI stress) protocol but not seen on the single isotope study (rest/stressTc-99m MIBI). Coronary angiogram showed diffuse coronary atherosclerosis but without significant obstruction.
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PMID:Right ventricular wall "ischemia" findings using a dual isotope protocol. 1766 45

Systemic venous pressure is elevated in right heart failure, and this elevation may be reflected in pulsatile venous flow when there is significant tricuspid regurgitation. The presence of this systolic reversed flow in the femoral and popliteal veins may result in major difficulties for diagnosis and treatment. We report the case of a patient with signs and symptoms of acute ischemia of the right lower limb with palpable pulse in the groin and popliteal fossa. Tricuspid regurgitation was suspected by clinical examination, and Doppler ultrasonographic examination of the extremity revealed pulsatile flow in the femoral and popliteal veins while the iliac arterial axis was occluded. A preoperative angiogram revealed an underlying iliac artery thrombosis, which was successfully treated.
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PMID:Acute iliac artery thrombosis and pulsatile femoral and popliteal veins in the same extremity: a case report. 1875 77


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