[Bronchopneumopathies and chronic respiratory failure secondary to noxae. 4. Cardiac repercussion of respiratory insufficiency].
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The study of frequency and of the nature of post-tuberculous syndromes in a group including 1351 patients with pulmonary tuberculosis at their first treatment, investigated between 1974 and 1977, has demonstrated that in the present stage of initial chemotherapy with standardized drug regimens, the post-tuberculous syndromes are decreasing in most of the cases, developing in those of the patients that presented with advanced froms of the disease at the start of the the therapy (2,8% in our study). At the same time one should note the prevalence of patients that have benefited from initial courses of chemotherapy with classical and relay drugs, such patients usually having less severe anatomic and radiologic lesions. The study of types of post-tuberculous syndromes has revealed the increased frequency of the bronchitic syndrome.
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BACKGROUND: Carcinoid heart disease characteristically affects tricuspid (TV) and pulmonary valves (PV), and TV replacement is helpful in selected patients. There is uncertainty, however, regarding optimal surgical management of PV regurgitation. METHODS AND RESULTS: We reviewed 22 patients having operation for carcinoid heart disease and compared those having TV and PV replacement (n=12), to those who underwent TV replacement and excision of the PV (n=10). Pre- and postoperative right ventricular (RV) size and dysfunction were assessed by consensus of 2 echocardiographers blinded to type of surgical treatment. RV dysfunction was graded as none (0), mild (1), moderate (2), or severe (3). RV size was graded as normal (0), or mild (1), moderate (2), or severe (3) enlargement. Preoperatively, RV size (2.2+/-0.8 [no PVR]versus 2.7+/-0.6 [with PVR], P=0.15), RV dysfunction (0.9+/-0.9 [no PVR]versus 1.4+/-0.7 [with PVR], P=0.14), and NYHA class were similar in the 2 groups. Postop RV size decreased inpatients with PVR, 2.7+/-0.6 to 1.7+/-1.0 (P=0.008), but did not change appreciably in those without PVR, 2.2+/-0.8 to 2.3+/-0.8 (P=0.67). There was no significant change in RV dysfunction after surgery, 1.4+/-0.7 to 1.8+/-0.9 with PVR (P=0.26) and 0.9+/-0.9 to 1.6+/-0.9 without PVR (P=0.07). CONCLUSIONS: PV replacement appears to have a beneficial effect on RV size in patients after surgery for carcinoid heart disease. This may have important implications for RV remodeling after PV replacement.
OBJECTIVE: To investigate the effects of homologous conduits with valves in the treatment of complex congenital heart disease with insufficient pulmonary blood flow in children. METHODS: Homologous conduits with valves were used in the right ventricular outflow tract reconstruction among 212 pediatric patients with complex congenital heart disease with insufficient pulmonary blood flow, aged 2.6 (0.5 - 15). The patients were followed up for 2.6 years (6 months to 7 years) and underwent echocardiography to assess the degree of pulmonary insufficiency and calcification of blood vessel. RESULTS: The success rate of operation was 96.5% (204/212). The ratio of right ventricle to aortic pressure was less then 0.55. During the follow-up, echocardiography showed valvular regurgitation and calcification of the blood vessel in 34 patients, 23 (11.2%) being mild, 7 (3.42%) being moderate, and 4 (1.96%) being sever. 170 patients did not show obvious pulmonary insufficiency. CONCLUSION: Application of homologous conduits with valves in the treatment of complex congenital heart disease with insufficient pulmonary blood flow in children shows excellent early results in preventing pulmonary insufficiency.
BACKGROUND: We assessed the impact of comorbid conditions and revascularization for aortoiliac occlusive and aneurysmal disease and determined the functional health status of patients with the Medical Outcomes Study SF36 Health Survey. METHODS: One hundred twenty-five patients were surveyed prospectively, before operation, and at intervals ranging from 2 weeks to 2 years after operation. To identify the factors that influenced functional health, multiple regression analysis was performed to test the hypothesis that age, pulmonary disease, atherosclerotic heart disease, diabetes, aortoiliac occlusive disease (AOD) versus aneurysmal disease, and the preoperative physical summary score affected outcome. RESULTS: Regression analysis identified that before operation, the physical summary score (PCS) was affected by pulmonary disease, atherosclerotic heart disease, and AOD, and patients with AOD had significantly worse PCS than patients with aneurysmal disease (43.2 +/- 12.6 vs 30.1 +/- 8.3, P <.05). This difference was also present after 3 to 12 months, and the preoperative PCS was the strongest predictor of the postoperative score. For patients followed up between 1 and 2 years, there was no significant difference among the groups, and atherosclerotic heart disease and pulmonary disease were identified to most affect the PCS. CONCLUSIONS: Patients with AOD have significantly impaired physical function (as compared with patients with aneurysmal disease) that is successfully reversed with a surgical procedure. The functional health of patients after operation for aneurysmal disease returns to baseline after 3 and 12 months. Ultimately, cardiac and pulmonary comorbidities have a continued effect on the functional health of patients.
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Gated magnetic resonance (MR) imaging was used to evaluate central cardiovascular anatomy in 172 subjects, 31 of whom were healthy volunteers. Using the spin-echo technique, images of diagnostic quality were obtained in 93% of cases with TE = 28 msec and in 65% of cases with TE = 56 msec. Transverse multisection sequences encompassing most of the left ventricle required approximately 6-8 minutes. Corroborative studies were available in 134 of 141 patients who had cardiovascular disease; two dimensional echocardiograms and angiography in 133 and 100 patients, respectively. Gated MR demonstrated the wall thinning and complications caused by prior myocardial infarctions and high signal intensity of the myocardium at the site of acute myocardial infarctions. MR accurately demonstrated anatomic abnormalities owing to hypertrophic and congestive cardiomyopathies, congenital abnormalities of the heart and great vessels, rheumatic heart disease, pulmonary hypertension, and cardiac and paracardiac masses. Depiction of cardiovascular anatomy and pathoanatomy was attained without the use of any contrast media. Consequently, gated MR is an effective technique for cardiac diagnosis. The short time required for tomographic examination of the entire heart using the multisection technique renders this a practical cardiac imaging modality.
An evaluation of the pulmonary vascular resistance and the reversibility of pulmonary vascular reaction in children with congenital heart disease is essential for determining the surgical indication and for assessing the long-term prognosis. We report the clinical efficacy of low dosage inhaled nitric oxide and investigate the relationship between its effect and hemodynamic parameters in 18 patients with congenital heart disease. The patients were divided into 3 Groups; Group 1 consisting of 3 patients with Eisenmenger syndrome, Group 2 of 10 patients whose mean pulmonary artery pressure was more than 30 mmHg, and Group 3 consisting of 5 patients whose mean pulmonary artery pressure was less than 30 mmHg. High concentration (90%) oxygen, and also normal oxygen (21%) containing 10 parts per million nitric oxide were administered by cardiac catheterization. In Group 1, both the 90% oxygen and the normal oxygen with nitric oxide showed no affect on the hemodynamical variables. In Group 2, the pulmonary artery pressure and the pulmonary vascular resistance both significantly decreased with the 90% oxygen, and with the nitric oxide inhalation, but these decreases were not found in Group 3. In the 15 patients (of Groups 2 and 3 combined) who were considered to have reversible pulmonary vascular changes, significant correlations were found between the baseline pulmonary artery pressure and the magnitude of pulmonary vasodilation. No clinical evidence of toxicity was seen with the administration of the inhaled nitric oxide. These data suggested that inhaled nitric oxide, even in a low dosage, was a potent and selective pulmonary vasodilator in patients with congenital heart disease complicated with pulmonary hypertension. Since a positive correlation was found between the baseline pulmonary artery pressure and the magnitude of pulmonary vasodilation, this examination demonstrated potential efficacy for objective analysis in patients with pulmonary hypertension.
BACKGROUND: Although surgical shunt is still considered as the best palliation of congenital heart disease with reduced pulmonary blood flow, stent implantation may be technically simpler, safer and more cost-effective than surgery in high-risk patients. This study evaluated the feasibility and results of this option in patients with duct-dependent pulmonary blood flow or systemic-to-pulmonary shunt malfunction. METHODS: Between April 2003 and July 2004, 9 patients (age 11 days-52 years, weight 2.1-52 kg) with complex congenital heart disease underwent stent implantation inside the patent ductus arteriosus (4 patients) or a stenotic surgical shunt (5 patients). RESULTS: The stenting procedure was successfully completed in all cases. The procedural time was 162 +/- 36 min (range 90-225 min). The fluoroscopy time was 33.8 +/- 6.8 min. No patient died. The morbidity rate was 22.2% (1 patient had local infection at the site of puncture and 1 had transient femoral artery pulse loss). After the procedure, the ductus/shunt diameter increased from 1.2 +/- 0.6 to 3.6 +/- 0.6 mm (p < 0.0001) and oxygen saturation improved from 74.0 +/- 6.5 to 85.2 +/- 3.3% (p < 0.01). Three patients underwent corrective surgery without technical problems after 8.0 +/- 1.0 months while oxygen saturation remained constantly >80% in patients still waiting for surgical repair (follow-up 5.3 +/- 3.1 months). CONCLUSIONS: Stent implantation is a technically feasible, safe and effective palliative option in high-risk surgical patients with congenital heart disease and reduced pulmonary blood flow. Although larger series are required to define the cost-effective clinical impact of this therapeutic option, it is reasonable to hypothesize a further extension of its indication even to elective and low-risk surgical patients.
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A prospective study of congestive cardiac failure in 221 elderly Nigerians seen at Ahmadu Bello University Hospital, Zaria, and Ife University Teaching Hospitals Complex, Ile-Ife from 1974 to 1979 is reported. Hypertension, iodopathic cardiomegaly and pulmonary heart disease were major causes of cardiac failure. No case of coronary atherosclerotic heart disease was seen. Ventricular conduction defect was the commonest E.C.G. abnormality recorded. In over half of the patients, there was coexisting disease, mild to moderate anaemia being the most common.
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