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PubMed1991

Dextrocardia, situs inversus and severe mitral stenosis in a pregnant woman: successful closed commissurotomy.

A 16-weeks' pregnant woman with situs inversus and dextrocardia underwent successful closed commissurotomy for severe mitral stenosis. The electrocardiogram revealed sinus rhythm with right axis deviation and progressive diminishing of QRS amplitude towards the left precordial leads. The chest X-ray showed dextrocardia with situs inversus. Doppler echocardiography depicted severe mitral stenosis; the mitral valve area increased from 0.9 cm2 pre-operatively to 1.8 cm2 post-operatively with mild increase of mitral regurgitation from grade I to II post-valvotomy. She also had associated mild functional tricuspid insufficiency and moderate pulmonary hypertension. No thrombo-embolic complications occurred intra- or post-operatively. There was no evidence of either clinical or Doppler restenosis. The course of pregnancy was uneventful. At 39 weeks a healthy baby was vaginally delivered. The patient is still free of cardiac symptoms.

Adult↗
PubMed1990

[Preoperative risk assessment: long-term electrocardiography for directed diagnosis of arrhythmias].

The role of ambulatory electrocardiography for detection, confirmation, or exclusion of severe forms of arrhythmias was investigated in our preoperative anesthesia clinic. In a prospective study over a period of 21 months, 30 of 8935 preoperatively evaluated patients (0.3%) scheduled for noncardiac surgery were monitored by 24-h ambulatory ECG. Indications included common clinical reasons for ordering an ambulatory ECG and additional specific "anesthesiologic" indications: Syncopes, dizziness, or other manifestations possibly related to cardiac arrhythmias; Rhythm disturbances under antiarrhythmic drug therapy; Suspected paroxysms of supraventricular tachycardia; Q-T syndrome, R- on-T phenomenon; Insignificant rhythm disturbances in patients with significant cardiac disease such as cardiomyopathy, aortic stenosis, mitral valve prolapse; Rhythm disturbances in patients with poor general medical status; Recent myocarditis with arrhythmias; Previous known or suspected intraoperative cardiac complications; Suspected sick sinus syndrome. The mean age of the patients was 63.9 years; most (24/30) were classified as ASA III. In 4 patients with suspected bradycardic rhythm disturbances the ambulatory ECG proved a useful method for further decision-making compared to the routine resting ECG. According to the long-term ECG recordings 22 patients were classified as Lown IV. After effective antiarrhythmic therapy--usually with propafenon--none of these patients (n = 13) or those classified as Lown 0 to III (n = 8) showed intraoperative arrhythmias or other hemodynamic problems. In contrast, of the patients with complex rhythm disturbances refractory to antiarrhythmic drug therapy (n = 4) or those in whom emergency operations were performed without antiarrhythmic drug therapy (n = 2), 4 developed severe arrhythmias or other intraoperative hemodynamic problems. Two died on the 1st postoperative day.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1978

[Hemodynamic classification of 2d-stage mitral stenosis].

Thirty patients with mitral stenosis were examined according to the Bakulev-Damir classification during right heart catheterization at rest, with loading and during the rehabilitation period. The relationships found between the extent of the resistance at rest and the character of the degree of its changes at loading, reflecting the stenosis evolution, provide grounds for the differentiation of four stages, four substages resp., in its classification, namely: Second A substage with sinus rhythm, without included protective reaction of a. Pulmonalis periphery at rest, with markedly manifested peripheral vasodilation with loading. Second B substage with sinus rhythm, protective reaction of a. Pulmonalis periphery at rest included to a lesser degree, excluded loading, with a following manifested vasodilation. Second C substage with absolute arrhythmia, included to a lesser degree protective reaction of a. Pulmonalis periphery at rest, excluded with loading, with a following slighter vasodilation. Second D substage with sinus rhythm, included protective reaction at a. Pulmonalis periphery at rest, considerably intensified with loading. The extent and dynamics of the rest of the values studied are followed up in the separate stenosis substages aiming at their complete hemodynamic characterization. The pathogenetic mechanism of the pulmonary edema in the second stenosis stage is analyzed, not rarely conditioning the clinical pardox "minor stenosis of mitral valve with menacing pulmonary edemas".

Blood Circulation Time↗
PubMed1995

[Cardiac myxoma in 13 patients].

OBJECTIVE: To gain insight into the occurrence, the manifestation and the treatment of cardiac myxoma. DESIGN: Retrospective. SETTING: The departments of Cardiology and Cardiac Surgery of Middelheim General Hospital, Antwerp, Belgium. PATIENTS AND RESULTS: Thirteen patients in the period 1985-1995 were subjected to surgical resection of a cardiac myxoma. In accordance with earlier studies, most patients were middle-aged and female. The site of predilection was the left atrium. Cardiac auscultation suggested mitral valve stenosis and insufficiency in three and five patients, respectively; in only one case was the specific 'tumour plop' heard. Cardiac symptoms were atypical thoracic pain (4 times), syncopes (3) and effort dyspnoea (7). Although embolism is described in the literature in 20-70% of the cases, it occurred in only three patients of this group. General symptoms were observed in only seven patients, as against 90% in earlier studies: they were elevated sedimentation rate in five (one also polycythaemia and leucocytosis) and abnormal fatigue in two (one also anorexia) patients. In all 13, the diagnosis of 'intracardiac mass' was made on the basis of ultrasonography. In six of 11 patients who subsequently underwent coronary roentgenography, neovascularization was visualized. All 13 tumours were resected successfully, after which in ten cases a dacron patch was implanted at the level of the interatrial septum. In addition, two patients underwent coronary bypass surgery. Postoperatively, atrial flutter (two patients), atrial fibrillation (one) and fatal cerebral bleeding (one) were observed. The other patients suffered no recurrences. CONCLUSION: Cardiac myxoma is a rare tumour which in general can be accurately diagnosed on the basis of ultrasonography and which almost always can be cured by surgical excision.

Adolescent↗
PubMed1995

[A case of massive air embolism during cardiopulmonary bypass].

Massive air embolism during cardiopulmonary bypass is one of the most serious complications in open heart surgery. We report such an accident, which was managed by temporary retrograde perfusion through the superior vena cava. A 59-year-old woman with severe mitral stenosis underwent mitral valve replacement. Soon after the start of the bypass, a massive air embolism occurred, probably because a bend in the tubing caused the blood level in the oxygenator to fall. The pump was stopped immediately and the patient was placed in the deep Trendelenburg position. The pump circuit was primed rapidly with fluid and retrograde perfusion through the superior vena cava was done at a flow rate of 1.5 L/min for 5 min. After air return from the aortotomy was confirmed, the standard bypass procedure was resumed with hypothermia. When the accident was discovered, and until the end of the operation, deep anesthesia was induced with pentobarbital for protection of the brain. Mitral valve replacement and tricuspid annuoplasty were done in the usual way thereafter. Postoperatively, the patient had no neurologic sequelae except for transient generalized convulsions, and has returned to normal daily activities.

Cardiopulmonary Bypass↗
PubMed1993

The age-related advancement of arterial disease measured by Doppler ultrasound diastolic flow analysis.

OBJECTIVE: To quantify by A-mode Doppler sonography the age-related progression of arterial disease so that age dependent normal values may be established for the screening Doppler peripheral arterial exam. Arterial distensibility was assessed by A-mode Doppler diastolic flow analysis as a measure of atherogenesis. These values will increase the sensitivity and decrease the incidence of false-positive results when the Doppler exam is utilized to differentially diagnosis vascular and sciatic neurogenic claudication. The relationship between age and results from the standard ankle/arm index ultrasound pneumatic cuff examination was also analyzed. DESIGN: A two by three analysis of variance with orthogonal Helmert contrast codes and simple linear regression analysis was utilized for this cross-sectionally designed investigation. The dependent measures of diastolic flow analysis and ankle/arm pressure index were obtained within three nested successively increasing age groups. SETTING: Chiropractic office. SUBJECTS: Studied were a total of 90 sedentary nonsmoking subjects, aged 23-79 yr, all of whom had normally accepted levels of serum glucose, cholesterol and blood pressure. Subjects were screened for evidence of aortic coarctation, myocardial infarction, tachyarrhythmia, aortic valve stenosis, mitral prolapse, hypertension, hypercholesterolemia, diabetes and peripheral occlusive arterial disease. Anthropometric measurements and percent body fat were obtained. A predictive oxygen consumption bike ergometer test was performed to obtain aerobic capacity. The commonly utilized standard ankle/arm index ultrasound pneumatic cuff examination and arterial diastolic flow analysis were performed with A-mode Doppler ultrasound on all subjects. RESULTS: These results demonstrate that a significant inverse linear relationship exists between aging and arterial compliance (p < .0001) in our population. Diastolic flow analysis had a greater sensitivity to arterial disease than the standard ankle/arm index ultrasound pneumatic cuff procedure. CONCLUSION: When utilizing A-mode Doppler ultrasound diastolic flow analysis as an indicator of early peripheral atherosclerotic arterial disease, increased sensitivity may be obtained when the age-related elevation in atherogenesis is taken into account.

Adult↗
PubMed1993

[Cardiac myxoma--morphology, clinical observations, diagnosis].

The authors, presenting a group of 23 cardiac myxomas over the past 20 years, provide a review of the most common clinical symptoms, such as mitral valve stenosis, dyspnoea, tachycardia, and/or myxoma mass embolizing the systemic circulation as well as the diagnostic modalities available, echocardiography and angiography in particular. Based on the histologic picture and the ultrastructure. They assume that, histogenetically, cardiac myxomas are true neoplasms from undifferentiated mesenchymal cells. Echocardiographic confirmation of cardiac myxomas warrants immediate surgical removal of the neoplasm.

Adult↗
PubMed1996

Thrombocytopenia corrected by warfarin in antiphospholipid syndrome.

We describe a case of antiphospholipid associated thrombocytopenia in which warfarin, but not heparin, normalized the platelet count. Systemic lupus erythematosus was present in association with chorea, mitral valve stenosis, and renal thrombotic microangiopathy. No evidence of platelet consumption was detected. Low dose aspirin, pulse methylprednisolone, intravenous gammaglobulin, and cyclophosphamide also partially elevated the platelet count. Platelet activation, measured by P selectin assay, was not present during warfarin or aspirin therapy, suggesting that platelet activation may have been decreased by these treatments. We discuss possible mechanisms for correction of thrombocytopenia in antiphospholipid syndrome by warfarin.

Anticoagulants↗
PubMed1996

[Shone's syndrome].

Explore the source record for details and available documents.

Aortic Coarctation↗
PubMed1997

[Hemolytic anemia and thrombocytopenia induced by cimetidine: recurrence with ranitidine administration].

A 69-year-old woman was admitted with apoplexy after operation of mitral valve stenosis and gastrectomy due to a gastric ulcer. In June 1994, her condition gradually worsened after acute pneumoniae in her right lung. Intravenous hyperalimentation with cimetidine administration was started to improve her undernourishment, because she had a history of gastric ulcer. However, after 10 days from the start of cimetidine therapy, anemia progressed rapidly. Biochemical examinations revealed that the serum indirect bilirubin and LDH levels were elevated and no serum haptoglobin was detected. These results indicated the development of hemolytic anemia, but at that time we could not clarify the reason. In October 1994, thrombocytopenia gradually progressed, and we halted the administration of cimetidine to ranitidine. Both hemolytic anemia and thrombocytopenia was dramatically improved after cessation of cimetidine administration. We then changed the drug from cimetidine, however the same phenomena have appeared again. The patient was in stable condition, after cessation of H2-blockers administration. The complication of hemolytic anemia and thrombocytopenia associated with H2-blocker administration in Japan.

Aged↗
PubMed1996

[Correlation of selected hemodynamic parameters of pulmonary circulation and indices of pulmonary function in patients with mitral stenosis].

The aim of this study was to test if the lung compliance and other indices of pulmonary function correlated with hemodynamic parameters in patients with secondary pulmonary hypertension due to mitral stenosis. 36 patients (mean age 50 years) with mitral stenosis (mean mitral valve area-1.2 cm2), without history of lung diseases were analyzed in the study. 16 patients (group A) were in the II-nd and 20 patients (group B) were in the III-rd and IV-th NYHA class. All patients underwent Swan-Ganz catheterization with evaluation of pulmonary pressures, resistances and pulmonary veins compliance. Pulmonary function tests (spirometry, plethysomography, lung compliance) were also performed. In both analyzed groups the pulmonary artery pressure and pulmonary vein compliance correlated significantly with pulmonary compliance.

Adult↗