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Query: UMLS:C0042373 (vascular disease)
 17,070 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Three patients with interruption and seven with hypoplasia of the aortic arch were treated surgically. The subclavian artery and the aortic isthmus were employed for reconstructing the aortic arch in five, and a Dacron prosthesis was used to restore the aortic continuity in five. A ductus arteriosus coexisted in all patients and a ventricular or atrial septal defect in nine. Congestive heart failure and pulmonary hypertension were prominent clinical features, and the role of the ductus and other intracardiac anomalies on their pathogenesis in discussed. Six patients, one with an interrupted and five with a hypoplastic arch survived but three have evidence of either pulmonary vascular disease or significant pulmonary hypertension. Only one patient with hypoplasia of the arch is now considered cured after his ventricular septal defect was closed in a second operation. The analysis of this and other series in the literature indicate a high mortality rate of the conditions; however, early surgical treatment, which is the only effective means to control heart failure and avoid the effects of prolonged pulmonary hypertension, has brought upon a decline in mortality in recent years.
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PMID:[Surgical treatment of congenital interruption and hypoplasia of the aortic arch]. 13 70

Clinical, experimental and pathologic studies strongly indicate that hypertension is a major factor in coronary heart disease, sudden death, stroke congestive heart failure and renal insufficiency. The deleterious effect of the elevated blood pressure on the cardiovascular system appears to be due mainly to the mechanical stress placed on the heart and blood vessels. Humoral factors and vasoactive hormones such as angiotensin, catecholamines and prostaglandins may play a role in the pathogenesis of hypertensive cardiovascular disease but this role has not yet been defined and is probably secondary. Hypertension and the resulting increase in tangential tension on the myocardial and arterial walls, leads to the development of hypertensive heart disease and congestive heart failure as well as hypertensive vascular disease that affects not only the kidneys but also the heart and brain. Hypertensive vascular disease involves both large and small arteries as well as arterioles and is characterized by fibromuscular thickening of the intima and media with luminal narrowing of the small arteries and arterioles. The physical stress of hypertension on the arterial wall also results in the aggravation and acceleration of atherosclerosis, particularly of the coronary and cerebral vessels. Moreover, hypertension appears to increase the susceptibility of the small and large arteries to atherosclerosis. Thus the patient with hypertension is a candidate for both hypertensive and atherosclerotic vascular disease of the coronary and cerebral vessels leading to occlusive disease of both the large and small arteries and resulting in myocardial infarction and stroke. Other major complications of hypertensive vascular disease include rupture and thrombotic occlusion of blood vessels, especially in the brain. Disease of the arterial media, which begins in childhood with the deposition of calcium in the vessels, may be an important cause of arterial hypertension. This form of hypertension may manifest itself in adults as arteriosclerotic hypertension and lead to cardiovascular complications very similar to those of essential hypertension. The relation of arteriosclerotic hypertension to nutritional factors, including dietary salt intake, deserves study.
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PMID:Role of hypertension in atherosclerosis and cardiovascular disease. 13 91

The effects of mechanical ventilation with and without positive end-expiratory pressure (PEEP) on hemodynamic performance and blood-gas exchange were studied in ten patients following open-heart surgery. Ventilation at constant tidal volume (15 ml/kg body weight) with 10 cm H2O PEEP following aortic valve replacement (AVR) IN FIVE PATIENTs without pulmonary vascular disease was associated with the following significant changes: a rise in arterial Po2, a fall in the alveolar-arterial Po2 gradient when Fio2 = 1.0, decreases in calculated Qs/Qt and cardiac index. Using a similar pattern of ventilation following mitral valve replacement (MVR) in patients with elevated pulmonary vascular resistance, we found a significant decrease in cardiac index (but less than in the AVR group), a significant elevation of calculated physiologic deadspace (Vd/Vt) and no change in Qs/Qt. An hour after removal of PEEP, intravascular pressures, blood flow and blood-gas exchange values of all patients with AVR had returned to control levels; patients with MVR had persistently significantly low cardiac indices, while Vd/Vt returned to pre-PEEP values. These findings suggest that evaluation of responses to different ventilation patterns must take into account pre-existing V/Q abnormalities secondary to pulmonary vascular disease, particularly when these are secondary to chronic congestive heart failure. Following AVR, Qs/Qt changed in the same direction as cardiac index (CI) irrespective of ventilatory pattern: CI decreased and rose as CI increased. The authors conclude that with increasing severity of pulmonary vascular disease, changes in airway pressure will have an unpredictable effect on cardiac index unless the level of myocardial competence is taken into account. In the presence of ventricular failure, changes in pleural (and therefore transmural) pressures will be minimal compared with the high filling pressures and exert no influence on stroke volume. Although pulmonary venous hypertension was more pronounded in the MVR than in the AVR group, there was no significant difference between the postoperative values for Qs/Qt (Fio2 = 1.0), a condition probably fostered by marked differences in pre-existing V/Q.
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PMID:The effect of pre-existing pulmonary vascular disease on the response to mechanical ventilation with PEEP following open-heart surgery. 23 11

The detection of congenital complete heart block (CCHB) in a fetus should alert the obstetrician that the welfare of both the mother and the newborn infant may be in jeopardy. An awareness of this uncommon cause of fetal bradycardia and judicious intrapartum monitoring can avert hasty and unnecessary cesarean section for suspected fetal asphyxia. Neonatal consequences may range from no effect to life-threatening congestive heart failure. The apparently healthy mothers of these infants may be at increased risk for the subsequent development of collagen vascular disease. Three recent case reports demonstrate the spectrum of neonatal and maternal disease that may accompany CCHB. The significance of abnormal serology suggesting a propensity for collagen vascular disease in an otherwise healthy parturient is discussed, and a program for follow-up is proposed.
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PMID:Maternal and neonatal implications of congenital complete heart block in the fetus. 49 29

Blood pressure should be routinely measured in all infants and children. Measurements should be performed with an appropriate size cuff and observed pressures compared to normal values for age. Elevated blood pressure is seen in one to ten percent of children, depending on the age group surveyed and the definition of hypertension selected. Thirty to fifty percent of children with elevated blood pressures are asymptomatic. The remainder have symptoms which are nonspecific, including headaches, visual disturbances, seizures, congestive heart failure, and facial palsy. Hypertension in children, unlike hypertension in the adult, usually has a definite cause which often responds to adequate medical and/or surgical treatment. For this reason, children with well-confirmed hypertension should be thoroughly evaluated. The most common causes of hypertension found in children are renal disease (pyelonephritis, vascular disease, structural malformations) and coarctation of the aorta. An approach to the child with transient or persistent hypertension is described. Diagnostic studies should be individualized and should follow clinical clues where possible. Medical management of the child with acute hypertension is discussed.
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PMID:Elevated blood pressures in infants and children. 62 65

Two cases of nonocclusive mesenteric vascular disease associated with stenosis of the superior mesenteric artery are described. In one patient with congestive heart failure and atrial fibrillation treated with digitalis, the first episode after a bout of sepsis was treated supportively, but a stricture of ileum secondary to full thickness intestinal infarction resulted. His second episode required emergency ileal resection for perforation. The superior mesenteric artery was subsequently reconstructed with an aortomesenteric bypass. The second patient had segmental intestinal necrosis occurring in association with superior mesenteric artery narrowing without total occlusion. These cases emphasize the importance of awareness of nonocclusive mesenteric vascular disease occurring in individuals with narrowing of the mesenteric arteries. A variety of modes of presentation are suggested. Arteriography is essential for diagnosis and, in selected cases, for therapy.
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PMID:Surgical treatment of nonocclusive mesenteric infarction. 92 Aug 97

Autopsy observations suggested that lesions of hypertensive pulmonary vascular disease (HPVD) due to elevated venous pressure differ from those with arterial hypertension only. Clinical and pathologic features were reviewed in patients from the Hopkins autopsy files with proved pulmonary hypertension; 50 had venous HPVD due to left-sided congestive heart failure, 50 had arterial HPVD due to congenital malformations, and 15 had idiopathic pulmonary hypertension (IPH). The two forms of HPVD have consistent distinctive histologic changes. In venous HPVD intimal fibroelastosis (IFE) develops in veins and arteries with retention of normal lumen diameters. Intensity of IFE correlates with severity and duration of venous hypertension. Arterial HPVD has IFE in conducting arteries, but the characteristic lesion is cellular intimal proliferation in regulatory arterioles, producing progresssive irreversible lumenal narrowing. Glomoid and angiomatoid lesions appear with prolonged severe arterial hypertension. They do not occur in venous HPVD. Hypertensive arteritis may develop with either form of HPVD. IPH has arterial-type HPVD. IFE of venous HPVD appears to be a response to increased mural tension. Arteriolar intimal cellular proliferations seen in arterial HPVD may be produced by blood flow boundary layer separations. IPH may be explainable as protracted inappropriate pulmonary arteriolar constriction.
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PMID:The pathogenesis of the two forms of hypertensive pulmonary vascular disease. 99 86

The first 350 patients having coronary surgery at Stanford Medical Center (excluding patients with aneurysmectomy or valve replacement) have been followed sequentially utilizing a computer-based information system. Our experience spans 72 months (900 patient-years), with an average follow-up of 30 months. Hospital mortality was 4.9%. Actuarial analysis revealed survival of 91% at 1 year and 80% at 6 years. Forty patients (11.5%) had 43 late myocardial infarctions, of which 5 were fatal. Analyses of selected patient subgroups revealed significantly poorer survival in patients with prior myocardial infarction (P less than 0.05), significant congestive heart failure, or mitral regurgitation (P less than 0.01). Survival in multigrafted (and multivessel) patients was not significantly different from survival in single-grafted (predominantly single-vessel) patients. Actuarial studies suggest improved survival in patients with multivessel disease after coronary artery surgery. Between an initial evaluation at 9 months postoperatively (range: 2 to 40 months) and the most recent evaluation after 30 months (range: 6 to 72 months), 13% of patients showed further clinical improvement, 47% were unchanged, while 40% deteriorated with respect to chest pain. We conclude that initial symptomatic benefits may not be maintained in late follow-up studies owing to progression of underlying vascular disease.
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PMID:Changes in survival and symptom relief in a longitudinal study of patients after bypass surgery. 108 Apr 47

Surgical closure of VSDs is indicated mainly for those that are larger and causing either servere congestive heart failure or else pulmonary vascular disease. The latter, producing an increased pulmonary vascular resistance, is usually reversible if the VSD is closed under 2 years of age, but may become irreversible if left for longer times. Primary closure of the VSD, even in infants is in many centers done with a lower mortality than banding of the pulmonary artery and late VSD repair. Selection of patients needs great care because VSDs frequently get smaller or close spontaneously, even if initially large.
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PMID:Indications for and results of surgery in ventricular septal defects. 127 84

The endothelium possesses the ability to modulate vascular tone by the release of vasodilator and vasoconstrictor substances, among them endothelium-derived relaxing factor (EDRF) and endothelin. Abnormalities in EDRF generation were demonstrated in various cardiovascular pathophysiological states, specifically atherosclerotic vascular disease, congestive heart failure, and essential and pulmonary hypertension. Moreover, increases in plasma endothelin concentration have been reported as well in these disease states. When these observations are taken together, these states may be characterized by an attenuated release of EDRF, whereas the release of endothelin is augmented. An imbalance between EDRF and endothelin may contribute to the alteration in vascular tone characteristic of cardiovascular disease. The following review summarizes the present knowledge of the role of EDRF and endothelin in such disease processes.
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PMID:Intact and altered endothelium in regulation of vasomotion. 142 46


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