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Query: UMLS:C0599766 (functional recovery)
 13,441 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The literature concerning postcardiotomy delirium contains confusing definitions and contradictory results. In a critical review of the subject, we conclude that cardiac status, the severity of physical illness, the complexity of the surgical procedure, and preoperative organic brain disease are the determining factors in postcardiotomy delirium. Preoperative anxiety, denial, and depression also have some correlation. Age, sex, time on bypass, and preoperative psychological profile seem to have no influence on outcome. No psychological etiology for delirium has been proven consistently. The therapeutic influence of preoperative interviews in preventing postoperative psychiatric complications remains equivocal as do theories implicating sensory deprivation in the intensive care unit. Long-term follow-up studies suggest that psychological problems impair functional recovery from heart surgery. The suggested treatment of patients with delirium includes chemotherapy, psychotherapy, and environmental support. Finally we suggest that investigation of biochemical abnormalities in delirium may prove to be a model for clarifying the role of neurotransmitters in functional psychiatric illnesses.
J Thorac Cardiovasc Surg 1979 Apr
PMID:Postcardiotomy delirium: a critical review. 37 Apr 60

Excellent results with respect to preservation of the limb and improvement of claudication were obtained with profundaplasty in 29 patients with Fontaine's stage III or IV chronic obliteration. The method is regarded as one of choice for saving the limb, but not as a replacement for other methods of direct revascularisation of the femoropopliteal axis in cases where complete functional recovery is also required. A comparison is made between the results of profundaplasty and reconstruction of the axis in a personal series.
J Cardiovasc Surg (Torino)
PMID:Angioplasty of the profunda femoris in revascularisation of the lower extremity. 44 63

Malperfusion due to increased coronary vascular resistance is presumably one of the factors responsible for incomplete functional recovery of the heart after aortic cross-clamping. Myocaridal blood flow (MBF, radioactive microspheres) was measured before and after 60 min of hypothermic ischemia in 16 dogs on cardiopulmonary bypass. After ischemia the hearts were reperfused for 30 min. MBF was measured in the empty beating heart and in the isovolumetrically contracting ventricle loaded with enddiastolic volumes (EDV) of 10, 20 and 30 ml (intraventricular latex balloon).
Thorac Cardiovasc Surg 1979 Apr
PMID:Regional myocardial blood flow after hypothermic arrest and cardioplegia. 45 86

Contraction and relaxation of the canine myocardium were examined during normothermic ischemia in an isolated heart model. Decrease in the development of tension depends on the duration of ischemia. Deficient functional recovery was observed after ischemic periods extending beyond 30 minutes, in spite of reperfusion periods of over 1 hour. A decrease in compliance was observed during the anoxic period, but a persistent defect of relaxation occurred only after 60 minutes of ischemia. After this period there was also a disturbance in the autoregulative mechanisms of coronary perfusion and an uncoupling of O2-consumption and mechanical efficiency. A prolonged reperfusion period of the heart beating empty allowed ultrastructural recovery of the damaged myocardium. In contrast, functional recovery of the myocardium, as determined by several parameters of contraction and relaxation, did not correlate with ultrastructural recovery and was not improved by prolonged reperfusion.
Thorac Cardiovasc Surg 1979 Jun
PMID:Recovery of the heart after normothermic ischemia. Part II: Myocardial function during postischemic reperfusion. 46 62

A rationale is presented for extra-anatomic carotid cross-over bypass to maintain or restore blood flow to the internal carotid artery distal to sites of disruption and ligation of a common carotid artery. Anatomic evidence indicates that the attachment of the carotid sheath to the hyoid bone is a barrier to spread of infection cephalad to that level. A patient with infected and disrupted right common carotid artery associated with an esophageal fistula was treated by double ligation of the artery. Contralateral hemiplegia 48 hours later forced consideration of cerebral revascularization. Left carotid angiography demonstrated patent cerebral vessels on the right, with retrograde filling of the right internal carotid artery to the bifurcation. These findings were interpreted as consistent with technical feasibility of external carotid to external carotid cross-over vein bypass in a suprahyoid location, avoiding reconstruction in an infected area and resulting in prompt recovery of function.
J Cardiovasc Surg (Torino)
PMID:Carotid cross-over bypass. Cerebral revascularization after ligation of common carotid artery. 59 57

The extent of myocardial protection afforded by a procaine cardioplegic solution during cardiac ischemia has been evaluated and compared with the protection seen using a potassium cardioplegic solution. An isolated cat heart model was employed, and ventricular function parameters, intramyocardial gas tensions, and postischemic myocardial edema were measured and compared following 60 minutes of induced ischemia at 37 degrees C. and 27 degrees C. There was no significant improvement in recovery of postarrest ventricular function when procaine cardioplegia was used during normothermic ischemia. When used at 27 degrees C., however, both cardioplegic solutions were associated with significantly better recovery of postarrest ventricular function, although there was less myocardial edema formation in the potassium-treated hearts. Results of this study indicate that procaine-induced cardioplegia provides myocardial protection during anoxic cardiac arrest which is additive to that afforded by hypothermia alone. In addition, procaine cardioplegia results in postarrest functional recovery which is similar to that seen with potassium cardioplegia.
J Thorac Cardiovasc Surg 1978 Jun
PMID:Effects of procaine-induced cardioplegia on myocardial ischemia, myocardial edema, and postarrest ventricular function. A comparison with potassium-induced cardioplegia and hypothermia. 66 57

Oxy and hydroxy radicals produced during postischemic reperfusion may contribute to the mechanisms responsible for the sustained contractile dysfunction and ultrastructural injury that occur under these conditions. At the molecular level, the consequent peroxidation of membrane-located lipids (including membranes that delineate the sarcoplasmic reticulum, the mitochondria, and the myocytes) probably contributes to the associated loss of Ca2+ homeostasis. Protection against oxy and hydroxy radical-induced injury can be approached in several ways. Oxy and hydroxy radical formation can be limited, or the radicals "trapped." Alternatively, agents that protect membranes against lipid peroxidation-induced injury can be used. To determine whether the calcium antagonist nisoldipine has such a protective effect, isolated hearts were exposed to 0.9 mM H2O2 for short periods of time, and the functional recovery on removal of the H2O2 was used to assess the protective effect of 5 x 10(-9) M nisoldipine. In addition, further evidence of protection was obtained by exposing hearts to an oxy radical-generating system in the presence and absence of 10(-8) M nisoldipine and using the inhibitory effect of nisoldipine on the oxy radical-induced externalization of the endothelin-1 ETA binding sites to quantify protection.
J Cardiovasc Pharmacol 1992
PMID:The role of oxygen radicals during reperfusion. 128 8

U74006F, a novel new 21-aminosteroid inhibitor of lipid peroxidation, has been effective in preventing free-radical-mediated injury in central nervous system models. To assess its ability to diminish myocardial injury due to ischemia and reperfusion, U74006F (n = 11) or its vehicle (n = 11) were administered intravenously to New Zealand white rabbits. After allowing for distribution, the hearts were excised and exposed to 30 min of stop-flow ischemia and 30 min of reperfusion on a nonrecirculating Langendorf apparatus. There was diminished creatine phosphokinase release; improved peak positive dP/dt, developed pressure, and peak negative dP/dt; and diminished diastolic pressure in the group treated with U74006F. Thus, pretreatment with U74006F diminished myocardial injury and enhanced systolic and diastolic functional recovery, probably by protecting the lipid component of cell membranes from peroxidation by reactive oxygen metabolites.
J Cardiovasc Pharmacol 1992 Aug
PMID:The lazaroid U74006F, a 21-aminosteroid inhibitor of lipid peroxidation, attenuates myocardial injury from ischemia and reperfusion. 138 Oct 14

It is unclear whether the protective effects of calcium antagonists on reperfused myocardium are secondary to increased blood flow during ischemia (anti-ischemic action) or reperfusion (Gregg phenomenon), or are mediated through altered calcium kinetics in ischemic or reperfused myocardium. To study the effect of the calcium antagonist nisoldipine on the functional recovery of stunned myocardium, 32 enflurane-anesthetized dogs were subjected to 15 min of occlusion of the left circumflex coronary artery and subsequent 4 h of reperfusion. Eight dogs served as placebo controls (group I), and eight dogs received nisoldipine (5 micrograms/kg i.v.) before occlusion (group II), eight dogs at 10 min of occlusion (group III), and eight dogs at 4 min of reperfusion (group IV). The mean aortic pressure was kept constant with an intra-aortic balloon, and the heart rate did not change. In group I, posterior systolic wall thickening (WT, sonomicrometry) decreased from 18.3 +/- 2.4% (mean +/- SD) during control conditions to -3.0 +/- 2.0% at 13 min of occlusion. At 10 min of reperfusion, WT was 1.7 +/- 3.9% and did not recover further (-1.2 +/- 3.7% at 4 h of reperfusion). Posterior transmural blood flow (BF, colored microspheres) decreased from 1.42 +/- 0.43 ml/min/g during control conditions to 0.26 +/- 0.08 ml/min/g at 13 min of occlusion. BF was 2.07 +/- 0.93 ml/min/g at 10 min and 0.95 +/- 0.31 ml/min/g at 4 h of reperfusion. In groups III and IV, the WT and BF were not different from those in group I throughout the experimental protocol. In group II, however, the WT, although similar to the WT of group I before and during ischemia, recovered from 2.7 +/- 4.3% at 10 min to 11.8 +/- 6.0% at 4 h of reperfusion (p less than 0.05 vs. groups I, III, and IV). The BF in group II decreased from 2.52 +/- 0.66 ml/min/g after administration of nisoldipine to 0.22 +/- 0.14 ml/min g at 13 min of occlusion. The BF was 1.31 +/- 0.51 ml/min/g at 10 min and 1.33 +/- 0.43 ml/min/g at 4 h of reperfusion. Nisoldipine exerts no beneficial effect when given immediately before or after the onset of reperfusion. The improved functional recovery of reperfused myocardium in dogs pretreated with nisoldipine cannot be attributed to an increased regional myocardial blood flow during ischemia or reperfusion. The better myocardial recovery, therefore, appears to be related to an attenuated myocardial calcium overload during the first few minutes of ischemia.
J Cardiovasc Pharmacol 1992 Jul
PMID:The calcium antagonist nisoldipine improves the functional recovery of reperfused myocardium only when given before ischemia. 138 32

Mechanisms and kinetics of the effects of the ionic composition of two different storage solutions, an intracellular type and an extracellular type, were analyzed by examining the myocardial functional and metabolic recovery processes during the early reperfusion periods after 3 hours of cold storage using an isolated perfused working rat heart model. The hearts were stored either in our own cardioplegic solution (group 1) or in Collins' solution (group 2) for 3 hours at 4 degrees C and were then reperfused. The electromechanical activity in group 1 was elevated, as indicated by a higher incidence of ventricular fibrillation at 5 minutes of reperfusion (group 1: 5/6; group 2: 0/5; p < 0.05). The coronary flow rate in group 2 was significantly lower, at least for the first 15 minutes after reperfusion, than that of group 1, suggesting the possible existence of vasoconstriction in group 2. Although myocardial oxygen uptake during this period was smaller in group 2, the recovery of myocardial high-energy phosphate levels was better and creatine kinase leakage was less in group 2. The recovery of aortic flow after 30 minutes of reperfusion was significantly better in group 2 (group 1, 59.1 +/- 5.8%; group 2, 71.7 +/- 6.0%; p < 0.01), although the early recovery was somewhat worse in group 2. These data suggest that the heart stored in an intracellular-type solution, compared with one stored in an extracellular-type solution, recovers in an electromechanically suppressed fashion during the early reperfusion phase, associated with a better metabolic recovery and a slower but larger functional recovery. The disadvantage of the intracellular-type solution, however, may be its effect on the increase of coronary vascular resistance during the early reperfusion period.
J Thorac Cardiovasc Surg 1992 Nov
PMID:The myocardial recovery mode after cold storage for transplantation with Collins' solution and cardioplegic solution. A functional and metabolic study in the rat heart. 143 13


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