Multidisciplinary Cardiovascular Annals
Volume:2 Issue: 2, Apr 2008

We evaluated the vascular complications of Intra-aortic balloon pump and risk factors associated with the development of these complications in patients undergoing myocardial revascularization

103 consecutive patients with Intra-aortic balloon pump support were evaluated. Univariate and multivariate analyses were performed to identify risk factors for the development of vascular complications.

Seven (7%) patients developed major and 8 (8%) patients developed minor vascular complications. Ischaemia of the limb, requiring thromboembolectomy, developed in 2 (3%) patients. Mean age of the patients was 59 ± 2 years and 41% of the patients were female. Vascular complications (leg ischemia) were not affected by age. The overall mortality was 44%. Multiple logistic regression analysis revealed duration of intra-aortic balloon pump support, emergency of operation and diabetes as independent risk factors. The duration of intra-aortic balloon pump therapy ranged from 9 hours to 7 days (mean 2 days) and it had a direct linear relation with occurrence of limb ischemia so that the risk was about 16% of patients per 24h (p = 0.055). prevalence of limb ischemia proved to be higher in diabetic patients (p = 0.04). The emergency of operation had clear impact on leg ischemia in patients with intra-aortic balloon pump (p < 0.02).

Elderly patients are the fastest growing segment of the CABG patient population over the last two decades, and despite a steady increase in acuity, the mortality from CABG surgery has consistently declined. In many goals of surgical care for the elderly, although cure might not be possible, palliation and comfort are equally important. The purpose of the present study was to examine the postoperative course and events in octogenarians undergoing CABG and compare it with younger patients. Demographic, mortality, morbidity and resource utilization data were collected from the records of patients undergoing CABG from January 2005 until July 2007. Mean time to extubation was 9.3 h in octogenarians and 6.3 h for their younger cohorts (p<0.01)Blood transfusion was required in 87.8% of octogenarian compared with 58.5% of youngers (p<0.01). Mean ICU stay was 2.1 days for octogenarians and 1.4 days for non octogenarians (p<0.001). The 30 - days mortality rate was 9% for the octogenarian vs 2.8% for the younger group (p<0.001). Octogenarians undergoing CABG had significantly higher morbidity, with increased incidence of postoperative renal failure, neurological complications, and 30 - day mortality.

Back ground: Coronary artery disease (CAD) is commonly seen in patients older than 50 years old. The purpose of this study was to evaluate demographic variables and risk factors among patients with premature coronary artery disease (PCAD) who were candidate of coronary artery bypass grafting. In this retrospective study which was conducted in Baqiyatallah hospital in Tehran, from March 2005 to March 2007, 83 patients with angiographically proved CAD were included; PCAD defined as CAD under the age of 45 in males and 55 in females. There were 48 (57.8%) males and 35 (42.2%) females. The mean age of patients was 45.6 years (range, 31 to 55). Hyperlipidemia (70 cases, 84.3%) and hypertension (67 cases, 80.7%) were the most common detected risk factors. Fifty-one patients (61.4%) had three-vessel disease. Significant difference was seen between two genders in term of smoking and diabetes (P < 0.05). By earlier diagnosis of hyperlipidemia and hypertension in young population, premature coronary artery disease should be prevented.

A technique to improve patency of grafts in CABG is explained. It is based on laws of physics, flow dynamics and long term experience.

Back ground: New onset atrial fibrillation after cardiac surgery contributes to increased morbidity, hospital length of stay and resource utilization. Although many aspects of atrial fibrillation after cardiac surgery is obvious, the mechanism by which cardiac surgery predispose spatients to AF is unknown as yet. Recent evidence support an inflammatory role in development of AF. Blood transfusion augmented the inflammatory response and so incidence of postoperative AF. Retrospective study from January 2005 to July 2007 on 2095 patients who underwent isolated CABG with or without valve replacement. Variables associated with development of new onset AF were identified by logistic regression. Blood transfusion was performed in 487 patients that was associated with a significant increase in new onset of AF (45.9% vs 37.9%; p<0.01). Blood transfusion can increase the incidence of new onset AF after cardiac surgery. This factor should be considered in identifying patients who might benefit from prophylais to prevent this common postoperative complication and its adverse consequencies.

Background and context : Pulmonary regurgitation (PR) is the most important residual lesion remaining after repairing tetralogy of Fallot. Through a thorough review of the literature, we attempted to determine the Pathophysiology of chronic right ventricular volume load after tetralogy of Fallot repair. The risks, benefits, indications and timing of pulmonary valve replacement are controversies that we are going to pay attention to them in this article. Database search for articles in MEDLINE up to the year 2007, in which. chronic pulmonary valve insufficiency after repaired tetralogy of Fallot had been discussed were selected and if it could have a message regarding the answers to these questions,its message and methodology or results and conclusions were analysed and discussed.Results and data synthesis: 18 articles paying attention to the above mentioned questions and controversies were found and their findings are explained and discussed here. Although right ventricular volume load due to severe pulmonary regurgitation after repaired tetralogy of Fallot can be tolerated for years, there is now evidence that the compensatory mechanisms of the right ventricular myocardium ultimately fail and that if the volume load is not eliminated or reduced the dysfunction might be irreversible. In light of that data and with better understanding of risk factors for adverse outcomes late after tetralogy of Fallot repair, many centers are now recommending early pulmonary valve replacement before symptoms of heart failure develop.

In this article,we present 2 rare complications of device closure of Atrial Septal defects(ASD),and review the literature for device and surgical closure of these defects.In one case device embolisation and in the other case device perforation of heart and the way we managed them is presented.

Aortic valve repair is an alternative to valve replacement for treatment of chronic aortic insufficiency (AI). In order to standardize surgical management, we suggest a classification based on echocardiographic and operative analysis of valvular lesions. Classification was based on the retrospective analysis of chronic AI mechanisms of 781 adults operated on electively between 1997 and 2003. AI was isolated (406 patients (52%)), associated with supra-coronary aneurysm (97 cases (12.4%)), or with aortic root aneurysm (278 patients (35.6%)). Etiologies of valvular or aortic lesions were respectively rheumatic, dystrophic and atheromatous in 17%, 73.6% and 9.4% of cases. Lesional classification is based on the analysis of chronic AI mechanisms defining type I with central jet (354 cases, 45.3%) and type II with eccentric jet (54.7%). Type Ia is defined as isolated dilation of sino-tubular junction (47 supra-coronary aneurysms), and type Ib as dilation of both sino-tubular junction and aortic annular base (233 root aneurysms, 74 isolated AI). The type II associates dilation of sino-tubular junction and annular base to a valvular lesion: IIa cusp prolapse (95 aneurysms, 200 isolated AI); IIb cusp retraction (132 rheumatic AI), IIc cusp tear (endocarditis, traumatic). A lesional classification aims to standardize the surgical management of aortic valve repair: type Ia, by supra-coronary graft; type Ib, by subvalvular aortic annuloplasty associated with the aortic root replacement with a remodelling technique (root aneurysm) or double sub- and supravalvular annuloplasty (isolated AI). For chronic AI type II, aortic annuloplasty associated a remodelling technique or double sub- and supravalvular annuloplasty is combined with the treatment of the cusp lesion (cusp resuspension, cusp reconstruction with autologous pericardium).

A congenital coronary arteriovenous fistula (A-V-Fistulae) is a direct communication between a coronary artery and the lumen of any one of the four cardiac chambers, the coronary sinus or its tributary veins, or the SVC, pulmonary artery or pulmonary veins close to the heart. We are presenting a case of fistulae from distal part of RCA to right pulmonary artery. This form of fistula is very rare

Myxoma is the most common benign tumor of the heart, with an estimated incidence of 0/5 to 1 per million per year. Over 75 percent originating in the left atrium and 15 to 20 percent originating in the right atrium, with the remaining 8% arising in either the right or left ventricle. The mean age of patient with nonfamilial myxoma is 56 years and 60 to 70 percent of these patients are female. These myxomas occur most frequently between the third and sixth decades of life. Most myxomas are grossly round or oval in shape with polipoid features and others are gelatinous’ many are prone to fragment spontaneously (figure 1). They are essentially nonmalignant. In the 90% of cases. The tumors originate in the atria and the pedunculated masses typically have a base of attachment in the atrial septa. Myxomas analyzied in surgical series typically average 4 to 8 cm in diameter, but the range varies from 1 to 15 cm in the literature. One study reported the weight of resected myxomas ranging from 8 to 175 g. A diagnosis of myxoma requires the presence of myxoma cells. On microscopy, myxoma characteristically shows patterns of lipidic cell embedded in a myxoid stroma.