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

During the period November 1969 to June 1972, a frame-supported autologous fascia lata graft was implanted in 71 consecutive patients with surgically treated aortic valve disease at the Department of Thoracic & Cardiovascular Surgery, University Hospital, Uppsala. The follow-up period was between 1 and 4 years. Eleven patients died within 28 days of the operation (16%) and 13 after discharge from hospital (18%); the cumulative mortality was thus 34%. Forty-five percent of the patients who died had associated cardiovascular or other diseases. The causes of death were infection (10), myocardial failure (6), myocardial infarction (3), cerebral damage (3), and intraoperative aortic dissection from the cannulation site (2). The majority of the deaths (88%) occurred within 6 months and all within 13 1/2 months after operation. Two fascia lata valves were removed because of endocarditis 23 and 26 months, respectively, after operation. Two valves were also removed on account of mechanical malfunction. The remaining 44 patients with fascia lata valves had returned to work. No embolic complications occurred, despite the fact that only patients with a concomitant prosthetic mitral valve or atrial fibrillation received anticoagulatant treatment. Haemodynamic studies of the valve in vitro and pressure measurements during the operation showed that the valve had a low primary systolic peak gradient of 0-16 mmHg. Certain modifications in the construction aimed at improving the haemodynamic properties of the valve are discussed. Increased stringency in the sterility precautions during the valve construction procedure may have contributed to the fact that early endocarditis, which is a serious complication, did not occur in any of the last 43 patients. As yet the observation time is too short to judge, however, to what extent susceptibility to infection and possible late changes of the valve can affect its function.
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PMID:Aortic valve replacement with frame-supported autologous fascia lata grafts. I. Technical consideration and early results. 117 2

We report the case of a 76-year-old woman who suffered cardiopulmonary arrest three days after being hospitalized with an acute myocardial infarction. She underwent standard cardiopulmonary resuscitative measures for approximately 25 min before being pronounced dead. Autopsy examination revealed a recent myocardial infarction, as well as an acutely fractured tenth thoracic vertebra. Thoracic vertebral fractures are a previously unrecognized complication of cardiopulmonary resuscitation.
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PMID:Thoracic vertebral fracture as a complication of cardiopulmonary resuscitation. 317 Nov 15

The case is reported of a young male who presented with massive anterior myocardial infarction after sniffing cocaine. The cardiovascular complications of cocaine abuse are numerous (sudden death, arrhythmia, myocardial infarction, myocarditis) and are being reported more and more frequently in the literature. Thoracic or abdominal pain in any patient known to abuse cocaine should be thoroughly investigated, despite the youth of these patients.
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PMID:[Myocardial infarct following cocaine abuse]. 318 82

To establish an appropriate echocardiographic model for wall motion analysis we first determined the precise dynamic geometry of the left ventricle during systole, as visualized by two-dimensional echocardiography. With the epicardial apex and the aortic-ventricular and mitral-ventricular junctions as anatomic landmarks, we quantitatively analyzed apical long-axis views in 61 normal subjects, 41 patients with anterior myocardial infarction, and nine patients with posterior myocardial infarction. Thoracic impedance registration allowed exclusion of extracardiac motion from the measurements. In normal subjects the epicardial apex moved outwardly only 0.6 +/- 0.3 mm (mean +/- standard error). Examination of 15 hearts fixed in formalin revealed apical myocardial thickness of 1.5 +/- 0.2 mm. These data suggest that the observed inward motion of the endocardial apex (4.1 +/- 0.7 mm) resulted from obliteration of the apical cavity as a result of inward motion of the adjacent walls. Translation of the base was considerable in normal subjects (14.1 +/- 0.4 mm) and decreased in myocardial infarction (9.1 +/- 0.5 mm, p less than 0.0001). Unequal shortening of the adjacent walls in anterior and posterior myocardial infarction caused basal rotation in the opposite direction (-9.1 +/- 0.8 degrees and 9.7 +/- 1.4 degrees, respectively, p less than 0.0001 versus that of normal subjects, -3.4 +/- 0.7 degrees). Long-axis rotation was not clinically significant (less than 1 degree). We conclude that during ventricular contraction the apex serves as a stable point, whereas the base translates toward the apex because of shortening of the adjacent walls. We then propose a model for analyzing regional wall motion from two-dimensional echocardiograms on the basis of these observations.
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PMID:Two-dimensional echocardiographic analysis of the dynamic geometry of the left ventricle: the basis for an improved model of wall motion. 262 77

During the 20-year-period 1959-78, 7 patients with pulmonary arteriovenous fistula were treated at the Department of Thoracic and Cardiovascular Surgery. There were 5 men and 2 women, with a mean age of 26 (14-47) years. Cyanosis with elevated haematocrit was present in 4, dyspnoea in 4, neurological signs in 3 (including one brain abscess and one hemiplegia). Systolic hum was audible in 3 cases. Three patients had the hereditary type of the disease (Rendu-Osler-Weber) with telangiectasiae also elsewhere in the body. The calculated right-to-left shunt varied from 14 to 56 per cent of the cardiac output. The treatment was lobectomy in all cases (4 upper lobe, one middle lobe and 2 lower lobe resections). The patient with a brain abscess underwent craniotomy prior to lobectomy and developed epilepsy necessitating anticonvulsive treatment. The other patients had an uneventful recovery with relief of the symptoms. During the follow-up time (2-20 years), one patient (with hemiplegia) died of myocardial infarction 10 years after the operation. The others were doing well. It is concluded that the safest way to treat a pulmonary arteriovenous fistula is to operate as soon as it has been detected in order to prevent the complications so often associated with the disease.
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PMID:Pulmonary arteriovenous fistulas. 715 28

The endothelins are a recently discovered family of potent contractile peptides produced by endothelial cells. These peptides have been suggested to play an important role in the pathogenesis of hypertension, myocardial infarction, cardiogenic shock, and so on. The aim of our study was to compare the responses to endothelin-1 (ET-1) with those to L-noradrenaline (NA) in aortic rings from rats of different strains and ages. Thoracic aorta rings from spontaneously hypertensive (SHR), Wistar Kyoto (WKY), Brown Norway (BN) and spontaneously hyperlipemic (Yoshida, YOS) rats 2-4 (young), 6-8 (adult) and 20-25 (old) months old were used. There were no changes in the pD2 values for ET-1 and NA between WKY and SHR rats at the ages studied. The ET-1 and NA Emax in adult SHR rats was significantly lower than in the age-matched WKY animals. Old age reduced the ET-1 and NA Emax in both SHR and WKY rats abolishing the difference observed at 6-8 months in the same groups. The reactivity to ET-1 and NA of BN and YOS rats was modified only in young rats. In YOS strain aging did not modify the ET-1 and NA responses as the pD2 and Emax values remained unchanged. Our findings demonstrate that ET-1 is a more potent vasoconstrictor than NA and that this potency remains unchanged throughout the ages and the pathologies studied. In contrast, the pD2 of NA decreases with old age in SHR and WKY rats. We conclude that rat strain but not hypertension or hyperlipemia can modify the response to ET-1 or NA in old age. We suppose that this functional change may involve alterations in the responsiveness of vascular smooth muscle.
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PMID:Aging and in vitro vascular responses to endothelin-1 in several rat strains. 810 9

A 44-year-old man with aortic valve disease presented with myocardial ischaemia and ultimately infarction in the presence of suspected endocarditis. Thoracic computerised tomographic scan and coronary arteriography suggested the ischaemia was caused by external compression of the left coronary artery due to an aortic root abscess, later confirmed at surgery. Myocardial ischaemia is an infrequent accompaniment of infective endocarditis and is most commonly due to coexisting coronary disease. More rarely, emboli from vegetations may give rise to infarction. Although aortic root abscess is a well recognised complication of aortic valve endocarditis, coronary artery compression is an unusual mode of presentation and we believe this to be the first reported case of myocardial infarction resulting from external compression in this setting.
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PMID:Myocardial infarction due to coronary artery compression by aortic root abscess. 828 41

A technique of coronary surgical angioplasty is described. The long arteriotomy of the coronary artery over the stenosis is closed with the Internal Thoracic Artery (ITA) giving an enlargement patch effect. The majority of the atheromatous plaque is excluded from the lumen of the anastomosis and placed outside the suture line. The origin of the collateral arteries is preserved in the vascular lumen. The remodeled coronary artery is composed of a small gutter of native coronary artery and the whole surface of the ITA wall. In some cases, it is useful to associate a limited endarterectomy with the angioplasty. 66 surgical angioplasties have been performed in extensive coronary disease. Operative mortality was 5.4% with a myocardial infarction rate of 5.4%.
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PMID:[Complex coronary reconstructions using the internal mammary artery. Technique of surgical angioplasty, preliminary results]. 855 77

Percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) are major coronary revascularization procedures to relieve angina, prevent myocardial infarction and improve long-term survival. The quality of their 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 coronary revascularization. For this a modified RAND approach (Delphi method) was used. An expert panel rated 992 indications for coronary revascularization 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 65% was noted. In 35% we observed neither agreement nor disagreement, and there was almost no disagreement among the panelists. The results of the necessity ratings were 48% agreement, 49% indetermination and 3% disagreement. The average median rating for appropriateness on a 1-9 point scale (1 = extremely inappropriate, 9 = extremely appropriate or necessary) was 7.7 over all given single indications and 7.2 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 revascularization. Members of the Swiss Society of Cardiology, Swiss Society of Internal Medicine, Swiss Society of Thoracic and Cardiovascular Surgery. 926 Feb 97

This study was undertaken to investigate changes in aortic geometry and compliance after long-term blockade of angiotensin receptors type 1 (AT1) and AT2 receptors under basal conditions and after myocardial infarction (MI). Sham-operated (sham) or MI rats received either no treatment, AT1 antagonist GR138950C (GR; 2 mg/kg/day i.v.), or AT2 antagonist PD123319 (PD; 3 mg/kg/day s.c.). After 3 weeks, mean arterial blood pressure (MAP) was measured. Thoracic aorta diastolic diameter (D[dia]), compliance coefficient (CC), and distensibility coefficient (DC) were determined noninvasively in anesthetized rats by using ultrasound and wall tracking. After the rats were killed, histologic measurements were made on aortic cross sections. In sham rats, MAP was reduced by GR treatment (76 +/- 6 vs. 106 +/- 5 mm Hg), but not by PD. D(dia) was reduced in both GR-treated (1.74 +/- 0.08 vs. 2.09 +/- 0.05 mm) and PD-treated (1.83 +/- 0.05 vs. 2.09 +/- 0.05 mm) sham rats. CC and DC were not modified by either treatment. Although media cross-sectional area was not affected by either GR or PD treatment in sham rats, media thickness and media/lumen ratio were increased in both cases. Induction of MI had no effect on aortic structure, geometry, or mechanics; however, treatment with either GR or PD improved DC versus untreated MI rats. We conclude that AT1 and AT2 receptors are involved in angiotensin II-mediated effects on aortic geometry and mechanics under both basal conditions and after MI. Whereas blockade of AT1 receptors most likely influences vascular properties through a depressor mechanism, AT2 receptors induce pressure-independent remodeling.
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PMID:Effect of chronic blockade of angiotensin II-receptor subtypes on aortic compliance in rats with myocardial infarction. 955 15


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