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

Eighty patients underwent open-heart surgery from March 1990 to March 1993. We used combined aortic root (antegrade)/coronary sinus (retrograde) perfusion for cardioplegia delivery as a means of myocardial protection. The special retroplegia cannula was introduced to the coronary sinus (CS) in 67 patients by the transatrial (blind intubation) after one cannula cava insertion; the CS was cannulated under direct vision by right atriotomy after bicaval cannulation in 13 patients. Varied and prolonged cardiac procedures were done using cooled crystalloid cardioplegia (4 centigrades + potassium) except in one patient with severe ventricular damage in whom warm blood cardioplegia was infused. There was no CS or cardiac vein damage or disruption. There was no A-V blockade. The CS was intubated easily in all cases and cardioplegia solution readily infused. Coronary sinus pressure never exceeded 40 mm Hg. Overall hospital mortality (30 days postoperative) was 3.75% (3 cases). Sepsis was the cause of death in 2 patients and stroke in one. Inotropes were used in few cases as a means of renal protection. We conclude that the combined antegrade/retrograde cardioplegia delivery can be used routinely in most patients undergoing open-heart surgery.
Arch Inst Cardiol Mex
PMID:[The versatility of anterograde/retrograde cardioplegia in heart surgery]. 829 27

Endothelium-derived vasoactive factors are produced by the endothelium activated by effective stimulus, and with paracrine regulatory activity of the tone/proliferation of the vascular smooth muscle and platelet function. They are divided in two groups: endothelium-derived relaxing and contracting factors. Among the endothelium-derived relaxing factors, PG I2, EDRF (NO or other nitrous compound) and EDHF (still unidentified) have been considered Synthetized by the endothelium after stimulation by plasmatic, platelet-derived and endothelium-derived substances and mechanisms, towards the vascular smooth muscle (myorelaxing/cytostatic) and the platelets (antiaggregation). The endothelium-derived contracting factors include the EDCF1 (endothelins, 21 amino acids peptides), EDCF2 (O2-) and TxA2. Its production, induced by stimulus similar to those for relaxing factors, promotes constriction/mitogenesis of the vascular smooth muscle and platelet aggregation. Probably, endothelin-1 has indirect actions over hormonal mechanisms of cardiovascular and renal regulation. The vascular system establishes a tight regulation over the production of these endothelium-derived vasoactive factors. Its loss (usually due to alteration of endothelial responsiveness to stimulation) allows local or generalized modifications of the vascular tone. These can depend on hypertension, atherosclerosis, ischemia-reperfusion lesion, diabetes, inflammation and situations of farmacotoxicity (all developing vasoconstriction/vasospasm) or by septicemia (leading to vasodilation). This disregulation is also involved in the pathogenesis of hypertension, atherosclerosis and ischemia-reperfusion. The vascular tone regulation by endothelium also leads to systemic consequences. Essentially by decreasing cardiac, cerebral and renal blood flow it implies morphologic and functional modifications of these organs.
Rev Port Cardiol 1993 Jun
PMID:[Vasoactive endothelial factors]. 833 93

In-hospital and late complications related to percutaneous placement of 240 intraaortic balloon pump catheters in 231 consecutive patients from March 1985 through June 1990 were reviewed. Mean age was 64 +/- 11 years and 34% were women. Average duration of counterpulsation was 44.2 hours. Indications for counterpulsation included complications of myocardial infarction (34.6%), prophylactic placement before high-risk coronary angioplasty (20.0%) or open heart surgery (12.9%), complicated coronary angioplasty (18.3%), end-stage cardiomyopathy (5.4%) and miscellaneous (8.8%). Early major complications occurred in 11 cases (4.6%) and included limb ischemia requiring surgery (n = 9), bleeding requiring arterial repair (n = 1) and septicemia (n = 1). Other complications included hematoma requiring transfusion (n = 7), limb ischemia resolving with balloon catheter removal (n = 12), and superficial wound infection (n = 1). Overall in-hospital complication rate was 13% (31 of 240). Peripheral vascular disease and diabetes were found to be significant predictors of limb ischemia (p = 0.01 and p = 0.02, respectively). Follow-up information was obtained in 97% of patients with a mean duration of 19 months: 2 patients (1.1%) required vascular surgery for femoral false aneurysms and 1 patient experienced new onset of claudication. In conclusion, compared with previous experience, contemporary intraaortic balloon counterpulsation with percutaneous placement of smaller size (8.5Fr to 10.5Fr) catheters is associated with improved complication profile. This will further enhance the current trend for an expanding role of intraaortic balloon counterpulsation in complex interventional procedures.
Am J Cardiol 1993 Feb 01
PMID:Complications associated with percutaneous placement and use of intraaortic balloon counterpulsation. 842 77

From December 1975 to September 1989, nine children, ages 0.6-15.8 years (mean = 8.1 years) and weighing 5-44 kg (mean = 24 kg), were identified as requiring intraaortic balloon pump support. Indications included ventricular failure refractory to maximal conventional therapy, inability to wean from cardiopulmonary bypass, and myocardial ischemia. Prior to insertion of the balloon catheter, mean systolic blood pressure was 64 mmHg, one to four cardiotonic medications were being administered, mechanical ventilation was being performed in eight patients, and mean urine output was 0.4 ml/kg/min in eight. Following balloon catheter insertion, mean urine output increased to 0.9 ml/kg/min. Four patients survived following discontinuation of the balloon catheter 12-96 h (mean = 59 h) after initiation. Though complications such as loss of distal lower extremity pulses, sepsis, thrombocytopenia, and abdominal distention were observed, most could be attributed to other causes. Thus, the intraaortic balloon pump is a valuable addition to conventional medical therapy in the treatment of refractory cardiogenic shock in children.
Pediatr Cardiol 1993 Jan
PMID:Intraaortic balloon pump management of refractory congestive heart failure in children. 845 16

Topical congenital pulmonary vein stenosis is a uncommon defect, both isolated or associated to other cardiac abnormalities. Only the localization of the lesions seems to affect the survival, because 60% of survival cases has unilateral stenosis; the severity of associated cardiac lesions become the prognosis poor. We describe two cases: 1st case, a 43 days old boy presented with heart failure and convulsion and had a diagnosis of pulmonary hypertension, atrial septal defect and tricuspid regurgitation, without pulmonary abnormalities. He had recurrent pulmonary infections and a cerebral ischemia in the following months, and died at 15 months of age for sepsis. Autopsy revealed stenosis and atresia in all pulmonary veins, with venous and arterial hypertension. There was also aortic hypoplasia and aortic and tricuspid valves indifferentiation; 2nd case, a 7 days old girl had a diagnosis of aortic coarctation and atrial and ventricular septal defects. Surgical corrections, at 38 and 46 days old, firstly of the aortic coarctation and after for the septal defects, disclosed and relief a supra-valvar mitral stenosis, but she remained on heavy respiratory insufficiency. At 6 months old, she returned to the hospital with dyspnea and cianosis, heart failure and hemoptisis; a sepsis developed and she died. At autopsy, there were severe pulmonary vein stenosis on the left and in the superior right veins, with pulmonary hypertension and hemorrhage.
Arq Bras Cardiol 1995 Jul
PMID:[Pulmonary vein stenosis. Report of 2 cases and review of the literature]. 854 96

Adiposity of the heart is characterized by an increase in the amount of epicardial and other adipose tissue. The most pronounced changes involve the right ventricle. The adipocytes may be interposed between myocytes, and in severe cases the normal mechanics and function of the ventricle are impaired. Adiposity of the heart is usually an incidental finding at autopsy, and only rarely is it of clinical significance. This report describes a 46-year-old female with multiorgan failure secondary to bronchopneumonia, purulent pericarditis, tamponade and sepsis, whose clinical course was altered due to severe adiposity of the heart, so-called 'adipositas cordis'.
Can J Cardiol 1996 May
PMID:Right heart failure due to ventricular adiposity: 'adipositas cordis'--an old diagnosis revisited. 864 May 94

The use of cardiopulmonary bypass for surgical cardiac procedures is characterized by a whole-body inflammatory reaction due to the contact of blood through nonendothelialized surfaces; this stimulates the organism to recognize the cardiopulmonary bypass system as "nonself" and to activate specific (immune) and nonspecific (inflammatory) responses. These responses are then related with postoperative damage to many body systems, like pulmonary, renal or brain dysfunction, excessive bleeding and postoperative sepsis. In this paper, present knowledge on untoward responses of the patient to the use of cardiopulmonary bypass in cardiac surgery is reviewed and discussed, particularly focusing on the perturbation of the hemostasis and of the complement activation system.
G Ital Cardiol 1996 Apr
PMID:[Heart surgery, cardiopulmonary bypass and inflammatory response. I. Changes in hemostasis and complement]. 870 28

The use of cardiopulmonary bypass for surgical cardiac procedures is characterized by a whole-body inflammatory reaction due to the contact of blood through nonendothelialized surfaces; this stimulates the organism to recognize the cardiopulmonary bypass system as "nonself" and to activate specific (immune) and nonspecific (inflammatory) responses. These responses are then related with postoperative damage to many body systems of the body, like pulmonary, renal or brain dysfunction, excessive bleeding and postoperative sepsis. In this paper, present knowledge on untoward responses of the patient to cardiopulmonary bypass in cardiac surgery is reviewed and discussed, particularly focusing on the perturbation of the leukocytes, of the hormones and of the products of the arachidonic acid cascade.
G Ital Cardiol 1996 May
PMID:[Heart surgery, cardiopulmonary bypass, and organic inflammatory response. Part II: changes in leukocytes, arachidonic acid derivatives, and hormones]. 876 79

A 42-year-old man with aplastic anemia presented to hospital toxic and septic secondary to central Silastic catheter sepsis. The chronic indwelling catheter fractured during an attempt at removal and the distal remnant embolized to the right ventricular outflow tract and main pulmonary artery precipitating near cardiopulmonary collapse. The thrombosed catheter was successfully retrieved under fluoroscopy by an endovascular snare technique thus avoiding operative intervention in this immunosuppressed, thrombocytopenic and septic individual. The patient had an uneventful recovery.
Can J Cardiol 1996 Sep
PMID:Retrieval of Silastic catheter fragment from heart in septic thromboembolism complicating aplastic anemia. 884 31

Bidirectional cavopulmonary shunt is an alternative palliative procedure for patients with congenital cyanotic heart disease, specially those patients less than "ideal" candidates for a Fontan's procedure. We present our results with this shunt in patients with tricuspid atresia. Twenty patients with tricuspid atresia were operated on with this shunt, with these associated defects: 20 atrial septal defect, 17 ventricular septal defect, 10 pulmonary stenosis, 1 pulmonary atresia and 1 transposition of the great arteries. Sex: 10 males and 10 females; the age was 27 days to 6 years (mean 1.8 years), the weight was 3.2 kg to 24 kg (mean 10.7 kg), the mean pulmonary artery pressure was 11 to 24 mmHg (mean 17 mmHg), pulmonary vascular resistance was 1.5 to 5 UW (mean 3.1 UW). Postoperative oxygen saturation improved 15 to 120%. All patients survived the surgical procedure. Three patients died in the immediate postoperative period, 2 due to a complications in the postoperative period and 1 due to sepsis. There were two late deaths, 1 sudden death after 6 months of the shunt, and 1 due to sepsis after a Fontan's procedure. Four patients presented pleural effusion and 2 pericardial effusion, they resolved well. We have 15 patients alive and well, in functional class I, and minimal cyanosis. We can conclude that this surgical procedure is useful in the management of patients with tricuspid atresia.
Arch Inst Cardiol Mex
PMID:[Bidirectional cavopulmonary diversion for tricuspid atresia. Experience in the National Institute of Cardiology]. 896 17


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