International Cardiovascular Research Journal
Volume:6 Issue: 1, Mar 2012

Carotid stenosis is seen in about 10% of patients with ischemic stroke. Many studies have been performed that provide insight into the natural history, diagnosis, and optimal management of carotid disease. Both medical management and surgery have advanced to the point that patients and their providers have many options when considering treatment. Over the last several years, carotid artery stenting has been shown to be a viable treatment choice in selected patients. Both stenting and endarterectomy are superior to medical management alone in stroke prevention when patients are properly selected. In this article we try to review the most recent data regarding the two procedures in the treatment of carotid stenosis and also discuss the controversies in carotid artery revascularization.

QT dispersion, defined as the difference between maximum and minimum QT interval measured at 12 lead ECG, is the most simple and widely used index of ventricular dispersion. Increased ventricular dispersion predicts predisposition to cardiac arrhythmia and therefore affects the prognosis of patients after myocardial infarction. In this study we evaluated whether QT dispersion can predict the arrhythmogenic potential in acute myocardial infarction (AMI) and whether it can behave as a risk stratification tool in such patients. In all, 124 patients were included in the study. Mean QT dispersion at presentation was 112±5.4 ms. Those who were thrombolysed, or survived or did not develop significant ventricular arrhythmias had significantly lower QT dispersion than their comparative groups (P<0.001). In our study we found that measuring QT dispersion from presentation till hospitalisation can provide a method of risk stratification of AMI patients and can detect patients who are at increased risk of developing ventricular arrhythmias and increasedcardiac mortality

Different pharmacological agents may decrease the inflammatory response during cardiac surgery. The aim of this study was to evaluate the effect of ascorbic acid as an antioxidant on inflammatory markers (interleukins 6 and interleukin 8) released during cardiopulmonary bypass. Forty patients scheduled for elective coronary artery bypass grafting surgery, were randomly assigned to two groups. The patients in the case group were given 3 grams ascorbic acid 12-18 hours before operation and 3 grams during CPB initiation. The patients in the control group were given the same amounts of normal saline at similar times. Blood samples were collected 6 hours preoperatively and postoperative serum interleukin 6 and 8 were measured using enzyme-linked immunosorbent assay (ELISA). In both groups CPB caused an increase in IL6 and IL8 plasma concentrations compared with baseline levels, but the pattern of changes at such levels were similar in both groups after receiving ascorbic acid or placebo. Ascorbic acid did not reduce the inflammatory cytokines during CPB. Compared to the placebo, ascorbic acid had no significant effect on hemodynamic parameters such as systolic and diastolic blood pressure, heart rate, arterial blood gases, BUN, Creatinine and WBC and platelet counts. Ascorbic acid has no effect on the reduction of IL6 and IL8 during CPB. Also, it causes no improvement in hemodynamics, blood gas variables, and the outcomes of patients undergoing CABG.

and diastolic performance. To obtain circumferential rotation using tissue Doppler imaging, we need to estimate the time-varying radius of the left ventricle throughout the cardiac cycle to convert the tangential velocity into angular velocity. The aim of this study was to investigate accuracy of measured LV radius using tissue Doppler imaging throughout the cardiac cycle compared to two-dimensional (2D) imaging. A total of 35 subjects (47±12 years-old) underwent transthoracic echocardiographic standard examinations. Left ventricular radius during complete cardiac cycle measured using tissue Doppler and 2D-imaging at basal and apical short axis levels. For this reason, the 2D-images and velocity-time data derived and transferred to a personal computer for off-line analysis. 2D image frames analyzed via a program written in the MATLAB software. Velocity-time data from anteroseptal at basal level (or anterior wall at apical level) and posterior walls transferred to a spreadsheet Excel program for the radius calculations. Linear correlation and Bland-Altman analysis were calculated to assess the relationships and agreements between the tissue Doppler and 2D-measured radii throughout the cardiac cycle. There was significant correlation between tissue Doppler and 2D-measured radii and the Pearson correlation coefficients were 0.84 to 0.97 (P<0.05). Bland-Altman analysis by constructing the 95% limits of agreement showed that the good agreements existed between the two methods. It can be concluded from our experience that the tissue Doppler imaging can reasonably estimate radius of the left ventricle throughout the cardiac cycle.

Fasting and calorie restriction have some cardioprotective effects. In view of the effect of fasting on peripheral benzodiazepine receptors and widespread administration of benzodiazepines in medicine, the present study was designed to evaluate whether fasting may affect myocardial vulnerability to cardiac ischemia–reperfusion (I/R) following repeated diazepam administration. Rats were divided into six groups of 8 or 10 animals. Groups I and II were controls which received intra peritoneal injection of normal saline solution for 5 days. Also, Control II underwent fasting on 5th day of experiment. Four test groups received intra peritoneal injection of diazepam for 5 days (groups I and II 1mg/kg; groups III and IV 5 mg/kg). Also, test groups II and IV fasted on 5th day of experiment. The Langendorff isolated hearts were subjected to 25 minutes ischemia and 25 minutes reperfusion. Cardiac parameters including left ventricular developed pressure and rate pressure product were determined. Infarct size was measured by Triphenyltetrazolium staining. Recovery of the left ventricular developed pressure in diazepam groups were significantly lower than control I and II (P=0.049 and P=0.046 respectively). But there was no significant difference among the controls and test group II, which fasted following diazepam administration. This showed the preservation of the cardiac performance in the fasting animals following administration of diazepam (1 mg/kg). The results obtained showed the exacerbation of ischemia reperfusion injury in the presence of diazepam and demonstrated the protective effect of fasting which is probably due to modulation of the mitochondrial permeability transition pore.

The window ductus in adults is a rare, anatomical anomaly, successful closure of which is more challenging both to surgeons and interventional cardiologists. Eventhough various strategies are available, optimal method of repair of patent ductus arteriosus in adults remains controversial. We report the case of an adult female patient with window patent ductus arteriosus (2.5cmx0.5mm) with severe pulmonary artery hypertension, in whom circulatory arrest was used successfully as a surgical option for transpulmonary closure of the duct. Post operatively patient recovered well without any complications and is doing well in follow up.

Aorto-left ventricular tunnel (ALVT) is a congenital anomaly of aortic root which is an extra cardiac connection between the aorta and the left ventricle. It is usually short and direct but this report describes an aneurysmal aorto-ventricular tunnel which due to large left ventricular and small aortic hole culminated in aneurysm. This type of ALVT might be misdiagnosed as other cardiac lesions.