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Biomedical subjects

A D Cochrane

Publications and source records attributed to A D Cochrane.

31 records · Page 2Linked to original sources
PubMed1994

A comparison of amiodarone and digoxin for treatment of supraventricular arrhythmias after cardiac surgery.

Despite the widespread use of amiodarone in non-surgical patients, its role in the management of supraventricular tachyarrhythmias after cardiac surgery is not clear. We set out to compare the relative efficacy of amiodarone and digoxin in the management of atrial fibrillation and flutter in the early postoperative period. This prospective randomised trial comprised 30 patients, previously in sinus rhythm, who developed sustained atrial fibrillation or flutter following myocardial revascularisation, valve surgery or combined procedures. Amiodarone was administered as an intravenous loading dose followed by a continuous infusion. Digoxin was given as an intravenous loading dose followed by oral maintenance therapy. Electrocardiographic and haemodynamic monitoring was continued for 24 h after the commencement of treatment. There was a marked reduction in heart rate in both groups, mainly in the first 6 h, from 146 to 89 beats per minute in the amiodarone group and from 144 to 95 in the digoxin group. At the end of the 24 h, one of the 15 patients in the amiodarone group and 3 of the 15 patients in the digoxin group remained in atrial fibrillation. No patient in either group developed adverse reactions. We conclude that intravenous amiodarone therapy is safe and at least as effective as digoxin in the initial management of arrhythmias after cardiac surgery.

Aged↗
PubMed1994

Retransplantation in heart-lung recipients with obliterative bronchiolitis.

Obliterative bronchiolitis remains the leading cause of morbidity and mortality in long-term survivors after heart-lung transplantation. Despite enhanced immunosuppressive therapy, a significant number of patients progress to end-stage respiratory failure, leaving retransplantation as the only potential therapeutic option. Between October 1986 and August 1990, 25 heart-lung recipients (mean age 22 +/- 2 years) underwent repeat heart-lung transplantation at an average of 21 months after their first procedure. Twenty-one patients (83%) were ventilator dependent at the time of retransplantation. The Kaplan-Meier survival at 1, 6, 12, and 24 months was 52%, 33%, 25%, and 25%, respectively. Postoperative complications included bleeding, multisystem organ failure, and infection. Obliterative bronchiolitis resulted in death or graft failure in three patients between 12 and 36 months after the second transplantation. Five patients were currently alive at the time this article was written, with a median follow-up of 54 months. Three were in New York Heart Association class I, and two had obliterative bronchiolitis with class III symptoms. Recently, we investigated the role of single lung retransplantation in nine heart-lung recipients (mean age 23 +/- 3 years). The mean interval between procedures was 36 months, and eight patients (88%) were ventilator dependent. The Kaplan-Meier survival at 1, 6, 12, and 24 months was 89%, 67%, 67%, and 50%, respectively. We observed significantly less perioperative morbidity in this group. Five patients were alive (median follow-up 20 months); four were in New York Heart Association class I or II, and one was in New York Heart Association class III with recurrent obliterative bronchiolitis. We did not have enough patients to perform multivariate survival analysis. Survival curve comparisons with the use of the Wilcoxon test did show that the absence of performed antibodies in the recipient (panel reactive antibody frequency less than 10%) was associated with significantly improved survival after retransplantation. We also noted trends for improved survival in patients who had retransplantation at least 18 months after their original transplantation and in patients with negative preoperative sputum cultures. Retransplantation is a high-risk procedure that can result in rehabilitation in otherwise incapacitated patients. Single lung retransplantation appears to be the preferred option in carefully selected patients.

Adolescent↗
PubMed1993

Staged conversion to arterial switch for late failure of the systemic right ventricle.

Late failure of the systemic right ventricle is seen in up to 10% of patients after atrial switch for transposition of the great arteries and in patients with atrioventricular and ventriculoarterial discordance. Since 1981, 24 such patients have entered a program to achieve conversion to arterial switch. The primary diagnoses were transposition of the great arteries with ventricular septal defect (n = 10), transposition of the great arteries with intact ventricular septum (n = 5), Taussig-Bing anomaly (n = 4), and atrioventricular and ventriculoarterial discordance (n = 5). The mean interval from atrial switch to right ventricular failure was 7 years. Four patients underwent direct conversion to arterial switch, with one operative death. In 3 of these patients the initial left ventricular pressure was high. The fourth patient was too sick to undergo banding, and he required left ventricular assist device support after switch conversion. The other 20 patients underwent 34 procedures to place or tighten a pulmonary artery band to prepare the left ventricle to tolerate systemic pressure. There was one band-related operative death. Twelve patients have thus far gone on to switch conversion 13 days to 5 years (mean, 26 months) after banding. In total, therefore, 16 patients have had an arterial switch with atrial reconstruction. The early mortality for switch conversion was 2 of 16 (12.5%; 70% confidence limits, 4% and 27%), with one late death 12 months after operation. Including operative mortality, the 1-year actuarial survival probability after conversion was 80% (70% confidence limits, 62% and 92%). All survivors are asymptomatic.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

The "domino-donor" operation in heart and lung transplantation.

OBJECTIVE: To report the first "domino-donor" operation performed in Australia; review the results of the first five combined procedures at the Alfred Hospital; and discuss the advantages of the procedure and its place in transplantation. PATIENTS AND OUTCOME: The first domino-donor was a 25-year-old man with cystic fibrosis and pulmonary hypertension, receiving a heart-lung transplant, whose heart was transplanted into a 20-year-old woman with end-stage cardiomyopathy. The cardiac recipient's initial course was satisfactory, but at eight months she developed severe rejection, with failure of the donor heart, and required retransplantation. Subsequently four further combined procedures were performed. All 10 patients are alive and well. Four patients have had cytomegalovirus infection but without major complications. Improved function of the donor right ventricle has been observed when the ventricle is working against a lower resistance. CONCLUSIONS: Four advantages of the domino procedure are evident: an increased pool of donor allografts; the use of a heart with an hypertrophied ("prepared") right ventricle; absence of the adverse effects of brain-death in the live donor; and improved ability to match the donor and recipient before the operation.

Adult↗
PubMed1991

Cogan's syndrome with aortitis, aortic regurgitation, and aortic arch vessel stenoses.

Cogan's syndrome of interstitial keratitis and vestibuloauditory dysfunction is rare. Systemic vasculitic manifestations occur, and 10% of patients with this syndrome have aortic valvular disease. A patient with Cogan's syndrome is presented who had aortitis of the ascending thoracic aorta, severe aortic valve regurgitation, orificial stenosis of the right coronary artery, and orificial stenoses of all three aortic arch vessels. Histopathology confirmed aortitis. Aortic valve replacement combined with coronary and aortic arch vessel reconstruction was required for correction.

Adult↗
PubMed1991

Technique and results of cardiac transplantation using "domino-donor" hearts.

Heart-lung transplantation is now well established for treatment of patients with terminal cardiopulmonary disease. More than 50% of heart-lung transplant recipients have normal or near normal hearts, with the majority having some degree of right ventricular hypertrophy. This potential source of "prepared" cardiac allografts remained untapped until the introduction of the "domino-donor" operation, a procedure in which the heart-lung recipient serves as a cardiac donor. The implantation of these available allografts contributes to the alleviation of the short supply of donor organs for cardiac transplantation. Aspects of the surgical technique, results, and potential benefits of this procedure are presented.

Adult↗
PubMed1988

Salmonellal mycotic abdominal-aortic aneurysm.

A patient is described with a mycotic abdominal-aortic aneurysm that was caused by Salmonella typhimurium, who presented to hospital four months after a urinary-tract infection that was caused by the same organism. The urinary-tract infection may have resulted from an episode of transient salmonellal bacteraemia, the significance of which was not appreciated. The pathogenesis, clinical features, treatment and prognosis of arteritis due to Salmonella species are reviewed. The early diagnosis and appropriate treatment of salmonellal mycotic aortic aneurysm is vital for a satisfactory outcome.

Aneurysm, Infected↗
PubMed1979

Ciramadol. A new analgesic.

Ciramadol (WY 15705), a new analgesic and narcotic antagonist was studied on oral-dose form in 16 patients (15 of whom were suffering from malignant disease) to evaluate the analgesic dose and toxicity. Patients with mild or moderate pain experienced effective relief with doses of from 20 mg to 60 mg (mean dose, 47 mg). In patients with moderate to severe pain, effective pain control was not achieved (mean dose, 82 mg). There was no consistent effect on blood pressure level, heart rate, or respiratory rate. Mild or moderate sedation occurred in eight patients. Nausea and vomiting occurred in two patients.

Adult↗
PubMedDate not supplied

Unusual cause of persistent impairment of ventricular function after repair of coarctation of the aorta.

In neonates with coarctation of the aorta, left ventricular function may be impaired due to an increased afterload and an associated endocardial fibroelastosis. Repair of the coarctation usually results in improvement in left ventricular function over the postoperative weeks. We report a patient in whom, despite successful repair of coarctation, left ventricular performance continued to deteriorate. Investigation revealed the unusual coincidental finding of anomalous left coronary artery from the right pulmonary artery.

Aortic Coarctation↗
PubMedDate not supplied

Heterotopic heart transplantation for elevated pulmonary vascular resistance in pediatric patients.

BACKGROUND: The presence of significant elevation of pulmonary vascular resistance is a major risk factor for death after orthotopic heart transplantation. The choice of procedure for the pediatric patient remains contentious. METHODS: We report three pediatric patients with pulmonary hypertension and raised pulmonary resistance, including two infants, in whom heterotopic transplantation was performed with smaller donor hearts. The hearts were anastomosed to provide left ventricular support alone because predominant left ventricular failure was present, the pulmonary resistance was expected to fall gradually after surgery, and we wished to avoid the potential problems of a pulmonary conduit associated with growth and possible reoperation. RESULTS: The clinical results have been satisfactory in all three patients, who were well and without symptoms. No pulmonary compromise was observed in the smaller thoracic cavity of the two infants. The transpulmonary gradient fell in all three patients, although this reduction was not immediate. CONCLUSIONS: This technique in carefully selected recipients can allow safer transplantation in pediatric patients with elevated pulmonary resistance, can increase the donor pool by allowing use of smaller hearts and nonideal donors, and may reduce the mortality on the transplant waiting list by providing earlier transplantation.

Adolescent↗