Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0034063 (pulmonary edema)
 10,665 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Between 1979 and 1986, 30 patients underwent replacement of the aortic valve and ascending aorta by a composite graft, with aortic wrapping of the graft. Thirteen patients had annuloaortic ectasia; six had DeBakey type I dissection (five acute, one chronic); three had DeBakey type II dissection (one acute, two chronic); three had left ventricular-aortic discontinuity caused by prosthetic valve endocarditis; three had sinus of Valsalva aneurysms after previous aortic valve procedures; and two had atherosclerotic aneurysms. Three patients died (10%). The mean duration of follow-up was 54 months. Fifteen patients consented to be restudied by intra-arterial digital subtraction angiography; studies were performed 6 to 58 months (mean 25 months) after composite graft replacement. Two patients had pseudoaneurysms at the right coronary anastomosis, which were repaired successfully. One patient showed persistent dissection beyond the distal aortic anastomosis; no reoperation has been done. One patient had pulmonary edema. Emergency study and reoperation showed disruption of the proximal aortic anastomosis and right coronary anastomosis. Anastomotic dehiscence after composite graft replacement is potentially lethal. Follow-up by means of intra-arterial digital subtraction angiography is simple and highly accurate. We suggest that dehiscences may occur early in the postoperative period and that restudy may be appropriate within a few months after operation.
J Thorac Cardiovasc Surg 1988 May
PMID:Composite graft replacement of the ascending aorta and aortic valve. Late follow-up with intra-arterial digital subtraction angiography. 328 63

In 13 patients, sternal closure was delayed at the end of open heart procedures. Seven patients underwent coronary artery bypass surgery (CAB), 5 valve replacements, and one left ventricular aneurysmectomy and closure of post myocardial infarction VSD. In all, primary closure of the sternum was considered impossible or inadvisable. The major indications for delaying sternal closure were: cardiac dilatation with tamponade-like behaviour upon attempted sternal closure (8 patients); intractable bleeding (2); intractable arrhythmia (1); insertion of mediastinal assist devices (3) and intraoperative non-cardiogenic pulmonary edema (1). In all, only the skin was closed. Delayed sternal closure (DSC) was performed 36-120 hours later on 10 of the patients, when their condition had stabilized. Nine patients are long term survivors. None of these patients has developed mediastinitis, wound infection, osteomyelitis or instability of the sternum. The judicious use of DSC in selected situations has several advantages: hemodynamic deterioration from pressure upon the heart may be prevented; a quick access to the heart in case of tamponade or intractable arrhythmia is obtained; insertion of mediastinal assist devices is facilitated. With careful technique the risk of infection is low.
J Cardiovasc Surg (Torino)
PMID:Delayed sternal closure following cardiac operations. 348 35

Since 1973, 11 patients have had emergency valve replacement for severe mitral insufficiency and cardiogenic shock within 1 month (mean 10.0 days) of acute myocardial infarction. Mean age was 60 years (range 44 to 71 years). Nine infarcts affected the inferior wall, one patient had a prior myocardial infarction, and only two patients had a history of cardiac symptoms. Ten patients had pulmonary edema, five were oliguric (less than 0.5 ml/kg/hr for 12 hours), four required endotracheal intubation, nine required preoperative intra-aortic balloon support, and three had had a cardiac arrest. Preoperative cardiac index averaged 1.7 L/m2/min even with pharmacologic and circulatory support. Eight patients had cardiac catheterization and nine had echocardiograms. Left ventricular ejection fraction varied from 23% to 83% (mean 51%) and was not prognostic. Five patients had papillary muscle rupture and six patients had papillary muscle dysfunction. The mitral valve was replaced with a mechanical prosthesis in all patients. Five had simultaneous coronary artery bypass grafts. Three of five patients with papillary muscle rupture and two of six with papillary muscle dysfunction survived hospitalization. Two patients could not be weaned from cardiopulmonary bypass, two patients died within 24 hours of low cardiac output, and two patients died 3 weeks postoperatively of acute tubular necrosis and sepsis following prolonged preoperative cardiogenic shock. The interval from onset of shock to operative therapy averaged 1.7 days for survivors versus 9.3 days for nonsurvivors. Although the amount of viable left ventricular mass cannot be measured preoperatively, we recommend early operation, before other organ systems fail, for patients having severe mitral insufficiency and cardiogenic shock within 30 days of acute myocardial infarction.
J Thorac Cardiovasc Surg 1985 Apr
PMID:Operation for acute postinfarction mitral insufficiency and cardiogenic shock. 387 81

An experimental study was performed to evaluate the effects of positive end-expiratory pressure (PEEP) on central hemodynamics and on regional blood flow (RBF) using the radioactive microsphere (MS) method. Ten dogs with intact lungs and 10 dogs with oleic acid-induced pulmonary edema were ventilated with PEEP 10 and PEEP 20 (cmH2O). PEEP significantly reduced cardiac output (CO) by 25% at PEEP 10 and 40--50% at PEEP 20 despite volume expansion with dextran 60. RV afterload rose markedly due to a significant increase of pulmonary vascular resistance. PEEP tended to redistribute CO in favor of brain, heart and adrenals, at the expense of stomach, pancreas and thyroid glands. Hepatic artery flow was moderately reduced; renal RBF was seriously affected only when PEEP caused an extreme low-output state. RBF to the RV remained essentially unchanged, whereas RBF to the LV decreased, roughly paralleling the respective ventricular work. Nevertheless, the RV may suffer from underperfusion during PEEP, since its tension-time-index rises; this may indicate increased oxygen needs exceeding actual oxygen delivery.
Thorac Cardiovasc Surg 1980 Apr
PMID:The effect of PEEP ventilation on hemodynamics and regional blood flow with special regard to coronary blood flow. 615 99

A case of arterial embolization of a Beall mitral prosthesis disc (model 104) 5 1/2 years after implantation is presented. The patient was referred to use 3 days after the onset of acute symptoms and was immediately operated upon in pulmonary edema and cardiogenic shock. The migrated disc was removed from the abdominal aorta 26 days later, showing marked signs of wear. The postoperative course was complicated and the patient made a slow recovery. It is suggested that patients with models 103 and 104 Beall mitral prostheses be followed very closely and that electric valve substitution should be considered when first signs of prosthetic attrition are noted.
Thorac Cardiovasc Surg 1980 Jun
PMID:Late embolization of disc occluder of a Beall mitral prosthesis with survival. 615 20

A case of the escape of the disc occluder from a Beall model 104 mitral valve implanted 12 years earlier is reported. Acute dysfunction of the prosthesis was diagnosed and prompt operation was carried out. The patient, who was admitted in cardiogenic shock and pulmonary edema, survived and had a smooth postoperative course. Unnecessary investigations, which result in a delay of surgery, should be avoided under these circumstances. Since escape of the disc is rare with this type of valve (only one case has previously reported) elective reoperation is not recommended, but attention should be paid to the appearance of premonitory symptoms which may precede this dramatic event. Various investigations failed to located the embolized disc. Since no evidence of arterial obstruction was present, the patient was not submitted to an exploratory operation.
Thorac Cardiovasc Surg 1982 Feb
PMID:Escape of the disc occluder from a Beall model 104 mitral prosthesis. 617 36

We undertook a randomised between-group comparison of the haemodynamic effects of arteriolar dilatation and venodilatation in 20 males, following acute myocardial infarction, with persisting left ventricular failure after pretreatment with intravenous frusemide. All had radiographic pulmonary oedema and a pulmonary artery occluded pressure (PAOP) exceeding 15 mm Hg. The average cardiothoracic ratio was 52% (range 48-65%). Following control haemodynamic measurements, 10 patients received intravenous hydralazine (0.15 mg/kg) and 10 received intravenous isosorbide dinitrate infusion (50-200 micrograms/kg/h). Subsequent measurements were made at 30, 60, and 90 min. Isosorbide dinitrate reduced the PAOP by 3 mm Hg (p less than 0.01) and the mean systemic arterial pressure by 9 mm Hg (p less than 0.05) without significant change in the heart rate, cardiac output, or systemic vascular resistance. In contrast, hydralazine reduced the PAOP and systemic arterial pressure by a similar amount, but this was accompanied by a reduction in the systemic vascular resistance (p less than 0.01) and an increase in the cardiac output (p less than 0.01), heart rate (p less than 0.01), and stroke volume (p less than 0.01). This randomised study defines the contrasting haemodynamic results of arteriolar dilatation and venodilation in patients with resistant left ventricular failure following acute myocardial infarction. The different pharmacodynamic effects of these two methods of circulatory manipulation suggest that they are not mutually exclusive and together may offer therapeutic advantages.
J Cardiovasc Pharmacol
PMID:Arteriolar or venous dilatation in left ventricular failure following acute myocardial infarction: a haemodynamic trial of hydralazine and isosorbide dinitrate. 619 53

Twenty-three months after mitral valve replacement for mitral stenosis with a St. Jude Medical heart valve prosthesis size 31, a 29-year-old man suddenly went into a profound cardiogenic shock and pulmonary edema due to escape of one of the leaflets from the prosthesis. At emergency operation the valve was replaced with another type of prosthesis. The escaped leaflet was retrieved from the abdominal aorta and was found to be intact. The cause of the escape was found to be a fracture in the pivot area. Further examination with optic and scanning electron microscopy revealed an old fracture at the base of the pivot covered with organic material and another fracture at the top of the pivot area not covered with organic material and therefore probably very recent and responsible for the break-off of part of the area and subsequent escape of the leaflet. The cause of the primary fracture is unknown.
Thorac Cardiovasc Surg 1983 Oct
PMID:Escape of a leaflet from a St. Jude Medical prosthesis in the mitral position. 619 67

Blood conservation has been most successful when blood salvage techniques have been combined with postoperative normovolemic hemodilution. The hemodynamic and myocardial metabolic responses to normovolemic hemodilution were assessed in a prospective randomized trial. Twenty-seven patients were randomized to receive either blood and colloid solutions (colloid group, 13 patients) or crystalloid fluids (crystalloid group, 14 patients) following elective coronary revascularization. Although seven patients in the crystalloid group received blood products when the hemoglobin level fell below 7 gm/dl, blood bank requirements were less in the crystalloid group (colloid, 3.6 +/- 1.2 L; crystalloid, 1.5 +/- 1.0 L, p less than 0.01). The crystalloid group received twice as much fluid to maintain normovolemia (left atrial pressure between 8 and 10 mm Hg) in the first 72 hours postoperatively (colloid, 6.5 +/- 1.9 L; crystalloid, 14.5 +/- 3.1 L, p less than 0.01). The infusion of large volumes of crystalloid fluids resulted in a progressive postoperative anemia (hemoglobin: colloid, 12.1 +/- 1.6 gm/dl, crystalloid 8.9 +/- 1.7 gm/dl, p less than 0.01, 20 hours postoperatively). Although the crystalloid-treated patients had peripheral edema, pulmonary edema could not be documented and there was no difference in the physiological shunt fractions between the two groups. Preload (left atrial pressure), afterload (mean arterial pressure), and cardiac index were similar in the two groups. The crystalloid group had a delayed recovery of myocardial oxygen and lactate extraction postoperatively. Volume loading and atrial pacing 3 to 5 hours postoperatively maintained myocardial lactate extraction in the colloid group but decreased myocardial lactate extraction to ischemic levels in the crystalloid group. The use of crystalloid rather than colloid fluids in the early postoperative period conserved blood products but resulted in postoperative anemia and was associated with a delay in myocardial metabolic recovery. Normovolemic hemodilution should be employed with caution in patients who are at risk of perioperative ischemic injury.
J Thorac Cardiovasc Surg 1984 Jul
PMID:Limitations of blood conservation. 637 59

Six patients received heart-lung transplants between March, 1981, and January, 1982. There were four women and two men between 26 and 45 years of age, three with primary pulmonary hypertension and three with congenital heart disease and pulmonary hypertension (Eisenmenger's syndrome). Immunosuppression was primarily with cyclosporin-A, with additional corticosteroid, azathioprine, and rabbit antihuman thymocyte globulin. Six episodes of allograft rejection in four patients (10, 11, 21, 24, 53, and 86 days after transplantation) were detected by means of transvenous endomyocardial biopsy. All patients experienced pulmonary edema early after transplantation (reimplantation response), and two patients required mechanical ventilatory support for allograft rejection at 10 and 11 days. Treatment of rejection consisted of intravenous methylprednisolone (four episodes) or augmented oral prednisone (two episodes), with resolution. No episode thought to be pulmonary rejection has occurred in the absence of cardiac findings. Four patients are alive from 6 to 15 months after transplantation and are functionally normal. Early experience with heart-lung transplantation suggests (1) that allograft rejection can be detected by cardiac findings and successfully treated by augmented corticosteroids, (2) that lung rejection does not occur in the absence of cardiac findings, (3) that the frequency and severity of rejection episodes are not greater than with standard cardiac transplantation, and (4) that the frequency of rejection episodes is highest within the first 60 days after transplantation.
J Thorac Cardiovasc Surg 1983 Mar
PMID:Diagnosis and treatment of allograft rejection in heart-lung transplant recipients. 640 22


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