Multidisciplinary Cardiovascular Annals
Volume:5 Issue: 1, Feb 2013

Remote ischemic preconditioning (RIPC) is a biologic phenomenon in which a brief ischemia followed by reperfusion of an organ makes a distant organ more resistant against sustained ischemic insult. In order to assess whether RIPC can protect myocardium in CABG patients against ischemia, we conducted this study.Methods and materials: Elective coronary artery bypass grafting (CABG) patients were randomized to either receive RIPC (group A=145) or not (group B=145) after anesthesia. RIPC induction was by inflating a blood pressure cuff on the upper arm.The outcome was evaluated by comparison between serum troponin levels at various times after surgery. Mean serum troponin level at various times after surgery (6, 12, 24, 72 hours after the operation) in group A was significantly lower than group B (p<0.05). In addition decreasing trend of post operative serum troponin level was more significant in group A than group B (p<0.0001). RIPC can protect myocardium in CABG patients against ischemia and can be recommended for clinical use during open cardiac surgeries in order to decrease the incidence of myocardial ischemic injury following cardioplegic arrest.

Cardiac catheterization constitutes an essential method for diagnosis in cardiology. In addition to diagnosis, it is largely applied in electrophysiological studies of the heart, post-surgical follow-up and cardiac interventions.Similar to any other aggressive diagnostic technique, cardiac catheterization may entail certain complications. The objective of the present study is to determine complications of cardiac catheterization in children with congenital heart diseases with and without ranitidine and hydrocortisone. This is a clinical trial study on 400 children with congenital heart diseases who underwent cardiac catheterization in Ali Asghar and Ali-ebne Abitaleb Hospitals of Zahedan from March 2005 to February 2012. The children were classified into two groups. All patients underwent routine tests and para clinical procedures (Electrocardiography, Chest X-Ray, and Echocardiography) before cardiac catheterization andreceived premedication one hour before the procedure. The premedication consisted of morphine or promethazine for cyanotic patients and promethazine and pethedine for all other patients. All patients underwent cardiac catheterization by a pediatric cardiologist. After the procedure, all children were admitted to the hospital for 48 hours to monitor complications. Data were obtained from medical records using a specifically devised questionnaire, and analyzed on SPSS software version 17. Complications occurred in 15.5% of our patients, with 5 patients (1.25% of total) experiencing a major, and 57 patients (14.25% of total) experiencing a minor complication. Vascular events (32 cases; 8%) and arrhythmia (8 cases; 2%) composed the majority of complications. Death occurred in two patients (0.5%). The major complications included death (2 cases), cardiac arrest with a successful resuscitation (1case) and spell (2 cases). In the present study, we found no significant difference between the group receiving ranitidine and hydrocortisone and the group receiving neither to prefer one group over the other. The findings of the present study showed that the complications of cardiac catheterization is more or similar to other studies, except for small changes in minor complications and the fact that we observed no event of rupture or tamponade two serious complications. Moreover, our study demonstrates no significant difference between the two groups to indicate superiority for those receiving ranitidine and hydrocortisone, except for reaction to contrast.

Although valve repair is applied usually nowadays, particularly for mitral regurgitation (MR) or tricuspid regurgitation (TR), valve replacement using prosthetic valves is common especially in adults. Unfortunately the valve with ideal hemodynamic performance and long-term durability without increasing the risk of bleeding due to long-term anticoagulant therapy does not exist. Therefore patients and physicians must choose between bioprosthetic and mechanical valve. Currently clinical trends towards the increasing use of bioprosthetic valves instead of mechanical valves even in young patients apparently because of its advantages. Seventy patients have undergone valvular replacement using bioprosthetic valves. Mean age was 54.8 years, 24 were male and 46 were female.Atrial fibrillation has been found in 34(48.6%). The patients have been evaluated by ECG and Echocardiography to assess the rhythm and ejection fracture. Mean followup time was 33 month (min 9 max 92). Mortality rate was 25.9% (n=18) within 8 years of follow-up. Statistical analysis showed a significant relation between atrial fibrillation rhythm and mortality (p=0.02). Morbidities occurred in 30 patients (42.8%). Significant statistical relation has been found between the morbidities and age over 65 years old (p=0.005). In follow-up period 4 cases (5.7%) underwent re-operation due to global dysfunctionof valve. our study shows that using bioprosthetic valve could reduce the risk of morbidity occurrence in a patient who needs valve replacement. However if medical treatments fail, in result of any reason, patients should be refered to surgical unit. This would reduce the risk of mortality because of lower incident of complications such as atrial fibrillation and morbidities due to younger patients’ population.

Ventricular fibrillation occurs commonly after aortic crossclamping in patients undergoing cardiac surgery. Ventricular fibrillation increases myocardial oxygen consumption, and defibrillation may harm the myocardium. Thus, a pharmacologic approach to decreasing the incidence of ventricular fibrillation or the number of shocks required may be beneficial. The goal of this study was to evaluate whether amiodarone or lidocaine was superior to placebo for the prevention of ventricular fibrillation after aortic crossclamping in patients undergoing a variety of cardiac surgical procedures. Patients undergoing cardiac surgery requiring aortic crossclamping were randomized to receive lidocaine 1.5 mg/kg, amiodarone 300 mg, or placebo before aortic crossclamp removal The primary outcomes were the incidence of ventricular fibrillation and the number of shocks required to terminate ventricular fibrillation. A total of 342 patients completed the trial. On multivariate analysis, there was no difference in the incidence of ventricular fibrillation among treatment groups. The number of required shocks was categorized as 0, 1 to 3, and greater than 3. On multivariate analysis, patients receiving amiodarone required fewer shocks to terminate ventricular fibrillation (odds ratio, 0.51; 95% confidence interval, 0.31-0.83; P =. 008 vs placebo). There was no difference between lidocaine and placebo in the number of required shocks (odds ratio, 0.86; 95% confidence interval, 0.52- 1.41; P =. 541). In patients undergoing a variety of cardiac surgical procedures, neither amiodarone nor lidocaine reduced the incidence of ventricular fibrillation. Amiodarone decreased the number of shocks required to terminate ventricular fibrillation

Parasitic infections, hypersensitivity myocarditis, and hypereosinophilic syndrome are collectively regarded as eosinophilic myocarditis. Endomyocardial biopsy is the gold standard for the diagnosis in such types of myocarditis, particularly in patients with unexplained heart failure or ventricular arrhythmias.A number of pitfalls should be remembered by the pathologist, namely a focal lesion in the left side of the heart, which is missed if the biopsy is taken from the right ventricle.Endocardial fibrosis can be a non-specific finding or it may represent a specific pathology such as hypereosinophilic syndrome. In order to overcome this problem, adequate and deep sampling from the myocardium would facilitate its identification. Finally, if superficial sampling of the myocardium is done, the pathologist may only observe pieces of thrombi rather than the myocardium proper. Therefore, one is advised to look for even minute collections of inflammatory cells, including eosinophils in the mural thrombi.

In this case-report, we describe aortic valve replacement and CABG in a 50- year old female patient with Takayasu’s disease and severely calcified ascending aorta without cross– clamping the aorta or institution of total circulatory arrest. Intra aortic occlusion technique is explained and the literature is reviewed for different approaches to similar cases.

The most primary cardiac tumors are benign, and malignant tumors comprise about 25%. Primary cardiac angiosarcoma is the most common malignant tumor and aggressive tumor with a high incidence of metastatic spread. The diagnosis is often delayed because of the nonspecific clinical presentation. Cardiac angiosarcoma usually arises from the right atrium. We report an extremely rare case of primary angiosarcoma originating from the left atrium in a 57-year-old woman that had been referred with a onemonth history of exertional dyspenea. Transesophageal echocardiography showed a large mass on the left atrial that protrude through mitral valve. The tumor was resected successfully with curative intent. The patient underwent adjuvant chemotherapy. We have no problem up to now in six months follow-up.