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At least 505 records · Page 28Linked to original sources
PubMed1987

[Assessment of the hemodynamic state of ischemic heart disease patients following aortocoronary shunting in relation to indices during surgery].

Ninety-one coronary patients, aged 30 to 66 years, were investigated following aortocoronary shunting (ACS). The operations made use of assisted circulation (AC) and cold pharmacologic cardioplegia (CP). Three different cardioplegic solutions were used to achieve heart arrest and myocardial protection. Postoperative hemodynamic status was influenced by the duration of AC and CP as well as the composition of the cardioplegic solutions used, the number of shunts applied and the quality of revascularization. Temporary depression of the heart's pump function (within 1-2 months after ACS) was more pronounced in cases of: 1) longer time under AC and CP; 2) the use of a cardioplegic solution with a relatively low potassium content; 3) multiple shunts, and 4) partial revascularization.

Adult↗
PubMed1985

[Analysis of hospital mortality of patients with congenital heart defects in the 1st year of life].

Causes of mortality were analysed in a group of 122 patients with congenital heart disease in their first year of life following conservative management, closed surgery and operations under assisted circulation. Fatal outcomes were predetermined by a severe congenital defect in 18.2% of the patients, while in the remaining cases they could basically have been prevented by means of a timely primary diagnosis and referral to a specialized clinical institution, accurate topical diagnosis, correct assessment of the severity of the patients' condition and improved post-operative intensive care.

Heart Defects, Congenital↗
PubMed1984

[Repeated operations on the heart in patients with a history of mitral commissurotomy].

The article analyzes the results of surgical treatment of 262 patients, with 160 of them having undergone closed mitral recommissurotomy. One hundred and two patients were operated on under conditions of assisted circulation. The conduction of repeated closed operations is justified in uncomplicated forms of mitral restenosis. In cases of marked calcinosis and regurgitation on the mitral valve, left atrial thrombosis and attended defects, surgery must be performed with extracorporeal circulation.

Adult↗
PubMed1983

[Survival and late results following surgical treatment of coronary artery disease].

Two hundred and thirteen patients underwent surgical treatment for coronary artery disease from 1968, May to 1983, Feb. at our Department. Clinical diagnosis was stable angina in 55 patients, unstable angina in 47, angina with complication in 9, myocardial infarction in 54, and post-infarction complication in 48. Two hundred consecutive postoperative patients were evaluated. There were 11 late deaths occurred including 4 cardiac deaths in origin. Causes of late cardiac deaths were sudden death in 2 patients and cardiac decompensation in 2 patients. Reinfarction was seen in 1 out of 2 sudden deaths. This case underwent only left ventricular aneurysmectomy without A-C bypass grafting. Preoperatively, 49.2% of the patients were in NYHA 2, 34.8% in NYHA 3, and 15.9% in NYHA 4, but postoperatively 86.3% in NYHA 1 and 13.7% in NYHA 2. Reoperative surgical indications were native coronary progression in 1 patient, graft obstruction in 1, and ascending aortic aneurysm in 1. Surgical treatment of coronary arterial disease has still many problems to be solved, especially in patient with cardiogenic shock, multi-vessel disease, cerebral vascular disease, abdominal aortic aneurysm and patient of old age. But, we believe the surgical treatment will make much progress with development of myocardial preservation, assisted circulation, membrane oxygenator and simultaneous operative techniques including complete revascularization.

Adolescent↗
PubMed1994

[Use of dalargin in the intensive therapy of critical conditions].

The paper analyzes whether the national synthetic leukenkephalin analogue dalargin can be used in the prevention and treatment of postoperative polyorgan deficiency. Dalargin has been experimentally demonstrated to be effective in preventing impairments in transcapillary fluid exchange, by stopping the development of pulmonary edema. The use of the drug in the intra- and postoperative period in patients undergone cardiac surgery during general assisted circulation reduced the incidence substantially and decreased the severity of respiratory distress syndrome. The experimental and clinical findings suggest that dalargin has pulmono-, hepato-, and pancreatoprotective properties. Thus, dalargin should be used in the multimodality intensive care of postoperative polyorgan deficiency.

Animals↗
PubMed1994

[Myocardium protection using warm blood cardioplegia in corrective operation of tetralogy Fallot].

In this paper, the children, who had undergone the operation with the approach similar to that of Tetralogy Fallot, were selected and divided into 4 groups, according to different kinds of cardioplegia were infused during corrective operation. St. Thomas group (CC group) 24 cases, cold blood cardioplegia group (CBC group) 21 cases, terminal warm blood cardioplegia group (TWBC group) 12 cases, and continuous warm blood cardioplegia group (CWBC group) 12 cases. Through the measurement of left ventricular contraction pressure and CK-Mb release in the postoperative period, the effect of myocardial preservation was better in TWBC and CWBC groups than in CC and CBC groups (P < 0.05), ATP volume of myocardium in TWBC and CWBC groups were higher (17.1 and 18.2 mumol/g) than that in CBC group (2.48 mumol/g) (P < 0.01) CP values were respectively 8.74 mumol/g, 7.63 mumol/g and 5.5 mumol/g (P < 0.05). 9 cases (37%) in CC group needed inotropic drug to assist circulation postoperation, 4 cases (16%) in CBC group, 2 cases (12%) in both TWBC and CWBC group. The results demonstrated that WBC had a better myocardial protection effect.

Bicarbonates↗
PubMed1994

[Successful repair of acute traumatic rupture of the thoracic aorta].

We report four male patients (from 18 to 36 years in age) with acute traumatic rupture of the aortic isthmus due to blunt chest trauma caused by motor vehicle accident in three patients and a full in one patient. Of these patients, 3 underwent segmental replacements of the descending thoracic aorta with vascular prosthesis using cardiopulmonary bypass, and an additional patient underwent the same procedure using left heart bypass. All patients survived without the development of any serious complications. Since traumatic rupture of the thoracic aorta due to blunt trauma frequently occurs in the relatively young, some form of assisted circulation is necessary to prevent the ischemic spinal cord injury from cross clamping of the aorta during repair of the rupture. We prefer cardiopulmonary bypass as a most appropriate support in emergency situations, because extensive mediastinal hematoma or sudden hemorrhage could make dissection extremely hazardous without it. However, cardiopulmonary bypass requires systemic heparinization, which predisposes the patients with associated multiple injuries to a tendency of bleeding. Thus, a thorough investigation of the preoperative status, including the severity of multiple injuries, should be undertaken, and appropriate therapeutic measures instituted before the start of cardiopulmonary bypass. The determination of the timing of operation is crucial to success in the treatment of acute traumatic ruptures of the thoracic aorta.

Adolescent↗
PubMedDate not supplied

[Activity of free radical lipid oxidation and the state of antioxidant system in patients with ischemic heart disease during myocardial revascularization].

It has been established that aortocoronary bypass surgery is characterized by imbalance in lipid peroxidation and antioxidant defense system. These changes are more pronounced in patients with the most severe forms of ischemic heart disease. During surgery the greatest intensity of lipid peroxidation is observed at the end of assisted circulation period. To prevent these disturbances it is necessary to minimize surgical trauma, reduce the duration of operation stages, refuse pronounced normobaric hyperoxia during cardiopulmonary bypass.

Adult↗
PubMed1994

Anomalous origin of the left coronary artery from the pulmonary artery. Early results with direct aortic reimplantation.

Between January 1991 and June 1993, eleven children with anomalous origin of the left coronary artery from the pulmonary artery underwent direct aortic reimplantation of the left coronary artery at the German Heart Institute Berlin. The patients' ages ranged from 2.5 months to 10.5 years; six were infants. Three infants were intubated and their lungs ventilated before the operation, and one was resuscitated 2 days before the operation. The electrocardiograms of eight patients indicated deep Q waves. All but three of these patients had insufficient collaterals between the right and left coronary arteries. The entire group exhibited reduced left ventricular ejection fraction (minimum 15%) including mitral valve incompetence, which was moderate in six patients and severe in three. All six infants underwent emergency operations, and the remaining children, who were older, underwent elective operations involving moderate hypothermic perfusion and cold crystalloid cardioplegia. Aortic cross-clamping time ranged from 22 to 79 minutes (mean 54 minutes). A two-coronary artery system was established in all patients by direct reimplantation of the anomalous left coronary artery into the ascending aorta. Three patients who also exhibited severe mitral valve incompetence underwent modified Kay mitral valve annuloplasty. A delayed sternal closure procedure (closure performed 1 to 10 days after the operation) was used on eight patients. A 10-month-old patient was successfully treated after the operation with a centrifugal left heart assist device and a 9-year-old patient received extracorporeal membrane oxygenation because of severe heart failure. No postoperative deaths occurred. Left ventricular end-diastolic volume decreased dramatically after the operation and returned to near normal values 1 to 9 months postoperatively. At the same time, the preoperatively depressed left ventricular ejection fraction returned to normal and mitral valve incompetence decreased or vanished in eight patients. Color Doppler echocardiograms (eleven patients) and coronary angiograms (three patients) indicated that the reimplanted left coronary artery was patent in all eleven patients during the follow-up period. Reimplantation of the left coronary artery into the ascending aorta is an effective method of establishing a two-coronary artery system in children with anomalous origin of the left coronary artery from the pulmonary artery. Mitral valve annuloplasty is recommended for patients who also have severe mitral valve incompetence. Prolonged assisted circulation must be used in cases of severe postoperative heart failure.

Aorta↗
PubMed1993

[Therapeutic strategy of acute and chronic heart failure].

The immediate goal of management of heart failure is to improve cardiac function and eliminate symptoms. On the other hand, the final goal is to improve the quality of life and survival. In this chapter, general approaches to fulfill these goals are discussed. First, precise evaluation of the patient is necessary and the underlying cause of heart failure must be diagnosed. If possible, the underlying cause should be rectified. Precipitating factors, such as infection, should also be removed. Appropriate therapeutic measures are then selected according to the type and severity of heart failure. In pharmacotherapy, digoxin, diuretics and vasodilators are usually used in combination. In refractory heart failure, inotropic drugs, including sympatomimetic amines, are usually effective. Special measures including dialysis and assisted circulation, may also be considered in acute or refractory heart failure. Finally, management of ventricular arrhythmias in patients with heart failure is still controversial.

Adrenergic beta-Antagonists↗
PubMed1975

[Surgical correction of septal ruptures after recent acute myocardial infarct].

The problems which are raised by surgical correction of a rupture of the septum complicating an acute myocardial infarction are illustrated by a study of 15 patients admitted for resuscitation. Rarely (3 cases) the anatomical abnormality is well tolerated, and a "planned" secondary operative procedure can then be carried out. More often (12 cases) the severity of the circulatory sequelae makes urgent surgery mandatory; these very severe cases have benefited greatly from advances in medical resuscitation, assisted circulation, and operative techniques.

Acute Disease↗
PubMedDate not supplied

[Changes in the content of microelements--copper, zinc and iron--in the blood of patients following cardiopulmonary bypass].

Changes in the blood content of trace elements (E)--copper, zinc and iron--have been studied in 10 patients with ischemic heart disease subjected to cardiopulmonary bypass surgery. It has been shown that blood TE concentrations decreased considerably during surgery. Variability in blood TE levels could be accounted for by hemodilution caused by the administration of colloids and crystalloids that contained no TE under study. These solutions were used initially for filling assisted circulation device. However, it is noteworthy that the degree of hemodilution was not the only reason for the changes in blood TE content, as despite hematocrit normalization it was only blood iron content that returned to preperfusion level. It has been demonstrated that copper and zinc blood concentrations were considerably lower in patients developing heart failure in the early postperfusion period than in those with an uncomplicated postoperative period. It has been shown that the nature and degree of changes in copper, zinc and iron levels in the coronary sinus blood during heart surgery can be assessed by changes in their arterial blood content.

Adult↗
PubMed1993

[Suppurative mediastinitis after open heart surgery: in comparison between infants-children and adults].

Among 361 consecutive patients who underwent open surgery from Jan. 1987 to Sept. 1991, risk factors and clinical courses were analyzed retrospectively in comparison between infants-children and adults. Seven mediastinitis (4.0%) occurred in 173 adult patients (20 to 75 y/o, mean: 54.4 y/o) and were not associated with age, sex, type of disease, and duration of operation or cardiopulmonary bypass. Postoperative mediastinitis significantly increased in the patients with low output syndrome (LOS) determined as use of IABP and/or assistant circulations (p < 0.001) and reexploration for bleeding or tamponase was associated with an increased risk for mediastinitis (p < 0.01). Five mediastinitis (2.7%) occurred in 188 infants and children (0 to 17 y/o, mean: 4.2 y/o). All patients involved with mediastinitis were less than 12 month old (2.6 +/- 3.3 month). None of the other factors was associated with an increased risk for this complication. Bacterial cultures of exudate were positive in 11 of 12 patients, and identified as MRSA in 10 and Staphylococcus epidermidis in one. In the seven of adult patients, two developed sepsis and four died with other organic failures or mediastinal bleeding. All five of infants healed after postoperative 33 to 145 days. The immature state of immune response might associate with postoperative mediastinitis in infants, whether LOS may be important in the immune suppression by surgical stress in adults, and the prognosis of mediastinitis might be effected by prolonged depression of postoperative cardiac function in adult patients.

Adolescent↗
PubMed1993

[Surgical treatment of patent ductus arteriosus in the adult].

Ten patients over the age of 30 were operated on for isolated patent ductus arteriosus (PDA). Division was performed in 9 patients and ligation in only one. In two cases, the aorta had to be cross-clamped above and below the level of the ductus under normothermia because of massive bleeding. In another two patients with aneurysmal dilatation and calcification of the aortic side of the ductus, PDA was closed by aortic cross-clamping under LA-to-femoral-artery bypass with a centrifugal pump. Postoperatively, all patients are well and in NYHA class I. Therefore, in the adult, if the conventional method of division between ductus clamps is considered dangerous due to increased friability and atheromatous changes of the ductus and surrounding tissues, the ductus should be closed during aortic cross-clamping under assist circulation. In such a case, LA bypass is considered quite useful and safe.

Adult↗
PubMedDate not supplied

[Extrarenal purification of blood in patients with multiple organ failure: results and prognostic criteria].

Acetate hemodialysis (HD) with an artificial kidney an continuous hemofiltration were used in the treatment of 49 patients with the multiple organ failure syndrome (MOFS) developing as a complication of aortocoronary and mammary-coronary shunting and heart valve replacement. MOFS involved failure of the function of 3.5 +/- 0.2 vital organs on average. Acute circulatory disorders were observed in 100% of patients, acute renal failure in 75.5%, and perioperative myocardial infarction in 34.7%. In 93.9% of patients HD and HF were combined with forced ventilation of the lungs, in 97.9% with catecholamine infusion, in 26.5% with assisted circulation, and in 57.1% with the Swan-Ganz monitoring of the central hemodynamics and of oxygen transporting function of circulation. Multiple-modality intensive care resulted in survival of 21 (42.8%) patients. The survival of patients with MOFS depended on the number of involved organs, method of extracorporeal detoxication, and monitoring of central hemodynamics and oxygen-transporting function of the blood. Acute renal failure, respiratory distress syndrome, and shock deteriorated the prognosis for patients with MOFS.

Acute Kidney Injury↗
PubMed1997

[Acute heart failure].

Acute cardiac failure is the principal complication of all forms of heart disease. The goal of therapy is to improve the quality and length of life, and to prevent progression of the syndrome. Although improvement in survival with medical therapy has been obtained at each stage of heart failure, quality of life has been more difficult to assess and regression of the disease is most apparent before severe symptomatic heart failure develops. Decisive recent progresses have been the development of cardiac transplantation and of assisted circulation techniques, and the generalisation of reperfusion therapies at the acute stage of myocardial infarction.

Acute Disease↗
PubMed1999

Circulating activated platelets assist THP-1 monocytoid/endothelial cell interaction under shear stress.

Circulating complexes of leukocytes and activated platelets are markers for atherosclerosis, but their interaction with the arterial endothelial lining has not been studied. Therefore, the effect of activated platelets on rolling and adhesion of labeled human THP-1 monocytoid cells to human umbilical vein endothelial cell (HUVEC) monolayers was studied by epifluorescence microscopy in a parallel plate flow chamber. In the absence of activated platelets, THP-1 rolling on resting HUVEC was negligible at shear rates greater than 300 s(-1). Activation of HUVEC with 100 nmol/L phorbol myristate acetate (PMA) increased THP-1 cell adhesion at shear rates less than 400 s(-1). Therefore, a shear rate of 400 s(-1) was identified as a threshold for THP-1 adhesion. THP-1 rolling on activated HUVEC was reduced by 64% after L-selectin inhibition but was not affected by P-selectin inhibition. The addition of 1 to 50 thrombin receptor-activating peptide (TRAP)-activated platelets per THP-1 cell enhanced interactions between THP-1 cells and HUVEC, resulting in a steep bell-shaped dose-response curve, with a peak of 10 +/- 3 rolling cells/50 seconds at 3 platelets per THP-1 cell (P <.01 v control) with a concomitant 2- to 3-fold increase of firmly adhering cells (P <.01 v control). In reconstituted blood, low numbers of activated platelets had the same effect on THP-1 rolling and adhesion. P-selectin inhibition reduced platelet/THP-1 cell interaction in suspension and deposition of the complexes on the endothelial monolayer. Inhibition of both P- and L-selectin reduced THP-1/HUVEC interactions to 14% (P <.01, n = 4). Sialidase digestion and removal of terminal sialic acid residues from HUVEC or THP-1 cells but not from platelets abolished the platelet mediated augmentation of THP-1 cell adhesion. Thus, THP-1 rolling on HUVEC is shear-dependent and largely mediated by L-selectin. P-selectin expressed on activated platelets increases monocytoid cell adhesion to endothelial cells at shear rates found in coronary arteries through interactions with both endothelial and monocytoid cells and may facilitate macrophage accumulation in the vessel wall.

Antibodies, Monoclonal↗