Sirolimus and tacrolimus in clinical cardiac transplantation.
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
H Bolooki
Publications and source records attributed to H Bolooki.
Oral amiodarone reduces incidence of postoperative atrial fibrillation.
BACKGROUND: Atrial fibrillation (AF) is a common occurrence after heart operations that use cardiopulmonary bypass. It can cause life-threatening complications as well as delay discharge and increase hospitalization costs. The purpose of this study was to evaluate the effect of orally administered low-dose amiodarone on the incidence of new onset postoperative AF. METHODS: In this prospective study, 226 consecutive adult patients (group A) who had various heart operations utilizing cardiopulmonary bypass between April and November of 1998 at the University of Miami/Jackson Memorial Hospital, were given oral amiodarone (200 mg three times a day), starting immediately after arrival in the intensive care unit until the day of hospital discharge. The incidence of new AF in this group of patients was assessed and compared with a historical group of 239 patients (group B) who had had cardiac operations with cardiopulmonary bypass in the preceding 9 months at the same institution. RESULTS: Preoperative patient characteristics and procedure types were similar in the two groups. Among the 226 patients in group A, 13 (5.7%) had history of AF. Of the remaining 213 patients, new-onset AF occurred postoperatively in 10 (4.7%). Among the 239 patients in group B, 16 (6.7%) had history of AF. Of the remaining 223 patients, 44 (19.7%) developed new-onset AF (p < 0.001). Group A patients had a shorter length of hospital stay than those in group B (6.5 versus 7.8 days) but had a similar incidence of complications other than AF (23 of 226 patients in group A versus 24 of 239 in group B). The drug was well tolerated. CONCLUSIONS: Postoperative low-dose amiodarone given orally to patients who had cardiopulmonary bypass was well tolerated and appeared to reduce the incidence of new-onset AF and decrease the length of hospital stay.
Administration, Oral↗
Clostridial endocarditis following penetrating cardiac trauma.
Explore the source record for details and available documents.
Adult↗
Sinus of Valsalva aneurysm presenting as myocardial infarction during dobutamine stress test.
We report a patient with an undiagnosed left sinus of Valsalva aneurysm who, during a dobutamine stress test, had myocardial injury and subsequent infarction. Cardiac catheterization revealed an expanding sinus of valsalva aneurysm compressing the circumflex coronary artery. The clinical manifestations of sinus of Valsalva aneurysm are discussed. This report heightens awareness of the possible effects of the pharmacologic stress test.
Aortic Aneurysm↗
Cardiac transplantation. University of Miami/Jackson Memorial Hospital experience.
Cardiac transplantation at the University of Miami/Jackson Memorial Medical Center began in November 1986. Up to April 1993, 220 potential recipients were evaluated and 84 accepted. Sixty-three patients received transplants while 14 died awaiting a donor heart. Within six years, the average recipient age has increased from 40 to 59 years. The overall one, two, and five-year survival rates (including operative deaths) are 89.5%, 82%, and 76%, respectively. Postoperative complications and mortality were related to infection or rejection frequently encountered within the first 28 months; thereafter the actuarial survival curve showed minimal decay and the complication rate declined. One or more hospital readmissions were needed in 38 of 57 (67%) survivors. Among the 50 long-term survivors, 42% are working and 84% are in New York Heart Association functional Class I.
Adolescent↗
Cardiac transplantation. University of Miami/Jackson Memorial hospital experience.
Cardiac transplantation at the University of Miami/Jackson Memorial Medical Center began in November 1986. Up to April 1993, 220 potential recipients were evaluated and 84 accepted. Sixty-three patients received transplants while 14 died awaiting a donor heart. Within six years, the average recipient age has increased from 40 to 59 years. The overall one, two, and five-year survival rates (including operative deaths) are 89.5%, 82%, and 76%, respectively. Postoperative complications and mortality were related to infection or rejection frequently encountered within the first 28 months; thereafter the actuarial survival curve showed minimal decay and the complication rate declined. One or more hospital readmissions were needed in 38 of 57 (67%) survivors. Among the 50 long-term survivors, 42% are working and 84% are in New York Heart Association functional Class I.
Actuarial Analysis↗
Intraaortic balloon entrapment.
A review of intraaortic balloon pump use at the University of Miami/Jackson Memorial Medical Center over the past 21 years identified 2 cases where a balloon was found to be entrapped. The balloon catheters had been in place for approximately 10 days when this complication occurred. The retained balloons were torn, filled with clotted blood, and impacted in the vasculature. In our first case, forceful removal of the intraaortic balloon was complicated by unintentional extraction of the external iliac and common femoral arteries. In the second case, clot within the balloon was dissolved with tissue plasminogen activator injected into the drive lumen of the catheter before removal. The prevention and management of this rare but serious complication of intraaortic balloon pumping is reviewed.
Equipment Failure↗
Sequential internal mammary artery grafts for coronary artery bypass.
From 1985 to 1990, 145 patients underwent isolated coronary artery bypass with one (n = 128) or both (n = 17) internal mammary arteries (IMAs) used as sequential bypass grafts. All but 2 patients had angina pectoris preoperatively. A total of 162 sequential IMA grafts were constructed bypassing two (n = 152) or three (n = 10) coronary artery sites as in situ (n = 132) or free (n = 30) grafts. In 12 patients, one IMA was used as a nonsequential graft. Thirty-day mortality was 2.8% (n = 4 patients). Perioperative myocardial infarction occurred in 1 patient (0.7%). Only two sequential IMA grafts failed. Both were used to bypass coronary arteries 1.00 mm in diameter. Mean follow-up was 31 months (range, 6 months to 4.2 years). There were three late deaths. Of 136 survivors followed-up, 121 (89%) were free of angina. Postoperative rotational thallium 201 tomography was done in 73 patients. Myocardial ischemia was detected in 11 diabetic patients (15.1%), but corresponded to a sequential IMA graft in 4 (5.5%) and to nonsequential and venous grafts in 10 patients (13.7%). Coronary revascularization with sequential IMA grafts was safe and effective.
Adult↗
Late complications of plombage.
Plombage was used commonly in the management of tuberculosis before the early 1950s. From 1977 through 1990, 4 patients were seen with complications of plombage performed decades previously. Lucite spheres were used in 3 patients and paraffin in 1. One patient had bilateral apical plombage. In all cases, complications were related to infection or migration of the foreign material. Two patients had extrusion of foreign material or fluid into the chest wall. One patient had hemoptysis and infection due to erosion of a Lucite sphere into the lung. Another had intestinal obstruction subsequent to erosion into the esophagus. The patient with bilateral plombage had development of asynchronous complications on both sides. Treatment consisted of removal of the foreign material and individualized management of the remaining space. There were no operative deaths and the outcome was good in all cases.
Aged↗
Long-term surgical results in sudden death syndrome associated with cardiac dysfunction after myocardial infarction.
To evaluate the surgical results in patients with inducible ventricular tachyarrhythmias due to coronary disease and left ventricular dysfunction, the authors reviewed their experience in 170 patients who had survived one or more cardiac arrests after myocardial infarction and were unresponsive to drug therapy based on electrophysiologic studies (EPS). There were nine operative deaths (5%). Based on intraoperative EPS, surgical remodeling of left ventricular dysfunction (aneurysm resection, infarct debulking, and septal reinforcement) with map-guided cryoablation and coronary artery bypass graft was performed in 34 patients (group A), and left ventricular remodeling and coronary artery bypass graft without guided endocardial resection was performed in 25 patients (group B). Forty-three patients (group C) had coronary artery bypass graft with implantation of an automatic implantable cardioverter defibrillator (AICD). Group D (68 patients) received AICD only. After operation, based on EPS results, four patients in group A (12%) and three patients in Group B (15%) required AICD implantation. Overall survival at 6 years was 65%, 48%, 85%, and 58% in patient groups A, B, C, and D, respectively (p = not significant). During follow-up in group A patients, none died suddenly and none needed AICD. In group B, two patients required AICD 3 and 5 years later, and five patients died suddenly. The incidence of sudden death was 2.3%/patient/year and 3.5%/patient/year after AICD implantation (groups C and D). At 6 years, cardiac-event-free survival was 80% and 70% for groups A and B and 38% and 24% for groups C and D, respectively (p less than 0.001). Patients receiving map-guided ablative procedures had significantly improved cardiac-event-free survival rates.
Adult↗
Surgical treatment of complications of acute myocardial infarction.
Complications of acute myocardial infarction that develop within the first 2 weeks after its onset have been associated with a poor prognosis and dismal surgical outcome. In recent years, aggressive use of hemodynamic monitoring and interventions that improve myocardial oxygen supply and demand have noticeably altered the prognosis. Urgent relief of myocardial ischemia with coronary reperfusion has had the largest impact in improving the results. Surgical treatment of mechanical and nonmechanical complications of acute myocardial infarction requires prompt decision making and expeditious implementation. Persistent left ventricular dysfunction and cardiogenic shock are the most important factors that influence the overall results.
Angioplasty, Balloon, Coronary↗
Atrialization of right ventricular pressure during acute cardiac allograft rejection.
We describe a patient who, during an episode of acute cardiac rejection, developed such severe systolic dysfunction that there was transient near-adynamic function of the right ventricle. This right ventricular dysfunction was reflected hemodynamically by the unusual finding of atrialization of right ventricular pressures. The patient's cardiac function returned to normal after treatment with extensive immunotherapy.
Acute Disease↗
Pseudo-complete AV block following orthotopic cardiac transplantation.
Explore the source record for details and available documents.
Adult↗
Emergency cardiac procedures in patients in cardiogenic shock due to complications of coronary artery disease.
Onset of cardiogenic shock in patients with various manifestations of acute myocardial ischemia has high mortality, but use of improved hemodynamic monitoring, the intra-aortic balloon pump, and early operation have improved previously dismal results. Review of published experience spanning the last 20 years indicates that 66% of patients survive after emergency myocardial revascularization for acute myocardial infarction and cardiogenic shock. If cardiac damage is overwhelming and irreversible, selected patients may be "bridged" with mechanical biventricular circulatory assist devices and transplanted. Infarctectomy for acute myocardial infarction remains controversial and unproven; successful repair of free left ventricular wall rupture is uncommon. In patients with cardiogenic shock, operations for acute postinfarction ventricular septal defect or mitral insufficiency have operative survival rates of 45% and 54%, respectively. Long-term (greater than 2-year) survival for patients after repair of acute postinfarction ventricular septal defect is 84%. However, 5-year survival after successful operation for acute postinfarction mitral insufficiency complicated by cardiogenic shock is only 40%.
Actuarial Analysis↗
Hemodynamic effects of radical left ventricular scar resection in patients with and without congestive heart failure.
To evaluate the hemodynamic changes that occur following radical left ventricular scar resection we studied 40 patients (mean age, 59.2 years; 36 males) with complete hemodynamic evaluation preoperatively (preop) and 5 to 12 days postoperatively (postop). Severe congestive heart failure (CHF) was present in 15 patients, ventricular arrhythmias in 19, and angina in 19 patients preop. The operation consisted of extensive scar resection with complete myocardial revascularization (average 2.4 grafts per patient). Ten patients required intraaortic balloon pump assist for up to 8 days postop. Postoperative left ventricular ejection fraction (EF) was estimated with multiple gated acquisition scanning. A significant rise in heart rate was observed in the whole group of patients postop (P = 0.000). In the group of patients with CHF preop the EF was increased from 25.1 +/- 8.4% (mean +/- SD) preop to 30.9 +/- 11.2% postop (P = 0.003), the cardiac index was increased from 2.2 +/- 0.5 liters/min/m2 preop to 2.7 +/- 0.5 liters/min/m2 postop (P = 0.02), and the pulmonary artery wedge pressure was decreased from 22.0 +/- 7.7 mm Hg preop to 15.5 +/- 4.3 mm Hg postop (P = 0.005). In the patients without active CHF preop no improvement in the above hemodynamics was noted. In conclusion, radical left ventricular scar resection significantly increased EF and CI and decreased PAW in patients with preop CHF, whereas in the absence of CHF this procedure resulted in minimal hemodynamic changes.
Adult↗
Risk of aortic valve surgery.
Explore the source record for details and available documents.
Aortic Valve↗
Fatal acute aortic regurgitation in a person performing the Heimlich maneuver.
Explore the source record for details and available documents.
Acute Disease↗
Automatic implantable cardioverter-defibrillator: techniques of implantation and results.
An initial experience with use of the automatic implantable cardioverter-defibrillator (AICD) is described. Twelve patients received the device. One death has occurred during a mean follow-up of 15 months, and it was due to causes other than arrhythmias. Appropriate device discharge terminating a malignant arrhythmia occurred in 9 patients (75%). The observed survival (92%) far exceeds that to be expected in survivors of sudden death treated by conventional means. There have been no operative deaths. Morbidity has been minimal, although three reoperations were required in 2 patients because of lead dislodgment. The AICD has been demonstrated to be effective in treating patients at risk for sudden arrhythmic death. It can be employed safely with minimum morbidity using a variety of implantation techniques.
Aged↗