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Query: UMLS:C0729233 (Thoracic)
 6,478 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

During a two-year period (February 1973 to February 1975) 20 consecutive patients with post-infarction left ventricular aneurysm, seen at the Wessex Cardiac and Thoracic Centre, underwent aneurysmectomy with or without aorta-to-coronary artery saphenous vein bypass grafts, ventricular septal defect closure, or valve replacement. The diagnoses were established by clinical means, plain chest radiographs, left ventriculography, and selective coronary arteriography. The indications for surgery were uncontrollable congestive heart failure and angina, ventricular arrhythmias, or a rapidly growing aneurysm. Low cardiac indices or high left ventricular end-diastolic pressure were not considered to be contraindications to operation. Resection of the left ventricular aneurysm was performed with the use of normothermic cardiopulmonary bypass with haemodilution. In addition to the aneurysmectomy, four of these patients had concomitant closure of post-infarction ventricular septal defects; four had valve replacements; two had grafts to coronary arteries; and one had both replacement of the mitral valve and a right coronary vein graft. There were two hospital deaths (10%) and two late deaths (10%), making an overall mortality of 20%. All but one of the deaths were related to coronary artery disease. The survivors are active, and their rehabilitation was satisfactory. The longest survivor is doing well two years after left ventricular aneurysmectomy, ventricular defect closure, and tricuspid valve replacement. It is evident from our experience and from the reports of others that surgery has an established place in the management of post-infarction left ventricular aneurysm.
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PMID:Elective operations for post-infarction left ventricular aneurysms. 125 39

Patients scheduled for vascular surgery are considered at risk for perioperative cardiac complications. Choice of anesthetic in such patients is guided by a desire not to adversely affect myocardial function. On the basis of data from laboratory studies, thoracic epidural anesthesia (TEA) has been advocated to prevent myocardial ischemia. The aim of this study was to assess whether TEA combined with general anesthesia has any effect on segmental wall motion (SWM) monitored by transesophageal echocardiography in these patients. Patients received alfentanil, midazolam, vecuronium, and 50% N2O in oxygen, and ventilation was controlled after orotracheal intubation; 12.5 mL of 2% lidocaine HCl was injected through an epidural catheter placed at T6-7 or T7-8. Hemodynamic measurements and transesophageal echocardiographic recordings were obtained before and 10, 20, 30, 40, and 60 min after lidocaine injection. Segmental wall motion was graded a posteriori by two independent experts on a predetermined scale (from 1 = normal to 5 = dyskinesia). A decrease greater than or equal to 2 grades was considered an SWM abnormality indicative of ischemia. Thoracic epidural anesthesia induced a decrease in systemic arterial blood pressure, heart rate, and cardiac index. The SWM score decreased slightly from 1.34 +/- 0.68 to 1.27 +/- 0.64 (mean +/- SD) (at 10 and 20 min, respectively) (P less than 0.05). Patients were a posteriori analyzed according to whether they had documented coronary artery disease or not. The SWM score before TEA was significantly higher in patients with documented coronary artery disease (1.51 +/- 0.88 vs 1.17 +/- 0.51, respectively; P less than 0.05) and did not change significantly after TEA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Effect of thoracic epidural anesthesia combined with general anesthesia on segmental wall motion assessed by transesophageal echocardiography. 151 Feb 52

Cardiokymography is one of several noninvasive techniques able to detect coronary artery disease. It can qualitatively determine abnormal left ventricular motion, and, based on animal models, this can be directly related to abnormalities in the left coronary artery. Abnormal motion of the anterolateral, posterolateral, or inferior wall is not detected. The sensitivity and specificity of the technique in detecting coronary artery disease in a high-risk group are similar to those of thallium scintigraphy. No comparison has been made with tomographic thallium imaging or echocardiography. Cardiokymography is generally used along with exercise ECG. Most DATTA panelists considered the device safe but believed its effectiveness had not been established. Many cited greater familiarity with radionuclide methods and satisfaction with the amount of information provided by current techniques. Forty percent (8/20) of the panelists considered this technique unacceptable. A major concern was the possibility of missing coronary artery disease that had not affected the anterior wall of the left ventricle. Panelists who offered an opinion represent the following areas of medical specialty: cardiovascular diseases (20) and cardiovascular surgery/thoracic surgery (two). Their board certification includes the American Board of Internal Medicine (18) and the American Board of Thoracic Surgery (two). Fifteen physicians had no opinion regarding safety and 17 physicians had no opinion regarding effectiveness.
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PMID:Diagnostic and therapeutic technology assessment. Cardiokymography. 357 97

Arterial embolus is usually a serious complication of rheumatic or atherosclerotic heart disease. One hundred-fifteen surgical procedures performed in 86 patients with arterial emboli in a 10 years' period in the Department of Adult Thoracic and Cardiovascular Surgery of our university are analyzed regarding the etiology, the treatment, and the results of this complication. Most of the patients were delayed cases showing mild to severe degrees of trophic, sensory and motor disturbances in the limbs without gangrene. These cases are also subjected to vascular surgery (removal of the embolus) as a chance to enable them to use their extremities in lieu of prosthese even when motor and sensory changes persist.
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PMID:Arterial embolism. An analysis of 115 surgical procedures. 446 63

Late survival rates were compared and analysed for 1070 patients undergoing repair of ruptured infrarenal abdominal aortic aneurysm (RAAA, n = 364, mean age 70.0 years, male:female ratio 5.6:1) and non-ruptured abdominal aortic aneurysm (AAA, n = 706, mean age 66.6 years, male: female ratio 5.4:1) between January 1970 and July 1992 at the Department of Thoracic and Cardiovascular Surgery of Helsinki University Central Hospital, Finland. There was a statistically significant difference in survival rates between the RAAA and AAA groups during the first three months after repair of abdominal aortic aneurysm. Operative mortality rates were 7.4% for electively repaired abdominal aortic aneurysms and 48.7% for ruptured abdominal aortic aneurysms. For 3-month postoperative survivors there existed no statistically significant difference in late survival rates, nor did these rates differ from those of an age- and sex-matched population. Five-year survival rates for 3-month postoperative survivors were 60% in the RAAA group and 67% in the AAA group. Median survival time was 5.7 years and 7.5 years, respectively. Coronary artery disease, hypertension, chronic obstructive pulmonary disease and renal insufficiency statistically significantly reduced late survival rates after 3 months post-surgery for non-ruptured abdominal aortic aneurysm, whereas these risk factors did not alter late prognosis after successful repair of ruptured abdominal aortic aneurysm. Cerebrovascular disease reduced late survival rates both in AAA (median survival time 6.3 years) and RAAA group (median survival time 4.9 years). Of late deaths 41% were caused by coronary artery disease in the AAA group and 38% in the RAAA group.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Comparison of long-term survival after repair of ruptured and non-ruptured abdominal aortic aneurysm. 772 78

Coronary heart disease (CHD) is the leading cause of mortality in the United States. The present cohort study was conducted to determine whether rate of FEV1 loss independently predicts CHD mortality in apparently healthy men. White male Baltimore Longitudinal Study of Aging (BLSA) participants without CHD underwent clinical evaluation at 2-yr intervals; 883 had satisfactory pulmonary and lipid studies and returned for a least one visit. Cases were BLSA subjects without CHD on entry who died a "coronary death" (death from acute myocardial infarction, sudden death, or congestive heart failure in the presence of coronary artery disease). Forced expiratory maneuvers followed American Thoracic Society guidelines. Serum cholesterol, blood pressure, cigarette smoking, and body mass index were obtained from the BLSA database. There were 79 CHD deaths and 804 survivors during an average follow-up of 17.4 yr. After adjustment for age, initial FEV1% predicted, smoking status, hypertension, and cholesterol, a time-dependent proportional hazards model showed that cardiac mortality, but not all causes of mortality, generally increased with increasing quintile of FEV1 decline for the entire cohort (relative risk [RR] 2.92-5.13) and separately for the subset of never-smokers. Thus, excess CHD mortality follows a large decline in FEV1, independent of the initial FEV1% predicted, cigarette smoking, and other common CHD risk factors.
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PMID:Rapid decline in FEV1. A new risk factor for coronary heart disease mortality. 784 97

In an era of progressive cost containment and public scrutiny, the wisdom of aggressive surgical therapy for high-risk candidates has been questioned. At our center in the previous 24 months, 728 patients with coronary artery disease were entered into The Society of Thoracic Surgeons national database, and the hospital outcomes plus length of stay were analyzed. Patients were separated according to the predicted mortality based on the groupings in The Society of Thoracic Surgeons database: 0 to 5% (453 patients); 5% to 10% (126 patients); 10% to 20% (96 patients); 20% to 30% (17 patients); and 30% and greater (36 patients). There was a close correlation with the predicted rates of mortality. Importantly, the preoperative risk stratification demonstrated a strong correlation with the significant morbidity and excessive length of stay in the highest-risk groups (predicted risk of 20% to > or = 30%). The incidences of the most common complications in the group with the highest predicted risk (> or = 30%) were 28%, renal failure; 33%, ventilator dependence; and 17%, cardiac arrest. In addition, at short-term follow-up (6 to 8 months), a 24.3% mortality was identified in patients with a predicted mortality that exceeded 20%. These data quantify the risks and morbidities associated with the care of seriously ill patients with coronary artery disease and demonstrate the need for professional and public discussions focusing on the association of a high preoperative risk status and the consumption of resources.
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PMID:Risk stratification using the Society of Thoracic Surgeons Program. 797 57

Coronary angiography is used as a diagnostic procedure to identify patients with coronary artery disease who need to undergo revascularization. The quality of its indication is widely discussed at present. The Swiss Societies of Cardiology, of Internal Medicine and of Thoracic and Cardiovascular Surgery decided to set up a consensus conference to evaluate the indications for angiography. For this a modified RAND approach (Delphi method) was used. An expert panel rated 374 indications for coronary angiography twice for appropriateness (more benefits than risks for the patient), and once for necessity (procedure has to be offered or discussed with the patient). In the panel an agreement percentage of 54% was noted. In 40% we observed neither agreement nor disagreement and in 6% we found disagreement among the panelists. The necessity ratings showed similar results: 48% agreement, 46% indetermination and 6% disagreement. The average median rating for appropriateness on a 1-9 point scale (1 = extremely inappropriate, 9 = extremely appropriate or necessary) was 6.3 over all given single indications and 7.3 for necessity. The results of appropriateness and necessity ratings presented in this paper reflect the findings of a 15-member Swiss panel.
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PMID:Results of a Swiss consensus conference on coronary angiography. Members of the Swiss Society of Cardiology, Swiss Society of Internal Medicine, Swiss Society of Thoracic and Cardiovascular Surgery. 926 Feb 96

A 78-year old man operated for an acute aortic dissection 8 years ago was hospitalized for an unusual clinical presentation with acute cor pulmonale and superior vena caval syndrome. He had poorly controlled high blood pressure, and coronary artery disease with aorto-coronary by-pass 10 years ago. He underwent Bentall procedure 2 years later for type I acute aortic dissection, with vein graft reimplantation on the valvular conduit. A pseudoaneurysm was noted in the post-operative period, which remained stable at 45 mm during the follow-up. Thoracic CT-scan highlighted a 14.5 cm diameter pseudoaneurysm compressing the superior vena cava and right pulmonary artery. Detached right aorto-coronary by-pass, suspected on transesophageal echocardiography, was confirmed peri-operatively; the aortic anastomosis blood in the peri-prosthetic space, explaining the acute clinical picture. The severity of the lesions did not permit surgical repair and the patient died during operation. This observation evidences the complications observed after aortic root replacement and favors echographic and radiological follow-ups (J Mal Vasc 1999; 24: 381-383).
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PMID:[Acute complication of a composite graft replacement of the aortic root]. 1064 52

Based on data reported to the UNOS/ISHLT International Registry for Thoracic Organ Transplantation, we showed that: 1. The number of heart transplant operations performed in the United States has decreased by 164 procedures between 1998 (2,346) and 1999 (2,182). The number of lung transplants increased by 13 in 1999 to 877. 2. The most frequently reported indication for heart transplantation in the US is coronary artery disease (44.8%). For other thoracic transplants, the most frequently reported indications include cystic fibrosis (35.5%) for double lung, emphysema/COPD (49.7%) for single lung and congenital heart disease (46.6%) for heart-lung. The most frequently reported diagnoses for thoracic transplantation outside the US include cardiomyopathy (43.8%) for heart, cystic fibrosis (33.4%) for double-lung, emphysema/COPD (26.6%) for single-lung and primary pulmonary hypertension (24.8%) for heart-lung transplants. 3. US heart transplant recipients are predominately male (76.7%), between 50 and 64 years of age (51.3%) and white (81.4%). US lung transplant recipients are also predominately between 50 and 64 years of age (44.7%) and white (89.9%), but unlike heart recipients are more likely to be female (51.2%). No meaningful variance from the US recipient demographic profile is noted for the non-US recipients during the same time period. 4. Pediatric recipients (< 18 years of age) received 10.9% of the reported heart transplants and 6.2% of reported lung transplants. 5. One-year survival for thoracic transplants performed in the US is 82.4% for heart, 74.1% for lung and 62.0% for heart-lung. Five-year survival for US thoracic transplants is 66.8% for heart and 43.2% for lung. 6. Long-term patient survival rates are: 22.5% at 17 years for heart, 20.8% at 10 years for lung and 24.3% at 13 years for heart-lung recipients. 7. The most important risk factor for mortality of US heart recipients at one month, one year and conditionally at 5 years after transplantation was receipt of a previous heart transplant. Significant short-term risk factors include donor age, recipient age and ischemic time. Substantial long-term risk factors include older donor age, recipient age, recipient race and diagnosis. 8. The factors having the most significant impact on lung mortality at all time points are related to either the patient's medical condition (e.g., in the ICU prior to transplant, requiring mechanical ventilation) or diagnosis. 9. Mechanical ventilation, recipient race and recipient age have the largest impact on heart-lung mortality. 10. For heart and lung recipients, the major cause of hospitalization during the first year after transplantation is infection alone.
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PMID:Worldwide thoracic organ transplantation: a report from the UNOS/ISHLT International Registry for Thoracic Organ Transplantation. 1151 24


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