1/232. Anaesthesia for caesarean section in the presence of severe primary pulmonary hypertension.We describe the case of a pregnant woman, 35 weeks' gestation, with primary pulmonary hypertension and coarctation of the aorta requiring emergency Caesarean section under general anaesthesia. The patient had a pulmonary artery catheter inserted before operation which revealed pulmonary artery pressures in excess of 80/40 mm Hg. These were lowered using an infusion of glyceryl trinitrate. After delivery of the baby and administration of oxytocin, pulmonary artery pressures were more difficult to control. An infusion of prostacyclin was substituted which stabilized pulmonary pressures. After operation, she was transferred to the intensive care unit where prostacyclin was administered by an "aerosolized" route. Her trachea was extubated after 48 h and she made an uneventful recovery.- - - - - - - - - - ranking = 1keywords = artery (Clic here for more details about this article) |
2/232. Inhaled nitric oxide therapy in pregnancy complicated by pulmonary hypertension.The use of nitric oxide as an agent to reduce pulmonary artery pressure in a pregnancy complicated by pulmonary hypertension is reported for the first time. This therapy can reduce pulmonary vascular resistance and therefore potentially enable the right ventricle to better compensate for the physiologic changes of pregnancy.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
3/232. cesarean section in a mother with uncorrected congenital coronary to pulmonary artery fistula.PURPOSE: We report a case of a 33 yr old woman with pulmonary hypertension secondary to uncorrected right coronary artery to pulmonary artery fistula who underwent two successful operative deliveries under general anesthesia. CLINICAL FEATURES: This woman underwent an emergency Caesarean section at 32 wk gestation because she presented in NYHA Class IV, heart failure and premature labour. She did not have antenatal follow-up. For her second pregnancy, she was managed from the first trimester of pregnancy by the cardiologist, obstetrician and anesthesiologist. She received oral furosemide and digoxin from eight weeks gestation. pregnancy was managed to term before she progressed to NYHA Class IV and cardiac failure at 37 wk gestation. She had a Caesarean section under general anesthesia. She received rapid sequence induction of anesthesia and tracheal intubation with 0.1 mg x kg(-1) etomidate, 2 mg x kg(-1) succinylcholine and maintenance with nitrous oxide 50% in oxygen, isoflurane 1% and 0.1 mg x kg(-1) vecuronium. fentanyl, 2 microg x kg(-1) helped to obtund the hypertensive response to intubation. analgesia was provided with 1 mg x kg(-1) morphine. Glyceryl trinitrate infusion, 10-30 microg x min(-1) was used in addition to the anti-heart failure therapy. End-tidal capnography, electrocardiogram, pulse oximetry, continuous arterial blood pressure and pulmonary arterial catheter provided hemodynamic monitoring. The lungs were mechanically ventilated for 24 hr postoperatively. She received anti-heart failure therapy which she continued after discharge. She was NYHA class II upon discharge. She defaulted from further follow-up. CONCLUSION: Although the literature advocates, in this situation, controlled vaginal delivery utilising epidural analgesia, we describe the successful outcome for operative delivery under general anesthesia in a patient with secondary pulmonary hypertension and heart failure.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
4/232. The spectrum of dilated cardiomyopathy. The Johns Hopkins experience with 1,278 patients.This report describes the evaluation of 1,278 patients referred to The Johns Hopkins Hospital with dilated cardiomyopathy. After a careful history and physical examination, selected laboratory tests, and endomyocardial biopsy, a specific diagnosis was made in 49% of cases. In 16% of cases the biopsy demonstrated a specific histologic diagnosis. myocarditis and coronary artery disease were the most frequent specific diagnoses; 51% of patients were classified as idiopathic. Thus a rigorous and systematic search can demonstrate an underlying cause for approximately one-half of patients with unexplained cardiomyopathy. Endomyocardial biopsy plays a crucial role in this evaluation. Six cases are presented which demonstrate the utility of endomyocardial biopsy in specific clinical situations. In addition to its routine use in monitoring rejection in heart transplant recipients, endomyocardial biopsy is indicated in the evaluation of possible infiltrative cardiomyopathy, in differentiating restrictive cardiomyopathy from constrictive pericarditis, and in diagnosing and monitoring doxorubicin cardiotoxicity. The importance of diagnosing myocarditis remains controversial, and disagreement persists about the utility of immunosuppressive therapy in these patients. A combination of clinical and histologic features can divide patients with myocarditis into 4 subgroups--acute, fulminant, chronic active, and chronic persistent. This classification provides prognostic information and may identify those patients who may respond to immunosuppression, as well as those likely to have adverse outcomes from such treatment. The continued development of novel molecular techniques may allow endomyocardial biopsy to provide greater prognostic and therapeutic information in the future.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
5/232. Ruptured splenic artery aneurysm during pregnancy: a rare case with both maternal and fetal survival.The rupture of a splenic artery aneurysm during pregnancy has been reported. In this particular case uterine rupture was suspected; however, an aneurysm was diagnosed after cesarean delivery. After resection of the aneurysm, splenic artery revascularization was performed by reanastomosis. In conclusion, early diagnosis and 2-stage rupture increase the likelihood of survival.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
6/232. Spontaneous dissections of all three coronary arteries in a 33-week-pregnant woman.The clinical course and angiographic follow-up of a woman with spontaneous coronary dissections in all three coronary arteries during the third trimester of pregnancy is described. Mother and child survived and subsequent clinical course was uneventful. At 6-month follow-up, dissections in the right and circumflex coronary artery had healed completely. At the site of the dissection in the LAD, an aneurysm had formed. This is to our knowledge the first report of antepartum and antemortem diagnosis of pregnancy related coronary dissections in all three coronary arteries. Cathet. Cardiovasc. Intervent. 48:207-210, 1999.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
7/232. Bilateral vertebral artery dissection causing a cerebrovascular accident in pregnancy. A case report.BACKGROUND: vertebral artery dissection, occurring spontaneously or following a traumatic event, is a cause of posterior circulation stroke in young individuals, including pregnant women. CASE: A 20-year-old, primagravid woman acutely developed headache, right-sided hemiparesis and parasthesias, and blurred vision. Within days she complained of cervical neck pain. magnetic resonance imaging findings were consistent with a posterior circulation cerebrovascular accident (CVA). An arteriogram, performed to exclude vasculitis, revealed bilateral vertebral artery dissection. No inciting event could be recalled. CONCLUSION: Vascular dissections occur rarely during pregnancy. Spontaneous extracranial vertebral artery dissection itself is very rare in general. Cerebral ischemia can follow vertebral artery dissection. In young patients with CVA, consideration of the diagnosis of vertebral artery dissection followed-by angiography and anticoagulation is an important component of the workup and care.- - - - - - - - - - ranking = 3keywords = artery (Clic here for more details about this article) |
8/232. Idiopathic dilated cardiomyopathy presenting in pregnancy.PURPOSE: To describe the clinical course and management of a patient who presented with idiopathic dilated cardiomyopathy in early pregnancy. CLINICAL FEATURES: A 27 yr old, previously well, Chinese primigravida presented at 18 wk gestation with a history of irregular heart beat and decreased exercise tolerance. echocardiography showed moderate left ventricular dysfunction with left ventricular ejection fraction of 35-40%. Idiopathic dilated cardiomyopathy was diagnosed. She declined termination of pregnancy and was managed medically with furosemide, digoxin and potassium supplements. Low molecular weight heparin was prescribed. Emergency Cesarean delivery was performed at 31 wk gestation because of deteriorating liver function and a non-reassuring fetal heart rate pattern. General anesthesia was given because of relative urgency, the patient's wish, and concerns about potential risk of spinal hematoma. Invasive monitoring with pulmonary and radial artery catheters was used and low dose inotropic support was given. Postoperatively, she was managed in the intensive care and coronary care units where she was treated with dobutamine, furosemide, digoxin, potassium, captopril, losartin and warfarin. Her postoperative course was complicated by a severe embolic stroke five weeks after delivery and she died five months later. CONCLUSION: Idiopathic dilated cardiomyopathy may rarely present in pregnancy. A multidisciplinary approach and close peripartum monitoring are important in management and termination of pregnancy should be considered. Thromboembolic complications are a major risk.- - - - - - - - - - ranking = 0.33333333333333keywords = artery (Clic here for more details about this article) |
9/232. Intracardiac extension of intravenous leiomyomatosis in a pregnant woman: A case report and review of the literature.Intravenous leiomyomatosis is an uncommon clinical entity characterized by the growth of a benign, smooth muscle tumour within the venous system. Intracardiac extension of this tumour is rare, and approximately 35 cases have been reported in the literature. The second case of massive intracardiac extension of intravenous leiomyomatosis is reported in a pregnant patient diagnosed after the unusual presentation of seizure activity. Tumours were successfully removed from the right internal iliac vein, inferior vena cava, and right atrium and ventricle in a single-stage operation using cardiopulmonary bypass and circulatory arrest. Concomitant total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed. Nine months after diagnosis, the patient was evaluated for recurrent disease. A review of the literature from 1994 to 1998 is presented.- - - - - - - - - - ranking = 0.00091456630911285keywords = single (Clic here for more details about this article) |
10/232. Persistent hypoglossal artery associated with arteriovenous malformation: a case report.A rare case of persistent hypoglossal artery in conjunction with arteriovenous malformation was presented. MRA could delineate persistent hypoglossal artery and arteriovenous malformation very clearly. The patient suffered from intracranial hemorrhage from in the 37th week of pregnancy. MRI, MRA, angiography, and CT of this rare condition are reported.- - - - - - - - - - ranking = 2keywords = artery (Clic here for more details about this article) |
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