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Query: UMLS:C0036690 (sepsis)
 59,461 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Amongst 9000 patients on whom angiocardiograms had been carried out, a membranous septum aneurysm (MSA) was found in 47. In nine patients out of 27 the MSA could be demonstrated by sonography. The most common abnormalities accompanying this lesion were disturbances in rhythm and conduction (in 29 patients), ventricular septal defect in 29 and aortic insufficiency in 14. Complications included bacterial endocarditis in five patients (three with aortic insufficiency and two with sepsis lenta), aortic insufficiency (which was not of rheumatic or bacterial origin in three patients with conduction defects) and thirteen patients with abnormalities of cardiac rhythm with small VSDs.
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PMID:[Aneurysm of the membranous septum. Angiocardiographic study]. 642 Feb 75

From August 1974 through April 1981, 23 patients, ages 5 months to 40 years (median 11 years) with corrected transposition of the great arteries (C-TGA), underwent repair of associated intracardiac defects: 20 for ventricular septal defect (VSD), 19 for pulmonary outflow tract obstruction, and five for anatomic tricuspid valve regurgitation. Segmental anatomy was [S,L,L] in 18 or [I,D,D] in 5. Pulmonary outflow tract obstruction was resected in 10 and bypassed with a left ventricle-to-main pulmonary artery conduit in nine patients. Hospital mortality was 9% (two of 23). One patient died from arrhythmia and one from sepsis and arrhythmia. The late mortality rate was 14% (three patients). Two patients died from severe pulmonary vascular obstructive disease (5 months and 2 years postoperatively) and one from arrhythmia (2 months postoperatively). Fourteen have undergone cardiac catheterization 3 days to 4 years (mean 12 months) postoperatively. Three had a small residual VDS (Qp/Qs less than 1.5). Five had residual pulmonary outflow tract obstruction (peak systolic ejection gradient 30-130 mm Hg) after resection or pulmonary valvotomy. One patient had reresection and four had placement of a secondary left ventricular-pulmonary artery conduit. Anatomic tricuspid valve regurgitation became severe in three patients after VSD closure, two of whom required valve replacement; the other died of coexisting pulmonary vascular obstructive disease. Five with [S,L,L] segmental anatomy had complete atrioventricular block preoperatively and six developed complete atrioventricular block at surgery. Eleven of 18 patients with [S,L,L] anatomy had atrioventricular spontaneous or iatrogenic complete block; none of the five patients with [I,D,D] anatomy had atrioventricular block. Pulmonary outflow tract obstruction in [S,L,L] segmental anatomy required conduit interposition in 12 of 14 of our patients to significantly decompress the ventricle. Postoperative development or exacerbation of anatomic tricuspid valve regurgitation occurs in TGA [S,L,L] and may be causally related to surgical complete atrioventricular block.
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PMID:Corrected transposition and repair of associated intracardiac defects. 708 42

Forty-one children with transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction underwent a Rastelli operation between 1971 and 1978. A homograft valve preserved in an antibiotic solution and extended with A dacron tube was the conduit of choice. Alternatively, conduits with porcine heterografts or valves constructed from calf pericardium were used. They were positioned to the left of the aorta whenever possible. The intraventricular tunnel from the left ventricle to the aorta was constructed from Dacron velour. There were four early and seven late deaths. The last 13 consecutive patients have survived. Early deaths were related to unfavourable anatomy, conduit compression, and sepsis. Residual ventricular septal defects and postoperative infection were the main factors contributing to the late deaths.
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PMID:Rastelli procedure for transposition of the great arteries, ventricular septal defect, and left ventricular outflow tract obstruction. Early and late results in 41 patients (1971 to 1978). 719 40

Knowledge of the changes during transition from fetal to neonatal circulation is useful for the understanding of physiologic and pathologic variations in the neonatal cardiovascular system. Cyanosis as well as clinical symptoms of congestive heart failure in the neonate are unspecific and may represent cardiac and noncardiac disease (primary pulmonary disease, septicemia, intracranial haemorrhage or meningitis, polyglobulism). Besides detailed analysis of clinical symptoms, the examination of arterial bloodgases when breathing from room air and 100% oxygen, the electrocardiogram, the chest-roentgenogram, and the echocardiogram are of diagnostic value. Specific cardiovascular problems during the neonatal period are the patent ductus arteriosus in the premature infant and the so-called persistent fetal circulation. Among the many congenital cardiac defects potentially causing problems in the neonate the most important are complete transposition of the great arteries, coarctation of the aorta, hypoplastic left heart syndrome, and severe tetralogy of Fallot or pulmonary atresia with ventricular septal defect. With good cooperation between obstetrician, neonatologist and paediatric cardiologist, most neonates with cardiologic problems can nowadays be timely diagnosed and successfully treated.
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PMID:[Cardiological problems in the neonatal period (author's transl)]. 719 20

As heart transplantation becomes more commonly applied to the pediatric population, it is important to determine if previous palliative or reparative operations increase the risk of transplantation. Since 1988, 13 children aged 23 months to 14 years (mean 9.5 years) who had undergone previous heart operations underwent orthotopic heart transplantation. These children had undergone an average of 3.2 previous operations (range 1 to 7):1.9 sternotomies (range 0 to 5) and 1.2 thoracotomies (range 0 to 3). Three children had undergone only palliative operations (Norwood procedure, Waterston shunt, and transthoracic pacemaker); the remaining 10 had undergone at least one "corrective" operation: four valve replacements or repairs (three mitral and one aortic), three Fontan procedures, one Rastelli procedure, one double-outlet right ventricle repair, and one ventricular septal defect repair. At the time of transplantation, seven patients (54%) were on inotropic support, two with mechanical ventilation. Three patients (23%) had significant levels of preformed antibodies necessitating a prospective cross-match, which significantly delayed transplantation. The transplant procedure was complicated by the need for pulmonary arterial reconstruction in six patients (46%), transposition of the great arteries in three patients (23%), and atrial baffling to redirect anomalous venous drainage in one patient (8%). There was one death 4 days after surgery from sepsis in a patient who had undergone a previous Konno procedure who required 24 hours of mechanical right ventricular assistance after transplantation. Two children (15%) required mediastinal exploration for bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Heart transplantation in children who have undergone previous heart surgery: is it safe? 750 51

The spectrum of patients operated on without preoperative catheterization and angiography, the accuracy of echocardiographic diagnosis and its impact on the results of surgical treatment were prospectively assessed in 2,788 children consecutively operated for congenital heart defects (CHD) between 1986 and 1992. The overall percentage of surgery based solely on noninvasive preoperative examination increased from 63% in 1986 to 81% in 1990 and decreased to 72% in 1992. There were no differences in the preoperative diagnostic approach between groups of newborn, infants and children. A high percentage of patients with patent ductus arteriosus (96.5%), atrial septal defect (94%), incomplete atrioventricular septal defect (88.6%), ventricular septal defect (86.3%), coarctation of the aorta (80.2%) and total anomalous pulmonary venous connection (79.3%) was referred for surgery without prior invasive examination, while a lower percentage was found in univentricular heart (48.4%), pulmonary atresia (34.6%) and double outlet right ventricle (27.7%). More patients with pulmonary and tricuspid atresia were catheterized before complete repair compared to those who underwent palliative surgery (p < 0.01 and p < 0.0001, respectively). The echocardiographic diagnosis was correct in 96% of patients. Two patients of those with incomplete preoperative diagnosis died early postoperatively, both with missed apical ventricular septal defect. One with tetralogy of Fallot died after reoperation, the other with persistent truncus arteriosus due to sepsis. When the echocardiographic findings are in full agreement with the clinical status, physical examination, ECG and chest X-ray, we recommend cardiac surgery without prior catheterization in many patients with CHD.
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PMID:Seven-year experience of noninvasive preoperative diagnostics in children with congenital heart defects: comprehensive analysis of 2,788 consecutive patients. 758 60

Interrupted aortic arch (IAA) is often related developmentally to subaortic obstruction (SAO). When severe, SAO must be addressed in surgical management of IAA. From 1990 to 1993, 25 neonates presented for initial surgical management of IAA complexes. Associated lesions were ventricular septal defect (VSD) with or without atrial septal defect (19 patients), truncus arteriosus (3 patients), tricuspid atresia with transposition of the great arteries (1 patient), aortic atresia with VSD (1 patient), and d-transposition of the great arteries with VSD (1 patient). Overall hospital mortality was 20% (five deaths). One death was related to sepsis and two to sudden hemodynamic decompensation (a 2-kg premature infant after arch repair and VSD closure and a neonate with IAA-truncus arteriosus after arch repair and truncus repair with aortic root replacement). Two deaths were related to low cardiac output in patients with severe subaortic narrowing (< 3 mm by two-dimensional echocardiography), which was not addressed surgically. Of 10 additional patients judged preoperatively to have severe SAO, 1 underwent resection of the infundibular septum together with VSD closure and arch reconstruction, and 9 underwent a modification of Norwood's operation with arch reconstruction and proximal pulmonary artery to aortic anastomosis (7 with systemic to pulmonary artery shunts and 2 with right ventricle to pulmonary artery outflow tract reconstruction). One patient died 2 months after surgery of staphylococcal sepsis. All 9 others were discharged well. Subaortic narrowing is a physiologically important element of IAA complexes. When SAO is severe, satisfactory initial palliation can be achieved by a modification of Norwood's operation.
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PMID:Interrupted aortic arch. Impact of subaortic stenosis on management and outcome. 758 95

Three consecutive neonates (aged 7, 14 and 30 days, body-weight 2980 g, 3000 g and 3400 g respectively) with interruption of the aorta (n = 2) and severe coarctation (n = 1) in the presence of left aortic arch and right descending aorta are reported. Associated lesions were an aortopulmonary window in the first case and an unrestrictive ventricular septal defect in the two others. Intractable heart failure and the complexity of the malformation led to the decision of a staged operation. A prosthetic graft was interposed between the ascending and descending aorta via a right thoracotomy in order to bridge the atretic or hypoplastic segment without using extracorporeal circulation. There was no intraoperative complication. One patient developed a thrombocytopenia within the frame of a sepsis syndrome and died on day 5 after operation, death being caused by a massive bleeding into the left thoracic cavity, although the operation was carried out via a right thoracotomy. Angiography 1 year after operation revealed a good flow through the grafts and no stenosis at the site of the anastomoses. The two surviving infants are clinically well without any medication. The reported operative technique provides an alternative palliative possibility to manage critically ill neonates without any obstacle to later definitive repair.
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PMID:Left aortic arch and right descending aorta--interruption or severe coarctation of the aortic arch in the newborn. 778 Jul 16

Between January 1990 and September 1992, ten patients required assisted circulation for postcardiotomy heart failure which was unresponsive to inotropic drugs and aortic counterpulsation. All patients were supported by a Bio-Medicus centrifugal pump (biventricular assist in five, left ventricular in three, right ventricular in two); six had ischaemic heart disease, two a congenital ventricular septal defect, one an acute mitral valve incompetence and one an aortic type 'A' dissection. The mean duration of circulatory support was 5.1 days (range 2 hours to 8 days). Six patients were weaned from the device and four were discharged; the perioperative deaths among the patients weaned from support were the result of cerebral haemorrhage and multiorgan failure respectively. No late deaths occurred at a mean follow-up of 15 months. Common complications were bleeding (40%), acute renal failure (30%) and sepsis (30%). All patients who developed renal failure died. The high incidence of haemorrhagic complications makes the use of pre-heparinized circuits desirable as these patients do not then require additional anticoagulation.
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PMID:Assisted circulation in postcardiotomy heart failure: experience with the Bio-Medicus centrifugal pump in ten patients. 782 May 27

A 37-week gestation male boy was born to a gravida seven para six mother by spontaneous vertex delivery at home. The baby cried at birth. On day 3 of life, he was admitted for respiratory distress. Physical examination revealed ectrodactyly, thin dry skin, anomalous tear duct with cardiomegaly. X-ray revealed absent radii, cardiomegaly and hemivertebra at L1. Echocardiogram revealed perimembranous type of ventricular septal defect. A diagnosis of Ectodermal Dysplasia Ectrodactyly Clefting Syndrome with ventricular septal defect was made. He was managed conservatively in the nursery. However, he expired on day 27 of life following short spell of fever apnoeic episode due to neonatal sepsis.
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PMID:A neonate with ectodermal dysplasia ectrodactyly clefting syndrome and ventricular septal defect. 793 23


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