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At least 1,009 records · Page 56Linked to original sources
PubMed2005

Does preoperative multislice computed tomography predict operative times in total endoscopic coronary artery bypass grafting?

OBJECTIVE: Multislice computed tomography (MSCT) is currently discussed as a potential tool for procedure planning in endoscopic heart surgery. We aimed to assess the influence of various thoracic measurements on operative times in arrested heart totally endoscopic coronary artery bypass grafting (AHTECAB). METHODS: 34 patients (aged 59 years, 71% male) scheduled for AHTECAB were examined prospectively with ECG-gated 16-channel MSCT angiography of coronary arteries and internal mammary arteries. All AHTECABs were single LIMA to LAD bypass operations using the Da Vinci telemanipulator and the ESTECH remote access perfusion system. RESULTS: The LIMA-LAD distances were: I (at origin of the first diagonal branch) 4.3 cm (2.5-6.0), II (aortic valve level) 3.7 cm (1.1-6.4), III (mitral valve level) 2.9 cm (0.7-5.0), and IV (basis cordis) 2.3 cm (0.6-4.3). The anterioposterior thoracic diameter was 12.4 cm (8.9-15.6), and the transverse diameter was 24.9 cm (21.1-26.8). LIMA-LAD distances I (P = .025, r = .396) and III (P = .042, r = .356) significantly correlated with the anastomotic time. Increased rotation of the heart to the left was associated with a decreased cardiopulmonary bypass time (p = .016, r = -.451). CONCLUSION: These data suggest that MSCT has the potential to predict operative times in robotic AHTECAB.

Coronary Angiography↗
PubMed1981

Mitochondrial injury and autophagocytosis within the myocardial cell after the cold ischaemic anoxic asystole.

Right atrial myocardial biopsies were excised in the course of prosthetic aortic valve replacement operation from eight consecutive patients 1) before starting the extracorporeal circulation (controls) and 2) after the cold ischaemic anoxic asystole (aortic cross-clamping (50-70 min) during general hypothermia (30 degrees C) associated with local cardiac cooling with +4 degrees C saline solution and subsequent coronary reperfusion (20-30 min, until decannulation), and immediately processed for electron microscopy. In most cases no or only minimal changes were observed. These patients made a smooth recovery. In one case very severe damage was seen: extreme swelling, clearing and paling of the matrix, disruption of the inner and outer mitochondrial membranes, distortion, disruption and loss of the cristae and lamellar degeneration and vacuolization of the mitochondria. Huge amounts of large secondary lysosomal bodies in different stages of autodigestion were seen in company with the degenerating mitochondria. Also this patient ultimately recovered after a long-lasting low output syndrome. Pre- and intra-operatively until weaning from the cardiopulmonary bypass, nothing distinguished clinically this case with autophagocytosis from the other cases. The occurrence of autophagocytosis has been described earlier in relation to an irreversible lethal damage following extended normothermic ischaemia. Obviously this phenomenon may be associated also with sublethal myocardial injury occurring despite attempts to myocardial preservation by local cardiac cooling.

Aortic Valve↗
PubMed1986

Deep hypothermic arrest in children undergoing heart surgery.

Deep hypothermia with cold cardioplegia is a technique that increases the chances for successful palliative or reparative cardiac surgery for the critically ill infant or child with complex or severe cardiac anomalies. Perioperative nursing care is of vital importance to the child, family, and operative team. Nursing care measures include perioperative teaching as well as preoperative and postoperative physical assessment of the child and psychosocial assessment of the child and family unit. An understanding of the advantages and the potential complications of hypothermic techniques enhances the nurse's ability to carry out these nursing interventions.

Brain Diseases↗
PubMed1994

Simultaneous arterial and coronary sinus cardioplegic perfusion: an experimental and clinical study.

UNLABELLED: The existence of inhomogeneous distribution of coronary flow with antegrade or retrograde perfusion alone has led to alternating between these delivery routes to maximize their individual benefits. Concern over myocardial damage prevented the simultaneous application of antegrade and retrograde cardioplegic blood delivery. Based upon the predominance of retrograde drainage via Thebesian veins, and evidence that pressure-controlled intermittent coronary sinus occlusion during antegrade cardioplegic delivery enhances its distribution and protective properties, this study tests (a) the hypothesis that simultaneous aortic and coronary sinus perfusion is safe during aortic clamping, and (b) reports initial clinical application of this combined strategy in 174 patients. Five minipigs (25-30 kg) underwent 1 hr of aortic clamping with simultaneous aortic (antegrade) and coronary sinus (retrograde) perfusion at 200 ml/min with normal blood (37 degrees C) before and after 30 minutes of perfusion with either warm (37 degrees C) or cold (4 degrees C) blood cardioplegia (BCP). Furthermore, the combined strategy was used in 174 high-risk patients (NYHA class III-IV) at 3 university hospitals to perform myocardial protection during CABG or valve replacement, or a combination of both. Included were 16 patients in cardiogenic shock and 24 undergoing reoperation. In both the clinical and the experimental studies the coronary sinus pressure was always < 40 mmHg in beating or arrested hearts. EXPERIMENTAL: Compared to control values (81.4 +/- 0.4% tissue water content), no right-ventricular (80.8 +/- 0.8%) or left-ventricular (79.5 +/- 0.3%) edema developed, no lactate was produced (control: -1.0 +/- 0.5 mg/100 g/min, empty beating: -0.64 +/- 5, and BCP arrest: -8.6 +/- 6.6).(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed2001

Improving survival from sudden cardiac arrest: the role of the automated external defibrillator.

CONTEXT: Sudden cardiac death is a major public health problem in the United States, and improving survival after out-of-hospital cardiac arrest has been the subject of intense study. Early defibrillation has been shown to be critical to improving survival. Use of automated external defibrillators (AEDs) has become an important component of emergency medical systems, and recent advances in AED technology have allowed expansion of AED use to nontraditional first responders and the lay public. OBJECTIVES: To examine advancements in AED technology, review the impact of AEDs on time to defibrillation and survival, and explore the future role of AEDs in the effort to improve survival following sudden cardiac arrest. DATA SOURCES: MEDLINE was searched for articles from 1966 through December 2000 (Medical Subject Headings: electric countershock, heart arrest, resuscitation, emergency medical services; keywords: automatic external defibrillator, automated external defibrillator, public access defibrillation). Reference lists of relevant articles, news releases, and product information from manufacturers were also reviewed. STUDY SELECTION: Initial MEDLINE search produced 4816 articles, from which 101 articles were selected for referencing based on having been published in a peer-reviewed journal and on relevance to the subject of the manuscript as determined by all 5 authors. DATA EXTRACTION: All studies were critically reviewed for relevance, accuracy, and quality of data and study design by all authors. DATA SYNTHESIS: Recent advances in AED technology and design have resulted in marked simplification of AED operation, improvements in accuracy and effectiveness, and reductions in cost. Use of AEDs by first responders and laypersons has reduced time to defibrillation and improved survival from sudden cardiac arrest in several communities. Initial studies of the cost-effectiveness of AED use in comparison with other commonly used treatments are favorable. CONCLUSION: The AED represents an efficient method of delivering defibrillation to persons experiencing out-of-hospital cardiac arrest and its use by both traditional and nontraditional first responders appears to be safe and effective. The rapidly expanding role of AEDs in traditional emergency medical systems is supported by the literature, and initial studies of public access to defibrillation offer hope that further improvements in survival after sudden cardiac death can be achieved.

Cost-Benefit Analysis↗
PubMed1999

Mitochondrial protein and HSP70 signaling after ischemia in hypothermic-adapted hearts augmented with glucose.

Hypothermia improves resistance to subsequent ischemia in the cardioplegic-arrested heart (CAH). This adaptive process produces mRNA elevation for heat shock protein (HSP) 70-1 and mitochondrial proteins, adenine nucleotide translocator (ANT(1)), and beta-F(1)-ATPase. Glucose in cardioplegia also enhances myocardial protection. These processes might be linked to reduced ATP depletion. To assess for synergism between these protective processes, isolated rabbit hearts (n = 91) were perfused at 37 degrees C and exposed to ischemic cardioplegic arrest for 2 h. Hearts were in four groups: control (C), hypothermia adapted (H) perfused to 31 degrees C 20 min before ischemia, 22 mM glucose (G) in cardioplegia, and hypothermic adaptation and glucose (HG). Developed pressure (DP), dP/dt(max), and pressure-rate product (PRP) improved (P < 0.05) in G, H, and HG compared with C during reperfusion. DP and PRP were elevated in HG over H and G. ATP was higher in G, H, and HG, although no additional increase in HG over H was found. Lactate and CO(2) production were elevated in G only. The mRNA expression for HSP70-1, ANT(1), and beta-F(1)-ATPase was elevated severalfold in H and HG, but not G over C during reperfusion. In conclusion, glucose provides additional functional improvement in H. Additionally, neither ATP levels nor anaerobic metabolism are linked to mRNA expression for HSP70, ANT(1), or beta-F(1)-ATPase in CAH.

Adenosine Triphosphatases↗
PubMed1989

Purine-enriched asanguineous cardioplegia retards adenosine triphosphate degradation during ischemia and improves postischemic ventricular function.

Myocardial dysfunction after induced ischemic arrest is an important problem in cardiac surgery. Adenosine-5'-triphosphate content in myocardial tissue remains depressed for days after ischemia, perhaps because of reperfusion washout of diffusable purine substrates. Left ventricular function is also depressed after ischemia, but its relationship to absolute tissue adenosine triphosphate content is unclear. We tested the hypothesis that arresting hearts with a cardioplegic solution containing adenosine, hypoxanthine, and ribose would result in improved tissue adenosine triphosphate content and left ventricular function after 1 hour of normothermic global ischemia in dogs supported by cardiopulmonary bypass. Animals with ischemic arrest initiated with a crystalloid cardioplegic solution containing adenosine 100 mumol/L, hypoxanthine 100 mumol/L, and ribose 2 mmol/L demonstrated significant improvement (p less than 0.05) during postischemic reperfusion. A significant correlation (p less than 0.05) existed between myocardial adenosine triphosphate content and the recovery of left ventricular function. These experiments demonstrate that an asanguineous cardioplegic solution containing adenosine, hypoxanthine, and ribose maintains myocardial adenosine triphosphate content during ischemia and reperfusion and enhances functional recovery during the postischemic period.

Adenosine↗
PubMed2001

[Cardiac arrhythmias in Guillain-Barre syndrome. An overview of the diagnosis of a rare but potentially life-threatening complication].

Autonomic neuropathy is an important complication of Guillain-Barré syndrome (GBS). In particular, over-reactivity of vagal function may lead to serious cardiac disturbances ranging from bradycardia to asystole. Early recognition of these events is essential for appropriate intervention such as the insertion of a cardiac pacemaker. Recent studies indicate that serious bradyarrhythmias could be observed in severely and even less severely affected patients who were still able to walk more than 5 meters. Conventional measures such as the presence of tachycardia, heart rate and blood pressure fluctuations, or short-term heart rate variability and standardized autonomic function tests were not useful in predicting serious bradyarrhythmias. However, abnormal sensitivity to eyeball pressure testing correctly identified two of three patients who needed cardiac pacing or cardiopulmonary resuscitation due to heart arrest; eight of ten patients without bradyarrhythmic events showed normal responses. New methods such as the 24-hour heart rate power spectrum may yield sensitive and specific markers for assessing the risk of impending and potentially life-threatening arrhythmias in patients with GBS.

Autonomic Nervous System Diseases↗