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At least 487 records · Page 27Linked to original sources
PubMed1999

[The experience of telemedicine transmitting CT image of ruptured thoracic aortic aneurysm on the Internet].

The report describes our experience in establishing CT image transmission of ruptured thoracic aortic aneurysm to Gifu university hospital on the Internet. In this emergent case CT image transmission to the cardiovascular surgent provided medical informations in detail, which is very useful to decide the operative method and to prepare the assist circulation devices for the operation before the patient get to the hospital by ambulance. The Internet may prove to be major vehicle for telemedicine, consulting the professionals located in remote clinical institute.

Aged↗
PubMedDate not supplied

[Significance of anesthesiology and intensive care in the development of reconstructive surgery (as exemplified by the scientific school of the Academician B.V. Petrovskiĭ)].

B. V. Petrovsky, the creator of one of the leading surgical schools, realized, that surgery cannot develop without anesthesiological and resuscitation support. He actively promoted measures which ensured rapid transformation of such branches as anesthesia and postoperative care into independent disciplines. Introduction of neuroleptanalgesia, high-quality artificial ventilation of the lungs, prolonged regional and combined anesthesia, protection of the myocardium and brain, bronchofibroscopy, extracorporeal detoxication, assisted circulation, and computer monitoring allowed the performance of the most sophisticated interventions on the heart, aorta, lungs, esophagus, liver and bile duct, and peripheral vessels. Progress in anesthesiology and reanimatology promoted the development of new trends in reconstructive surgery, such as repair microsurgery, organ transplantation, endovascular and endoscopic surgery.

Anesthesiology↗
PubMed1975

[A prognostic index in acute myocardial infarction: discrimination analysis of clinical parameters on admission to hospital (author's transl)].

In 301 patients admitted to an intensive-care unit because of acute myocardial infarction a prognostic analysis was undertaken, based on 21 parameters (history, condition on admission, laboratory results) and related to ultimate outcome. Although some parameters were singly of prognostic value, discrimination analysis markedly improved predictive value. A prognostic index was constructed from seven easily available parameters: age, pulmonary congestion, leucocytosis, peripheral vasoconstriction, systolic blood pressure, site of infarct and hypertension. For those in a low-risk class (index less than 60, death-rate up to 5%), duration of stay in the intensive-care unit may be shortened and rehabilitation measures accelerated. Those at moderate risk (index 60-90, death-rate up to 25%) require careful monitoring. The highest risk classes (index 90-120, death-rate up to 90%; and index more than 120, death-rate more than 90%) require specially intensive and long-term monitoring, and various procedures for assisted circulation and possible cardiacsurgical intervention should be considered from the outset.

Acute Disease↗
PubMedDate not supplied

Air transport of the IABP patient. Intra-Aortic Balloon Pump.

The intra-aortic balloon pump (IABP) has evolved into an easily transported, computer-driven device for invasively assisting circulation. This article reviews the use of the IABP during interfacility patient transport by air. Air transport of the IABP-dependent patient creates unique clinical, logistical, and technical challenges. We review the function and clinical application of IABP in various air transport conditions. We also identify the complications of intra-aortic balloon pumping, such as hemorrhage, loss of trigger signals, cardiac arrest, and atmospheric pressure changes, and offer solutions. The effective clinical use of IABP in the air transport environment involves more than familiarity with the device and implications for its use; rapid identification of problems and implementation of solutions are required for successful transport and patient outcomes.

Air Ambulances↗
PubMed1975

[Monitoring of cardiac rhythm changes during surgical operations with total cardiopulmonary bypass with haemodilution and hypothermia in infants and small children (author's transl)].

Surgical corrections of some serious cardiovascular anomalies in infants and small children were attempted within the last 2 years; 12 severely ill infants and children below the age of 3 years were operated. All, but one, were below 10 kg of body weight, and in all of them there was a considerable weight deficit, more than 30%. The risk of operation was undertaken because of the ineffectiveness of medical treatment and very bad prognosis. The following cardiovascular lesions were operated: large aortopulmonary septal defects, localized just above the valvular rings in 2 patients with severe pulmonary hypertension, with very good effect in both; tetralogy of Fallot - in 2 babies, in one with good effect; congenital mitral obstruction with pulmonary hypertension in one case, with good effect; total anomalous pulmonary venous return of supracardiac type in one child, decreased 1 week following operation; type 1 complete transposition of great arteries in one baby, deceased one day following operation; large ventricular septal defects, with systemic or nearly systemic pulmonary hypertension in 5 children, in one with long-term good effect. A modification of the Barrat-Boyes, Neutze and Simpson method, based upon a combination of surface and core cooling was applied. Thoracotomy was performed after surface cooling to 34-32 centigrades, and then a single venous cannula was inserted into the right atrium and an arterial cannula -- into the aorta. Deep cooling was obtained during perfusion, using a heat exchanger. The duration of cooling perfusion was, on an average, 20 min., and the patients were cooled to a temperature of 23-21 centigrades. The corrections were performed on relaxed and bloodless heart, during the circulatory arrest lasting for 20-65 min. (40 min. on an average). Following repair the patients were rewarmed to temperatures of 36-37 centigrades by warming perfusion lasting on the average 40 min., including assisted circulation, until a haemodynamically sufficient cardiac output was present. Silicated ACD-blood, diluted to a hematocrit value of 28-30 Vol. % by a polyelectrolyte buffered solution was used for priming and perfusion. During all the procedures any pH and HCO3 deviations were balanced currently. At the time of cooling perfusion, when the patient's rectal temperature fell down to 30-25 centigrades, the heart started to fibrillate. At temperatures above 26 degrees C ventricular fibrillation was sometimes preceded by sinus bradycardia, or sinoatrial block/arrest, with an AV nodal rhythm and gradually increasing intraventricular conduction slowing. In some cases high degree AV block appeared. At temperatures of 25-23 centigrades - slow fibrillation appeared, followed usually by a complete cardiac arrest.

Age Factors↗
PubMed1992

[Current role of intra-aortic diastolic balloon counterpulsation in heart surgery].

Intra-aortic balloon counterpulsation (IABP) is a relatively non-invasive method of circulating assistance, easy to use and which has benefitted from a number of technological improvements in recent years. This retrospective study over 4 years was undertaken to analyse the results of IABP and to determine its role in therapeutic arsenal against cardiac failure. Sixty five patients, 57 coronary and 8 valvular cases, with an average age of 61 +/- 10 years were included. The indications of IABP were: a bridge to transplantation (3 cases), complications of coronary angioplasty (4 cases), and low cardiac output after cardiopulmonary bypass (58 cases), where IABP was curative in 85% of cases and prophylactic in 15% of cases (patients with risk factors of low output state after CPB). Beforehand, 65% of patients had poor left ventricular function (LVEF < 40% and/or CI < 2.2 l/mn/m2). An Aries Medical M700 console was used. The percutaneous femoral approach was feasible in 87% of cases. The results were: improvement with discharge from intensive care unit in 60% of cases, transient improvement in 7% of cases, no improvement in 15% of cases and cardiac transplantation in 8% of cases. The outcome was worse when the preoperative LV function was poor and when high dose inotropic agents had to be used. Survival was 100% in those patients in whom IABP was a prophylactic measure. The average duration of IABP was 72 hours, survival being significantly lower in those in whom IABP was continued for over 3 days. The complications (12.7%) were thromboembolic.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

[Oxygen transport in patients with ischemic heart disease operated on under a program to preserve the patient's blood].

The results of the studies performed in 112 patients operated on with preservation of the patient's blood are reviewed. This meant pre- and intraoperative blood taking, surgery under normovolemic hemodilution, blood taking and transfusion upon its neutralization with heparin, collection of the blood flowing from drainages. Acid-base balance, pO2, blood Hb level, the degree of Hb saturation with O2, free plasma Hb, platelet count, the level of 2,3-diphosphoglyceric acid have been determined and parameters of oxyhemoglobin dissociation curve have been calculated. Computer monitoring of O2 transport was performed before and after assisted circulation in 28 patients. During surgery it proved possible to collect and return to the patients 10% of the circulating blood. The blood collected during surgery had no negative effect on the hemostasis. The above technique makes it possible to reduce the amount of donor blood used during surgery and has no negative effect on O2 transport.

Adult↗
PubMed1992

[Clinical use of the multi-purpose circuit with a soft reservoir built in inflow side in replacement of the descending thoracic aorta].

The temporary bypass circuit under centrifugal pumping is generally applied for the assisted circulation of the operation for the aneurysm of descending aorta. The estimation of the bypass flow to the abdominal viscera, however, sometimes showed inadequate when excessive bleeding happened during operation. In order to keep constant flow to the lower body, we developed a new circuit, that has soft reservoir built in inflow side of the bypass line. In 8 subjects using this circuit, we studied the usefulness of the circuit and the choice of bypass route based on changes in the hemodynamics during bypass and operative complications in relation to bypass technique. During bypass, perfusion pressure to the lower body was 70-110 mmHg and flow was maintained at more than 21/min even if massive hemorrhage occurred. Comparing arterial bypass with LV bypass, the diastolic pressure in the upper limb was significantly depressed in arterial bypass with reading of 40-50 mmHg. Furthermore, in one case of arterial bypass involving the ascending aorta, false aneurysm is found in the site of cannulation. The rectal temperature dropped with the lapse of time from 35.5 +/- 0.8 degrees C to 33.5 +/- 0.4 degrees c in 120 min. These results indicate that multi-purpose circuit is capable of promptly supplying the circulating volume and is excellent means of providing adequate circulation to the lower body even if massive hemorrhage occurred. And LV bypass should be selected first, because arterial bypass has the hazard of depressing the diastolic pressure in the upper limb and involving complications associated with the insertion of cannula.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

[A case of extra-anatomic bypass for ruptured thoracoabdominal aortic aneurysm with tuberculosis].

Now aneurysmectomy and graft replacement is the most popular surgical method of aortic aneurysm, but there are many opinions about surgical methods and assist circulation for emergency operation of ruptured aortic aneurysm. We experienced the case of ruptured thoracoabdominal aortic aneurysm with tuberculosis, and rescued the patient by extra-anatomic bypass (EAB). A 60-year-old woman, who had been treated with tuberculosis for about 40 years, was operated on for cold abscess of her left psoas muscle by other orthopedic surgeons. At that time, massive bleeding happened, and she was transferred to us under diagnosis of ruptured thoracoabdominal aortic aneurysm. EAB, as emergency operation, was done because we considered it was dirty and dangerous to replace the prosthesis beside the abscess. The postoperative course was almost uneventful except the evidence of Gaffky's first stage. We considered EAB was an useful method for emergency cases and some infectious aortic aneurysms.

Aorta, Abdominal↗
PubMedDate not supplied

[The specific features of anesthesiological provision of operations removing malignant neoplasms with a tumorous thrombus in the inferior cava vein].

The paper presents the experience gained in performing 100 operations associated with removal of intravascular malignant tumors [tumorous thrombi (TT)] from the inferior cava vein (ICV), which were made without using artificial and assisted circulation. This approach is substantiated. The variants of TT extent and its associated surgical technical features are shown. The procedure developed by the authors for anesthesia and infusion therapy in performing these highly specific interventions is described. The postoperative period ran with complications in 27 patients: pulmonary thromboembolism (PTE) (n=6); pneumonia (n=5); acute renal failure (n=4); encephalopathy (4); acute pancreatitis (n=4); cardiac arrhythmia (n=4); hepatic failure (n=2); adult respiratory distress syndrome (n=2); sepsis with evolving multiple organ deficiency (n=1), gastrointestinal hemorrhage (n=2); intestinal paresis (n=1); ICV thrombosis (n=1); recurrent myocardial infarction (n=1). Intraoperatively, 3 patients died from massive PTE (n=1) and hemorrhage (n=2). In the early postoperative period, 2 patients died from hemorrhage and hypovolemic shock (n=1) and recurrent myocardial infarction (n=1). Two patients died from pyoseptic complications on days 11 and 35. Thus, the vast majority of patients successfully tolerate a surgical intervention when certain conditions (the stepwise design of an anesthesia scheme keeping in mind the specific features of the course of an operation, hemodynamic and laboratory monitoring, adequate venous access, efficient infusion-transfusion therapy, timely use of cardiovascular stimulants, use of intraoperative hardware reinfusion of autoerythrocytes) are met.

Anesthesia, General↗
PubMed1991

[Late results of TVSI for Ebstein's anomaly].

For 10 adult cases of Ebstein's anomaly, tricuspid valve supraannular imposition (TVSI) without excision of native tricuspid valve were performed and its late results (6 mo. to 11.5 y, mean 6.8 years) were investigated. All cases showed the severe low output syndrome after the surgery. But the postoperative recovery of the cardiac function was smooth and there was no early death nor A-V block. Both the A-V conduction and the RV subvalvular structures were preserved in TVSI and it contributed to the postoperative good contractility of RV. In two cases, the serious postoperative ventricular tachycardia or ventricular fibrillation were experienced, one case required open cardiac massage and 6 hours long assist circulation in the other. In late stage, one patient died 9 years after the TVSI from the failure of the bioprosthetic mitral valve which had been implanted simultaneously, and the other 9 survivors returned to the class I of NYHA classification. LVDd and DS obtained by echocardiography showed significant enlargement; 29 +/- 4.5 mm and 19 +/- 4.1 mm before operation to 42 +/- 3.1 mm and 29 +/- 5.8 mm in late stage respectively. EF showed the tendency of slight decrease from the preoperative supernormal value to the normal range. RVD showed significant decrease after the surgery (58 +/- 4.2 mm to 37 +/- 4.1 mm). Bioprosthetic valve failure in tricuspid position was not experienced. PAC or PVC were seen quite often and 8 of 9 cases received medication for arrhythmia even in late stage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[The automatic implantable cardioverter defibrillator--clinical experience in patients with life-threatening ventricular tachyarrhythmias].

Five patients (pts) with life-threatening ventricular tachyarrhythmias (idiopathic VF; 2 pts, Torsade de pointest; 1 pt, VT/VF after valve replacement; 2 pts) underwent surgical treatment of the automatic implantable cardioverter defibrillator (AICD). Implantation of an AICD was indicated for patients who survived circulatory arrest due to documented VT and/or VF. The patient should be medically refractory or medical treatment precluded by hemodynamic instability; other surgical treatment should not be possible. We selected myocardial electrode for sensing and small and large patch electrodes for defibrillating. VF/VT was induced 1 to 6 times for the measurement of defibrillation threshold (DFT). In all of our pts, the AICD appropriately discharged at postoperative EPS. In three of pts, the AICD discharged within the postoperative hospital phase, in two because of sinus tachycardia during treadmill test and restored sinus rhythm after non-sustained VT. As for complications, in one pt. with severe LV dysfunction, incessant form of VT/VF occurred after DFT testing and LV assist circulation and IABP were needed. In two pts, inappropriate discharge and in two, pericarditis were recognized postoperatively. It was considered that this system was effective for the treatment of life-threatening ventricular tachyarrhythmias but strict indication was necessary because of unsolved problems.

Adult↗
PubMed1990

[Disorders of the oxygenating function of the lungs during open-heart surgery].

A retrospective analysis of arterial blood oxygenation during open-heart surgery in 463 patients revealed pulmonary oxygenation disorders in 23% prior to perfusion and in 49% in the post-perfusion period. The basic mechanism underlying the fall in arterial blood oxygenation is the increasing venous admixture in the lungs. A growth in the venous admixture in the post-perfusion period is brought about by a decreased total ventilation/perfusion ratio, increased alveolar shunting, and impaired diffusion. It was found, that the assisted ventilation regimen at +5+8 cm H2O in the post-perfusion period caused a 30% reduction in the venous admixture and improved the blood oxygenation. Additional use of diuretics to diminish the intrapulmonary water causes a 59% reduction in the venous admixture. A prophylactic pre-perfusion administration of corticosteroids, vitamin E, and protease inhibitors maintains the oxygenating function of the lungs, which is manifested in a higher blood oxygenation in these patients after assisted circulation compared to the controls.

Adrenal Cortex Hormones↗
PubMed1989

[The surgical treatment of congenital heart defects in neonates and infants without using invasive study methods].

Echocardiographic analysis of 328 closed operations for aortic coarctation, patent ductus arteriosus, and congenital heart disease of the blue type with lower pulmonary flow in infants of the first year of life revealed diagnostic errors in 6 (2%) patients, this resulting in death of two patients. Surgery for congenital heart disease, which is based on the echocardiographic data without invasive diagnostic methods, requires proper patient selection. Quantitative two dimensional echocardiography allowed for higher accuracy of the preoperative diagnosis. Introduction of Doppler echocardiography made it possible to perform successful operations with assisted circulation in 16 patients for ventricular septal defects, atrial septal defect, transposition of great arteries, atrioventricular communication.

Echocardiography↗
PubMed1989

[Bilateral internal mammary artery grafting for a patient with poor left ventricular function].

The patient was a 49-year-old man with triple vessel disease. He had been suffered from inferior and antero-septal myocardial infarctions. His left ventricular ejection fraction was estimated as 17 percents. An exercise thallium myocardial scan revealed the area of septal and inferior reversible ischemia. Bilateral in situ internal mammary artery grafting was done; the left internal mammary artery was anastomosed to the left anterior descending coronary artery and right internal mammary artery to the right coronary artery. Assisted circulation with IABP was required after operation. Post operative course was uneventful, and clinical state was improved.

Coronary Disease↗
PubMed1977

[Design and haemodynamic evaluation of the ellipsoid heart for total heart replacement].

Thromboembolism is a complication which represents a major limiting factor in animals with long-term postoperative survival periods following total artificial heart replacement. Thrombi are formed on the artificial valves, the biomaterials and in stagnation areas within the artificial ventricles. In design planning the stagnation areas should be avoided as well as major turbulences. The filling volume should be maximally used for the stroke volume and the epicenter of the membrane should be underneath the valve areas. The ellipsoid heart eliminates stagnation areas and the stroke volume is 82% of the filling volume. The maximum cardiac output is 15.8 l/min. The ellipsoid heart was implanted in 20 female calves; the maximum length of survival was 213 hours. There was no compression of the inferior vena cava and the heart fitted well into the chest of the animals. The cardiac output, self-regulated in the sense of Starling's law, was adequate to perfuse the animals and to allow moderate exercise such as standing. The arterial pressure curves show normal physiological activity. The curves in both atria are unphysiological, owing to relative insufficiency of the valves. The limiting factors were pulmonary insufficiency and surgical complications. The ventricles showed no thrombus formation -- except in one case, in which faulty material was the predisposing cause. It was possible to develop an automatic driving system on the basis of these experiments. Regulation occurred by means of gas flow control in the driving tubes, whereby the form of the gas flow curve provides information on position of the membrane. As soon as the membrane has reached the end-diastolic position, systole is triggered off and lasts until the end-systolic position is reached. If the venous return is increased, the ventricles are filled more rapidly and the heart is driven at a higher rate. One part of the ellipsoid heart is used as ventricle for assisted circulation. The left ventricle is cannulated via the left appendage or the apex. The ventricle relieves the left heart to a large extent and the cardiac output is taken over by the pump placed in a paracorporeal position. The blood is directed back into the thoracic aorta.

Animals↗
PubMed1989

[Present status and future observation of membrane oxygenator].

The oxygenator has been developed as the most important tools for open heart surgery as a part of pump-oxygenator. Recently, two kinds of them are routinely selected. One is the bubble oxygenator (BO) and the other is the membrane oxygenator (MO). The latter is recognized as the most physiological and similar to the human lung. It is proved by many researchers that the denaturation of the blood elements is less in the MO compare with the BO even it is used for short period such as open heart surgery. The more hospitals and institutes have been taking more MO than BO. Microporous membrane and dense (silicone) membrane are used for MO. Combination of the both membranes is also considerable now. Hollow fiber (capillary) type MO is getting more than plate or coil type. ECMO (extracorporeal membrane oxygenation) is gradually developed as characteristic application of MO. ECMO is one type of assisted circulation by means of MO and is applied for acute respiratory failure (in original sense) and for acute cardio-respiratory failure (in wide sense). Earlier application for acute respiratory failure of neonate and children should be considered expecting with better results now. Bridge use for heart transplantation would be considered in future.

Adult↗
PubMed1989

[Myocardial infarctectomy in the acute stage].

Seven patients with ventricular septal perforation or left ventricular free-wall rupture underwent myocardial resection in the acute stage of myocardial infarction. One of them received direct closure of the left ventricle, and the others replacement of myocardium with a Dacron prosthesis. One patient died of cardiac failure 5 days after surgery, and 4 in the late-stage between 2 months and 4 years. The following conclusions are obtained in our patients: 1. Echocardiography is very important for the diagnosis of cardiac free-wall rupture and determination of emergency surgery. 2. An intra-aortic balloon should be inserted in patients with VSP as soon as possible. If general state of the patients had been improved by the procedure, surgery might be withheld until the recovery, otherwise emergency surgery should be considered. 3. Myocardial replacement with a prosthesis seems to be useful when the left ventricular cavity is predicted to be small after resection of the myocardium. 4. The development of assisted circulation would improve a survival rate after the surgery. 5. Systemic managements are also important because the patients sometimes become fatal by non-cardiac complications even if they have survived from circulatory failure.

Aged↗