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P Alivizatos

Publications and source records attributed to P Alivizatos.

8 recordsLinked to original sources
PubMed2006

Inhaled iloprost in eight heart transplant recipients presenting with post-bypass acute right ventricular dysfunction.

BACKGROUND: During heart transplantation, weaning from cardiopulmonary bypass may be particularly laborious as a result of superimposed acute right ventricular dysfunction in the setting of pre-existing pulmonary hypertension. Research in recent years has focused on inhaled vasodilatory treatment modalities which selectively target the pulmonary circulation. METHODS: We present a series of eight patients in whom inhaled iloprost, a synthetic prostacyclin analog, was used to treat pulmonary hypertension and right ventricular dysfunction detected by transesophageal echocardiography during a heart transplant procedure. In addition to conventional inotropic support, 20 mug of inhaled iloprost was administered via nebulized aerosol for a 20-min period. Complete sets of hemodynamic measurements were obtained before inhalation and during and after cessation of the inhalation period. RESULTS: Inhaled iloprost decreased the transpulmonary gradient at the end of the inhalation period relative to baseline (8.2 +/- 1.6 mmHg vs. 11.2 +/- 0.9 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.24 +/- 0.07 vs. 0.44 +/- 0.09, P < 0.05). A statistically significant decrease in the pulmonary vascular resistance to systemic vascular resistance ratio was also observed (0.10 +/- 0.02 vs. 0.19 +/- 0.02, P < 0.05). Improved indices of right ventricular function were observed in echocardiographic monitoring. CONCLUSION: During heart transplantation procedures, episodes of pulmonary hypertension can be successfully treated with inhaled iloprost administration, without untoward side-effects or significant systemic impact.

Administration, Inhalation↗
PubMed1998

Unexpected cardiac arrest after cardiac surgery: incidence, predisposing causes, and outcome of open chest cardiopulmonary resuscitation.

STUDY OBJECTIVES: To assess the incidence of acute mechanical causes precipitating sudden cardiac arrest in cardiac surgery patients during the immediate postoperative period. In addition, we report the success rate of cardiopulmonary resuscitation (CPR) in which open-chest CPR was employed at an early stage of the resuscitation effort. METHODS: Data on all cardiac surgical patients who suffered a sudden cardiac arrest during the first 24 h after surgery were collected prospectively. CPR consisted of conventional closed-chest CPR initially and was followed within 3 to 5 min, if needed, by open-chest CPR. RESULTS: Of 3,982 patients undergoing cardiac surgery over a 30-month period, 29 patients (0.7%) had a sudden cardiac arrest. Of these, 13 patients (45%) were successfully resuscitated with closed-chest CPR, 14 (48%) with open-chest CPR, and 2 (7%) died despite closed- and open-chest CPR. Four CPR survivors died subsequently in the ICU, yielding an overall hospital discharge rate of 79%. Perioperative myocardial infarction was the underlying cause of sudden cardiac arrest in 14 patients (48%), and mechanical impediments to cardiac function (tamponade or graft malfunction) in another 8 (28%) patients; in the remaining 7 patients (24%), no underlying cause was found. The length of ICU stay was 6+/-1 (mean+/-SE) days. None of the patients developed wound infection and all were neurologically intact at hospital discharge. CONCLUSION: Mechanical factors account for a substantial portion (28%) of causes of sudden cardiac arrest occurring in hemodynamically stable patients during the immediate postoperative period. This high incidence, in conjunction with the high survival rate achieved by open CPR, supports an early approach to open-chest CPR in this group of patients.

Cardiac Surgical Procedures↗
PubMed1985

Pulmonary sequestration complicated by anomalies of pulmonary venous return.

Five anomalies of pulmonary venous drainage were seen among 12 children operated for lung sequestration. In two children, venous drainage from the sequestrated lobe and the rest of the right lung was via a single channel into the inferior vena cava ("scimitar syndrome"). In one of these children, the sequestrated lobe was resected and repair of the scimitar syndrome was delayed; in the second patient, the anomalous pulmonary venous drainage was not recognized preoperatively and the vein was ligated, resulting in acute hemorrhagic infarction of the right lung and death of the patient. Three patients had less severe anomalies of pulmonary venous drainage. We recommend very careful evaluation of patients with lung sequestration with special reference to pulmonary venous drainage.

Abnormalities, Multiple↗
PubMed1985

Atrioventricular septal defect with balanced ventricles and malaligned atrial septum: double-outlet right atrium. Report of two cases.

An unusual form of atrioventricular septal defect was found at operation. The anatomy was that of a primum atrial septal defect with deviation of the atrial septum to the left. Thus from the right atrium both right and left atrioventricular valves could be seen. The left-sided valve was tricuspid. Repair was achieved by closure of the septal commissure of the left-sided valve ("cleft"), excision of the lower part of the atrial septum, and insertion of a pericardial patch. The lower part of the patch was sutured between the left and right atrioventricular valves. A specimen with similar anatomy is also described.

Child, Preschool↗
PubMed1981

Successful orthotopic canine heart transplantation after 24 hours of in vitro preservation.

A protocol was developed to provide continuous, hypothermic, low-pressure perfusion for 24 hours' preservation of the isolated canine heart prior to orthotopic transplantation. Donor cardiectomy included coronary vasodilatation with diltiazem, potassium arrest, and rapid cooling of the heart. The graft was perfused at a pressure of 18 to 22 cm H2O and at an average flow of 0.743 cc/min/gm of tissue. The septal temperature was 5 degrees to 7 degrees C and perfusate pH was 7.25 to 7.4. Two groups of mongrel dogs were studied after orthotopic transplantation: Group I (n = 15) received hearts perfused for 24 hours. Group II (n = 9) received hearts removed by the same cardiectomy technique, but transplanted immediately. All grafts were able to support the recipient circulation after cardiopulmonary bypass. These was no significant difference in survival or in graft function when hemodynamic studies were done in five animals of each group, between 5 and 10 days after operation. We conclude that a reliable and reproducible method of 24 hours' in vitro perfusion of the canine heart has been obtained and should be applicable in clinical cardiac transplantation when prolonged periods of preservation are required.

Animals↗
PubMedDate not supplied

Hepatic dysfunction following cardiac surgery: determinants and consequences.

BACKGROUND/AIMS: We prospectively studied the determinants, characteristics, and consequences of hepatic dysfunction in the early postoperative period following cardiac surgery. METHODOLOGY: We examined 3041 adult patients, mean age 60.6 (+/- 8.9), with normal pre-operative liver function who consecutively underwent open heart surgery in a newly established Cardiac Surgery Center. Patients were divided into two groups; Group A included all patients who developed hepatic dysfunction, defined as the presence of jaundice associated with an elevated serum bilirubin above 3 mg/dl, in the early postoperative period. The control group included cardiac surgical patients who did not develop such dysfunction. RESULTS: Hepatic dysfunction developed in 96 patients (3.2%). The affected patients consisted of 63 males and 33 females, mean age 60.8 (+/- 9.4). Determinants of hepatic dysfunction based on univariate analysis were sex, NYHA class, type of surgery, operative times, low cardiac output syndrome necessitating administration of inotropic agents and/or IABP usage, cardiac arrest, presence of hematomas, and number of blood transfusions. Patients with hepatic dysfunction required prolonged mechanical ventilation, stayed longer in the ICU (and in the hospital) and experienced a much higher mortality rate (11.4%) compared to the control group (p = 0.001). CONCLUSION: Although the pathogenesis of hepatic dysfunction seems to be multifactorial, liver cell damage due to decreased perioperative hepatic flow and increased bilirubin load seem to be of critical importance. Early postoperative hepatic dysfunction resulted in increased morbidity and mortality.

Adolescent↗