Simple Deep Hypothermia Research Articles

Long-Term Outcome of Intracardiac Repair under Simple Deep Hypothermia

Development of cardiopulmonary bypass has contributed to pediatric cardiac surgery, but at the dawn of cardiac surgery, simple deep hypothermia was used to avoid the deleterious effect of cardiopulmonary bypass. Between 1981 and 1990, 45 patients with simple cardiac anomalies underwent definitive surgery under deep hypothermia. Age at operation was 35 days to 20 months, and body weight was 2.3 to 8.0 kg. Under morphine and ether anesthesia, a median sternotomy was performed when the esophageal temperature reached 26.3 degrees C +/- 1.3 degrees C by the application of surface cooling. At a minimum esophageal temperature of 19.6 degrees C +/- 2.3 degrees C, inflow occlusion and cold cardioplegia were applied to induce circulatory arrest for 32.4 +/- 10.2 min. Direct cardiac massage was used to restore cardiac activity during rewarming. All but one patient was in New York Heart Association functional class I postoperatively. The latest cardiothoracic ratio was 49.8% +/- 4.7%. All but 2 patients are free from medication. Five of 30 patients showed developmental delay in the long-term; 2 of these had a long circulatory arrest period, and 3 had prolonged heart failure postoperatively. The other 25 patients had excellent physiologic and mental development. The long-term outcome of perfusionless hypothermic cardiac surgery is satisfactory when applied appropriately.

Simple deep hypothermia for repair of congenital tracheal stenosis: a case report.

Simple deep hypothermia for repair of congenital tracheal stenosis: a case report.

Simple deep hypothermia for repair of congenital tracheal stenosis: a case report

Simple deep hypothermia for repair of congenital tracheal stenosis: a case report

Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia.

To investigate the hematological changes during the perioperative period of open-heart surgery without homologous blood transfusion under simple deep hypothermia in infants and small children, and to define the limits of body weight for open-heart surgery without homologous blood transfusion under simple deep hypothermia. We performed open-heart surgery without homologous blood transfusion under simple deep hypothermia on eight children, four infants, and a neonate with diagnoses of atrial septal defect, ventricular septal defect, on total anomalous pulmonary venous return (TATVR). All patients except for one with TAPVR were surface-cooled with ice water under deep ether anesthesia. Hematological examinations were performed seven times during the perioperative period. The body weight of the patients ranged from 2.5 to 15.0 kg (mean±SD, 9.5±3.5 kg) and the blood loss from 0.7 to 7.1g·kg-1 (4.6±2.0g·kg-1) The lowest values of the hematological findings in each case after surgery were as follows: Hb ranged from 7.6 to 10.9g·dl-1 (8.8±1.0g·dl-1), blood platelet count from 158×103 to 337×103 cells·µℓ-1-agonist (271±88 ×103 cells·µℓ-1-agonist, and total protein from 4.3 to 5.5 g·dl-1 (5.0±0.4g·dl-1) CONCLUSION: Severe anemia and hypoproteinemia were not detected in any case, and, in particular, the reduction of the platelet count was slight. No events occurred as a result of decreased Hb concentration, serum protein, or both.

Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia

Open-heart surgery without homologous blood transfusion in infants and children under simple deep hypothermia

Simple deep hypothermia with a large amount of fentanyl anesthesia in neonates undergoing correction for total anomalous pulmonary venous return

Simple deep hypothermia with a large amount of fentanyl anesthesia in neonates undergoing correction for total anomalous pulmonary venous return

Simple deep hypothermia with a large amount of fentanyl anesthesia in neonates undergoing correction for total anomalous pulmonary venous return

Simple deep hypothermia with a large amount of fentanyl anesthesia in neonates undergoing correction for total anomalous pulmonary venous return

Simple deep hypothermia for excision of a Wilms' tumor with intracardiac growth

Simple deep hypothermia for excision of a Wilms' tumor with intracardiac growth

Simple deep hypothermia for excision of a Wilms? tumor with intracardiac growth

Simple deep hypothermia for excision of a Wilms? tumor with intracardiac growth

The effects of urinastatin on the plasma levels of granulocyte elastase during open heart surgery under simple deep hypothermia.

Changes in granulocyte elastase (GLE) and Beta-gluculonidase (Beta-gl) were observed during open heart surgeries which were performed under deep hypothermia with surface cooling. In addition, the effect of urinary trypsin inhibitor, urinastatin, on the activities of these enzymes was studied. The patients were divided into three groups, namely group U-I with intravenous injection of 6000 u.kg(-1) of urinastatin before cooling, group U-II administered with an additional 6000 u.kg(-1) after warming to 30 degrees C, and an untreated group (Group C). The plasma level of GLE increased significantly in the three groups compared with the level before cooling respectively. In the group U-II, the GLE level after the warming was lower than that in the control group. The serum level of Beta-gl increased significantly in the three groups at the end of rewarming (36 degrees C). The release of GLE from lysosomes in granulocytes was inhibited in the group U-II. The insufficient inhibition of GLE release in the group U-I is probably due to relatively short half-life of urinastatin. Therefore double administration of 6000 u.kg(-1), before and after the cooling, may be required to achieve the therapeutic effect. Consequently, urinastatin appears to be useful in open heart surgery under deep hypothermia with surface cooling.

The relation between EEG and mental development following cardiac surgery performed under simple deep hypothermia in children

In order to assess the accuracy of electroencephalography (EEG), in children who have undergone cardiac surgery under simple deep hypothermia, the relation between IQ or schoolwork achievement and the duration of circulatory arrest was investigated in 75 such children. Abnormal preoperative EEG's were found in 16 per cent of the children while abnormal postoperative EEG's were found in 17 per cent. The children were divided into 4 groups, according to pre- and postoperative EEG results. Schoolwork achievement scores ranged between 3.0 and 3.2, the difference among the groups being insignificant. Moreover, no significant shift in IQ was found among the groups. Finally, regarding the number of children who were able to go on to a higher level of education, including high school then college or university, again no significant differences were found among the 4 groups. In a comparison with the number of such children in neighboring Nagasaki prefecture able to continue on to a higher level of education, no significant differences were seen either. The findings and statistics of this investigation therefore indicate that pre- and postoperative EEG's are not always a reliable reference for assessing the prognosis of cerebral activity.

大量フェンタニールによる単純超低体温麻酔時の循環動態と血中カテコラミン濃度に関する実験的研究

大量フェンタニールによる単純超低体温麻酔時の循環動態と血中カテコラミン濃度に関する実験的研究

A CASE OF SECUNDUM ATRIAL SEPTAL DEFECT WITH CONGESTIVE HEART FAILURE IN EARLY CHILDHOOD

We treated a patient with atrial septal defect (ASD) who had repeated congestive heart failure starting in infancy, but showed symptomatic improvement by early surgical treatment. The patient was a 20-month-old female. At the age of 10 months, she was hospitalized for severe cardiac insufficiency. Detailed cardiac examination at 12 months of age revealed ASD with a pulmonary arterial pressure of 36/10 (22) mmHg, a ratio of pulmonary to systemic flow rates of 2.5 and a left-to-right shunt of 66%. Improvement in the symptoms of cardiac insufficiency and the absence of pulmonary hypertension justified a non-surgical follow-up. At the age of 19 months, she was again admitted with cardiac insufficiency and was treated by medical therapy without success. Since cardiac catheterization performed again detected an elevation of the pulmonary arterial pressure from the previous level to 46/10 (24) mmHg, radical surgery was carried out at the age of 20 months. The surgical procedure consisted of direct suture of a 25×15mm ASD in the center under simple deep-hypothermia. The postoperative course was satisfactory, with marked improvement in clinical symptoms.

Results of the Non-Transventricular Closure of Ventricular Septal Defect under Simple Deep Hypothermia : Comoarison with the Transventricular Closure

Results of the Non-Transventricular Closure of Ventricular Septal Defect under Simple Deep Hypothermia : Comoarison with the Transventricular Closure

Inhibitory mechanisms of insulin secretion associated with hypothermic open-heart surgery.

In order to clarify the inhibitory mechanism of insulin secretion associated with open-heart surgery, the influence of insulin antagonistic hormones on insulin secretion was studied in 20 patients with congenital heart diseases undergoing open-heart surgery, under simple deep hypothermia. Despite a hyperglycemia, plasma immunoreactive insulin and C-peptide showed no change during the cooling period, while with the exception of plasma human growth hormone, dopamine-beta-hydroxylase, immunoreactive glucagon, cortisol and cyclic AMP in plasma, either showed no change, or a decrease during the cooling period. It is assumed that catecholamine, glucocorticoid and glucagon do not play an important role in the inhibitory mechanism of insulin secretion during hypothermic open-heart surgery, and a transient hypofunction of the pancreas as well as the liver and the adrenal gland is probably involved.

主題 I-13 単純低体温麻酔下乳児開心術の術後管理

主題 I-13 単純低体温麻酔下乳児開心術の術後管理

主題 I-1 乳幼児開心術における単純低体温麻酔の問題点と対策

主題 I-1 乳幼児開心術における単純低体温麻酔の問題点と対策

主題 I-10 乳児開心術の問題点

主題 I-10 乳児開心術の問題点

Central nervous system consequences in children of cardiac surgery using simple deep hypothermia and circulatory arrest

Central nervous system consequences in children of cardiac surgery using simple deep hypothermia and circulatory arrest

Open heart surgery performed under simple deep hypothermia

Open heart surgery performed under simple deep hypothermia