208 research outputs found
Effect of transannular patching on outcome after repair of tetralogy of Fallot
No full textAmong 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4\% with a transannular patch and 1.4\% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94\% with a transannular patch and 96.5\% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7\% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20\% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair
Supplemental_Material - Surgical Management of Heterotaxy Syndrome: Current Challenges and Opportunities
No full textSupplemental_Material for Surgical Management of Heterotaxy Syndrome: Current Challenges and Opportunities by Ashlyn M. Alongi, James K. Kirklin, Luqin Deng, Luz Padilla, Jozef Pavnica, Robb L. Romp, David C. Mauchley, David C. Cleveland and Robert J. Dabal in World Journal for Pediatric and Congenital Heart Surgery</p
The endothelin axis and gelatinase activity in alveolar macrophages after brain-stem death injury: A pilot study
No full textBackground: Endothelin-1 (ET-1) is a potent vasoconstricting mitogen that has been implicated in the development of primary graft dysfunction. Increased activity of matrix metalloproteinases (MMPs), specifically MMP-2 and -9, has been associated with tissue damage in acute lung injury and after lung transplantation. Using a validated model of brain-stem death (BSD), we aimed to determine whether alveolar macrophage up-regulation in the pulmonary system is an early feature of BSD injury and if expression levels of ET-1, endothelin A receptors (ETAR) and endothelin B receptors (ETBR), as well as MMP-2 and -9, are increased in comparison to sham controls
Successful outcome of human metapneumovirus (hMPV) pneumonia in a lung transplant recipient treated with intravenous ribavirin
No full textHuman metapneumovirus (hMPV) has recently been shown to be a prominent cause of respiratory infections in immunocompromised hosts, and is associated with high morbidity and mortality. We report a case of hMPV pneumonia in a lung transplant recipient presenting with respiratory failure and sepsis syndrome. hMPV was diagnosed by polymerase chain reaction, and treated with intravenous ribavirin with a successful outcome
Post-transplant colonization with non-Aspergillus molds and risk of development of invasive fungal disease in lung transplant recipients
No full textBackground: The clinical significance and risk of progression to invasive disease of the non-Aspergillus molds from the bronchoalveolar lavage (BAL) of lung transplant (LTx) recipients are not known. Methods: We reviewed the medical records from March 1996 to March 2006 of all LTx recipients whose BAL culture grew non-Aspergillus mold. The clinical characteristics, administration of prophylaxis, and outcomes were recorded. Results: Eighty-five non-Aspergillus molds were isolated from the BAL of 75 patients. Of these LTx recipients, 14.5% had a BAL with non-Aspergillus mold. Emphysema was the most common underlying diagnosis for transplantation (41.3%) and the most common isolate was Cladosporium. Isolation of a non-Aspergillus mold occurred at a median of 415 days after LTx. Prophylaxis with an anti-mold agent was noted in 44.7% (38 of 85) of the isolates. Median follow-up was 765 days. There were no cases of proven invasive fungal infection up to 1 year after isolation of the mold; and only 1 case of probable zygomycosis. Conclusions: Isolation of non-Aspergillus molds in the BAL of LTx recipients may not be associated with the development of invasive disease, irrespective of anti-fungal prophylaxis. These results suggest that initiation of targeted anti-fungal prophylaxis after isolation of non-Aspergillus molds from BAL may not be warranted
Modeling payback from research into the efficacy of left-ventricular assist devices as destination therapy
No full textObjectives: Ongoing developments in design have improved the outlook for left-ventricular assist device (LVAD) implantation as a therapy in end-stage heart failure. Nevertheless, early cost-effectiveness assessments, based on first-generation devices, have not been encouraging. Against this background, we set out (i) to examine the survival benefit that LVADs would need to generate before they could be deemed cost-effective; (ii) to provide insight into the likelihood that this benefit will be achieved; and (iii) from the perspective of a healthcare provider, to assess the value of discovering the actual size of this benefit by means of a Bayesian value of information analysis.
Methods: Cost-effectiveness assessments are made from the perspective of the healthcare provider, using current UK norms for the value of a quality-adjusted life-year (QALY). The treatment model is grounded in published analyses of the Randomized Evaluation of Mechanical Assistance for the Treatment of Congestive Heart Failure (REMATCH) trial of first-generation LVADs, translated into a UK cost setting. The prospects for patient survival with second-generation devices is assessed using Bayesian prior distributions, elicited from a group of leading clinicians in the field.
Results: Using established thresholds, cost-effectiveness probabilities under these priors are found to be low (.2 percent) for devices costing as much as £60,000. Sensitivity of the conclusions to both device cost and QALY valuation is examined.
Conclusions: In the event that the price of the device in use would reduce to £40,000, the value of the survival information can readily justify investment in further trials
The Brain-Dead Organ Donor
No full textAddressing all aspects of brain death and thoroughly detailing how a potential organ donor should be maintained to ensure maximum use of the organs and cells, The Brain-Dead Organ Donor: Pathophysiology and Management is a landmark addition to the literature. This first-of-its-kind, multidisciplinary volume will be of interest to a large section of the medical community. The first section of the book reviews the historical, medical, legal, and ethical aspects of brain death. That is followed by two chapters on the pathophysiology of brain death as investigated in small and large animal models. This includes a review of the many hormonal changes, including the neuroendocrine- adrenergic ‘storm’, that takes place during and following the induction of brain death, and how they impact metabolism. The next section of the book reviews various effects of brain death, namely its impact on thyroid function, the inflammatory response that develops, and those relating to innate immunity. The chapters relating to assessment and management of potential organ donors will be of interest to a very large group of transplant surgeons and physicians as well as critical care and neurocritical care physicians and nurses. Neurologists, endocrinologists, neurosurgeons, and pathologists will also be interested, especially in the more basic science sections on various aspects of brain-death and hormonal therapy. Organ procurement organizations and transplant coordinators worldwide will also be interested in this title. Other chapters will be of interest to medical historians, medico-legal experts, and ethicists.CONTENIDO: Introduction,
Dimitri Novitzky, David K. C. Cooper,
Pages 1-6 --
Historical Aspects of the Diagnosis of Death,
Félix Bacigalupo, Daniela A. Huerta Fernández,
Pages 7-11 --
The Determination of Brain Death,
Curtis M. Keller, Boris Chulpayev, Michael Hoffmann,
Pages 13-19 --
Legal Aspects of Brain Death and Organ Donorship,
Ricky T. Munoz, Mark D. Fox,
Pages 21-35 --
Ethical Issues in Organ Donation from Brain-Dead Donors,
Mark D. Fox, Ricky T. Munoz,
Pages 37-53 --
Pathophysiology of Brain Death in Small Animal Models,
Bernhard Floerchinger, Nicholas L. Tilney, Stefan G. Tullius,
Pages 55-64 --
Pathophysiology of Brain Death and Effects of Hormonal Therapy in Large Animal Models,
Dimitri Novitzky, Winston N. Wicomb, David K. C. Cooper,
Pages 65-90 --
The Efficacy of Thyroid Hormone Therapy in Brain-Dead Heart Donors: A Review of Thyroid Function in Health and Disease,
Lawrence E. Shapiro, Tatiana Baron,
Pages 91-105 --
The Inflammatory Response to Brain Death,
Anne Barklin, Christine Lodberg Hvas, Else Toennesen,
Pages 107-119 --
The Influence of Brain Death and Intensive Care Management on Donor Organs: Assessment of Inflammatory Markers,
Wayel Jassem, Susan V. Fuggle,
Pages 121-129 --
Brain Death-Induced Inflammation: Possible Role of the Cholinergic Anti-inflammatory Pathway,
Simone Hoeger, Benito A. Yard,
Pages 131-138 --
Innate Immunity and Injury During Brain Death: Opportunities for Intervention,
Marc A. Seelen, Henri G. D. Leuvenink, Rutger J. Ploeg,
Pages 139-145 --
Selection of the Brain-Dead Potential Organ Donor,
Kadiyala V. Ravindra, Keri E. Lunsford, Paul C. Kuo,
Pages 147-154 --
Infectious Disease Aspects of the Brain-Dead Potential Organ Donor,
Nicole M. Theodoropoulos, Michael G. Ison,
Pages 155-176 --
Malignancy in the Brain-Dead Organ Donor,
Michael A. Nalesnik, Ron Shapiro, Michael G. Ison,
Pages 177-189 --
Early Clinical Experience of Hormonal Therapy in the Brain-Dead Potential Organ Donor,
Dimitri Novitzky, Burcin Ekser, David K. C. Cooper,
Pages 191-207 --
Assessment, Monitoring, and Management of Brain-Dead Potential Organ Donors in the USA,
Demetrios Demetriades, Lydia Lam,
Pages 209-216 --
Assessment, Monitoring, and Management of Brain-Dead Potential Organ Donors in Europe,
Gabriel J. Echeverri, Bruno G. Gridelli,
Pages 217-235 --
Assessment, Monitoring, and Management of Brain-Dead Potential Organ Donors in Australia,
Peter S. Macdonald, Anders E. M. Aneman, Deepak Bhonagiri, Daryl A. Jones, Gerry O’Callaghan, Helen I. Opdam et al.,
Pages 237-249 -- Management of the Brain-Dead Organ Donor: Perspectives of the Transplant Coordinator,
Nicole T. Farina, David K. C. Cooper,
Pages 251-261 --
Surgical Aspects of Thoracic and Abdominal Organ Procurement from Brain-Dead Donors,
Michael J. Anstadt, Paul C. Kuo, Kadiyala V. Ravindra,
Pages 263-281 --
Impact of Brain Death on Storage of the Heart,
Winston N. Wicomb, David K. C. Cooper,
Pages 283-288 --
Impact of Brain Death on Abdominal Organs and Allograft Preservation Strategies,
Coney Bae, Anthony Watkins, Scot D. Henry, James V. Guarrera,
Pages 289-298 --
Functional Repair of Brain Death-Induced Injury,
Henri G. D. Leuvenink, Marc A. Seelen, Rutger J. Ploeg,
Pages 299-310 --
Functional Repair of Brain Death-Injured Donor Lungs,
Jonathan C. Yeung, Marcelo Cypel, Shaf Keshavjee,
Pages 311-320 --
Thyroid Hormone Therapy to the Recipient of a Heart from a Brain-Dead Donor,
Dimitri Novitzky, David K. C. Cooper,
Pages 321-331 --
Current and Potential Future Trends in the Management of the Brain-Dead Organ Donor,
Octavio E. Pajaro, James K. Kirklin,
Pages 333-341 --
Maximizing Utilization of the Potential Deceased Donor: The Challenge Continues,Eliezer Katz,Pages 343-35
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