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Query: UMLS:C0243026 (sepsis)
 52,417 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Transesophageal echocardiography provides excellent images of intracardiac masses; however, its use among a series of patients with central venous lines has not been fully described. Nineteen patients (aged 52 +/- 16 years; 10 women) had masses detected by transesophageal echocardiography in the presence of a permanent (0.2 to 16 years) pacing wire (n = 8), and a current (n = 9) or recent (n = 2) (1 to 281 days) indwelling catheter. Transthoracic echocardiography suggested the presence of a mass in 5 patients (26%), although in only 2 cases were its findings consistent with transesophageal findings. Transesophageal echocardiography indicated the presence of a mass in or near the superior vena cava in 13 patients, in the right atrium in 6, and adjacent to the tricuspid valve in 3. Discrete masses measured 1.6 +/- 2.1 cm2 in area during transesophageal echocardiography. Eleven patients had positive blood cultures, 7 with staphylococcal species. Mass size was not significantly altered by the type of line or sepsis, but showed a weak correlation with line age (r = 0.56). Transesophageal echocardiography altered the management of 9 patients, prompting surgery (n = 3) and line removal (n = 3), and antibiotic (n = 2) or anticoagulation (n = 3) therapy.
Am J Cardiol 1992 Oct 01
PMID:Transesophageal echocardiographic diagnosis of right-sided cardiac masses in patients with central lines. 152 48

From July 1988 to March 1991, extracorporeal membrane oxygenation (ECMO) was used in 8 infants (newborn to 16 months old) with unoperated cyanotic congenital heart disease and cardiopulmonary collapse, associated with hypercyanotic spells (4 infants), pulmonary hypertensive crises (3) and sepsis (1). Indications for ECMO support were arterial saturations less than or equal to 60% accompanied by hypotension and metabolic acidosis unresponsive to mechanical ventilation with 100% oxygen, paralysis and sedation, and pharmacologic support with inotropes or vasodilators, or both. Venoarterial bypass by carotid/jugular cannulation with flow rates of 100 to 840 ml/kg/min (mean 460) stabilized all patients. Duration of ECMO support ranged from 15 to 840 hours and was associated with transient seizures (1 patient) and renal failure (1). Seven patients underwent palliative (3 patients) or corrective (4) surgical procedures while on ECMO or within 48 hours of decannulation, including 1 patient bridged to double-lung transplantation with a long (840 hours) duration of ECMO. There was 1 operative and 2 late (greater than 1 month after decannulation) deaths, for an overall survival rate of 62%. These 5 survivors all have normal growth and development, and patent neck vessels at the site of cannulation. These early results indicate that ECMO can be effective mechanical support in cardiovascular crises untreatable with maximal conventional medical therapy and can be used as a bridge to successful surgical palliation or repair.
Am J Cardiol 1992 Mar 15
PMID:Extracorporeal life support in cyanotic congenital heart disease before cardiovascular operation. 154 55

Diseases accompanied by severe cardiac impairment like sepsis and chronic uremia are frequently linked to an increase in cytokine release. In order to investigate possible toxic effects of the immune mediators on myocardial cells, we studied the contractility of cardiac myocytes and the de novo formation of stress proteins in cultured heart cells under cytokine exposition. All cytokines investigated induce, concentration-dependently, arrhythmias and cessation of spontaneous contractions. Interleukin(IL)-2, IL-3, IL-6, and tumor necrosis factor (TNF) stimulate the synthesis of a 30 kD stress protein in heart cells, whereas IL-1 additionally evokes two proteins of the 70 kD family. These findings confirm a direct interference of the interleukins and TNF with myocytes and, especially, myocardial protein formation. As the induction of stress proteins makes cells more resistant towards a subsequent challenge, the cytokines are possibly involved in the activation of cell protecting mechanisms in cardiac myocytes.
Basic Res Cardiol
PMID:Cytokines induce stress protein formation in cultured cardiac myocytes. 156 50

This paper describes our preliminary experience with left main coronary angioplasty in 8 patients (9 procedures). In 6 patients the left main coronary artery was "protected" either by previous by-pass surgery (4 patients) or by collateral vessels from the right coronary artery (2 patients). Three patients had a total occlusion of the left main coronary artery and 2 of them had a recent or acute myocardial infarction and the coronary angiogram suggested a thrombotic occlusion of the infarct-related artery. Three patients were not considered surgical candidates and an additional patient, who was in cardiogenic shock, required an emergency coronary angioplasty as "rescue" procedure. A successful dilatation was achieved in 6 patients (including a patient with successful deployment of a Palmaz-Schatz stent) but, unfortunately, one them eventually died 7 days later from a femoral sepsis related to the procedure. However in the 2 remaining patients--with a total occlusion of the left main coronary artery in relation with a myocardial infarction--the dilatation procedures were unsuccessful. One patient underwent a successful repeat coronary angioplasty for restenosis of left main coronary artery. Our preliminary experience confirms previous reports suggesting the value of coronary angioplasty in patients with left main coronary artery disease providing a careful selection of possible candidates is performed prior to the procedure.
Rev Esp Cardiol 1992 May
PMID:[Transluminal percutaneous coronary angioplasty of the left coronary artery]. 160 35

Although often not considered, the heart is one of the targets of multiple organ failure in sepsis and septic shock, with myocardial depression being a prominent component of this "acute septic cardiomyopathy". Hypotheses concerning the etiology of this depression are increasingly elucidated on a cellular level, including dysfunction of the beta-adrenoceptor/G protein/adenylate cyclase system, calcium channel blockade by cardiodepressant factor, contractile impairment by activated leucocytes, as well as inhibition of protein synthesis by Pseudomonas exotoxin A. In the search for "mechanisms of myocardial depression in sepsis", isolated cardiomyocytes may play a role as research tools with respect to: a) discrimination between direct and indirect cardiodepressant effects; b) identifying not only the acute, but also chronic toxin- and mediator-induced cardiodepression; c) clarification of the mechanism of action of cardiodepressant bacterial toxins and sepsis mediators; d) establishment of in vitro models of leucocyte-mediated cardiodepression in sepsis.
Basic Res Cardiol
PMID:Mechanisms in acute septic cardiomyopathy: evidence from isolated myocytes. 166 46

Aortic valve replacement (AVR) using allografts is an established method of treating aortic valve disease. It is uncertain, however, whether the increased technical demands of allograft AVR can be justified in emergency operations. This study reports 15 patients treated between 1987 and 1990 for acute bacterial or fungal endocarditis involving the aortic valve. Patients underwent emergency AVR because of severe congestive failure, overwhelming sepsis or cerebral emboli. Eight patients received prosthetic valves (group I: 4 mechanical, 4 porcine) and 7 received human allografts (group II: 5 aortic and 2 pulmonary). The groups were comparable in age (group I, 55 years; group II, 51 years), intravenous drug abuse (group I, 1; group II, 3), and previous AVR (group I, 3; group II, 2). One group I and 4 group II patients had septal abscesses. Additional procedures in group I included mitral valve replacement (2), tricuspid valve replacement (1) and aortic root replacement (1). Additional procedures in group II were mitral valve repair (1), root replacement (1), atrial septal defect closure (1) and aortocoronary bypass (1). Mean bypass times (group I, 189 minutes; group II, 204 minutes) and cross-clamp times (group I; 108 minutes; group II, 121 minutes) were similar. Operative deaths occurred in 4 of 8 group I and 1 of 7 group II patients. All surviving patients have been successfully followed (group I, 28 months; group II, 18 months). No group I patient has required reoperation. One group II patients required reoperation for recurrent infection affecting the allograft, and another group II patient died 10 months postoperatively from noncardiac causes.(ABSTRACT TRUNCATED AT 250 WORDS)
Am J Cardiol 1991 Sep 01
PMID:Comparison of allografts and prosthetic valves when used for emergency aortic valve replacement for active infective endocarditis. 187 81

The outcome of 30 consecutive patients with active aortic prosthetic valve endocarditis and root abscesses treated by the technique of homograft aortic root replacement with reimplantation of the coronary arteries is detailed. The principles of this technique are the removal of all abscesses and infected areas likely to drain into the infected mediastinum, excision of infected tissues down to healthy noninfected tissue and replacement with an antibiotic-impregnated homograft aortic root. All patients had evidence of progressive cardiac failure and ongoing sepsis. Mean patient age (+/- SD) at the time of operation was 42 +/- 18 years. The mean number of previous aortic valve replacements per patient was 1.6 +/- 0.7; 14 patients (47%) had undergone greater than or equal to 2 previous replacements. At operation, aortic root abscesses were found in all patients; abscess extension to adjacent structures and partial valve dehiscence had occurred in 23. In-hospital death occurred in 9 (30%) of the 30 patients. The 21 hospital survivors have been followed up for a mean of 66 +/- 42 months (range 9 to 144). Overall, 17 (81%) of the 21 hospital survivors have remained free of major adverse events (recurrence of endocarditis, need for reoperation or death). The results of our study suggest that homograft aortic root replacement should be considered favorably in the treatment of patients with aortic prosthetic valve endocarditis and root abscesses.
J Am Coll Cardiol 1991 Apr
PMID:Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement. 200 19

A 17-year-old woman with mitral and tricuspid valve prolapse and myxomatous degeneration presented puerperal infection by Staphylococcus aureus with clinical picture of sepsis and multiple septic embolism (right eye, left thumb, spleen, and left calf). She underwent total hysterectomy on the 10th day postdelivery and right eye enucleation on the 16th. Temporary total AV block occurred on the 14th day with temporary external pacing during the next couple of days. Acute endocarditis with acute mitral regurgitation was diagnosed on the 13th day, demanding immediate valve replacement. On the 46th day she developed moderate tricuspid valve regurgitation due to another episode of endocarditis. Final clinical discharge took place on the 62nd day after antibiotic therapy completion.
Arq Bras Cardiol 1990 Dec
PMID:[Staphylococcus aureus endocarditis in a puerperal woman with mitral and tricuspid valve prolapse]. 209 20

The purpose of the present study was to review the results obtained in patients with a ventricular assist devices (VAD) in our hospital, and to discuss various problems concerning a VAD use, such as indications, right ventricular failure, and evaluation of cardiac function. Fourteen VADs were applied to 11 patients for left ventricular assist, including two for right ventricular assist and for one as biventricular assist with a VAD in the left and a biopump in the right. The clinical diagnoses of the patients were as follows: 10 ischemic heart disease, two valvular disease, one acute aortic dissection, and one corrected transposition of the great arteries. VADs were indicated in 11 patients because of difficulty in weaning from cardiopulmonary bypass (CPB), and in three patients because of cardiogenic shock after discontinuing CPB. Among the 14 patients, 11 had an effective VAD, six were successfully weaned from a VAD, and two survived. The VAD was ineffective due to uncontrollable bleeding and improper indications for the device, as in applying a one-sided heart assist when a biventricular assist was necessary. In spite of an effective VAD, five patients could not be weaned from VAD because of brain damage, sepsis, and hypoxia. After removing a VAD, four patients died; one due to mediastinitis, two due to respiratory failure, and one due to low output syndrome. All the four patients had renal failure followed by multi-organ failure finally, because of prolonged CPB time. The CPB time was shorter among the long survivors than in others. Cardiac function during assist and the weaning probability from a VAD were evaluated not only by the so-called on-off test, but also by transesophageal Doppler echocardiography. Ventricular wall motion and pulmonary venous flow pattern were analyzed by transesophageal Doppler echocardiography. The pattern of monophasic forward flow in the pulmonary vein was associated with reduced wall motion during deteriorated cardiac function, while the flow pattern became biphasic as cardiac function recovered. From these results, we concluded as follows: 1. Early decisions as to whether VAD is indicated are important. 2. A right VAD should be considered in cases with biventricular failure, during left ventricular assist, if right atrial pressures elevated more than 18 mmHg constantly. 3. The evaluation of cardiac function by transesophageal Doppler echocardiography is useful for making decisions as to wean patients from a VAD.
J Cardiol 1990
PMID:[Problems in patients with use of a ventricular assist device]. 210 21

Two methods of serial electrophysiologic testing are in widespread use. Most commonly, the electrode catheter is removed after each study and a new catheter reinserted through the femoral vein for every subsequent test. An alternative method employs an electrode catheter that remains in place during several days of serial testing. Little is known about differences between these two methods with respect to the likelihood of induction of arrhythmia or the frequency of complications. To determine whether inducibility of sustained arrhythmia is altered or if the frequency of complications is unacceptably high with use of an indwelling catheter, a prospective randomized study was conducted in 78 patients. Each patient underwent baseline testing, several days of electropharmacologic testing with an indwelling catheter, a 24 h drug elimination period and placement of a new electrode catheter. Ventricular stimulation studies were then performed in each patient with both the indwelling and new electrode catheters. No differences were found between the indwelling and new catheter tests with respect to induction of arrhythmia, number of extrastimuli required to induce arrhythmia, rate of arrhythmia or requirement for cardioversion. Ventricular pacing thresholds were higher and effective refractory periods were slightly longer when measured with the indwelling catheter. Complications related to the 156 catheter insertions included two that may have been related to the indwelling catheter (one episode of staphylococcal sepsis and one presumed pulmonary embolism) and four that were related to invasive procedures (pneumothorax in all). There were no long-term adverse sequelae of these complications.(ABSTRACT TRUNCATED AT 250 WORDS)
J Am Coll Cardiol 1990 Nov
PMID:Comparison of ventricular arrhythmia induction with use of an indwelling electrode catheter and a newly inserted catheter. 222 65


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