Journal of Cardiovascular and Thoracic Research
Volume:6 Issue: 4, Dec 2014

This study compares the effectiveness and cost of trans-catheter verses surgicalclosure of secundum atrial septum defect (ASD). ASD accounts for 10% of congenital cardiacdefects. Trans-catheter closure of secundum ASD is increasingly used as the primary intervention.Surgical repair is advised in a proportion of secundum type defects which are unsuitable fordevice closure. We reviewed the clinical course of 176 patients who underwent closure of isolatedsecundum ASD. The patients were assigned to either the device or surgical group depending uponthe treatment they received. Successful closure was assessed immediately after the procedure. Thefollowing outcomes were studied: mortality, morbidity, hospital stay, and costs. Ninety five patients were in the surgical group and 81 patients were in the groupundergoing device closure. The median age was 14.0 years (range 1.1-61.0) for surgical groupand 24.0 years (range 0.5-68.0) for the device group. The mortality in both groups was 0. Theprocedure success rate was 100% for the surgical group and 96.3% for the device group. Thecomplication rate was 13.7% for surgical group and 7.4% for the device group. The mean lengthof hospital stay was 5.0 ± 2.7 days for surgical group and 3.0 ± 0.4 days for device group. Theprocedure cost for surgery was found to be 12.3% lower than that of trans-catheter closure. Successful closure is achieved by both methods. Trans-catheter closure results inlower rate of complication and hospital stay but the cost of the procedure tends to be higherthan surgery.

Due to the importance of prolonged mechanical ventilation (PMV) as a postoperative complication, predicting “high-risk” patients by identifying predisposing risk factors is of important issue. The present study was aimed to identify perioperative variables associated with PMV in patients undergoing open heart surgery. A total of 743 consecutive patients, American Society of Anesthesiologists (ASA)physical status class III, who were scheduled to undergo open heart surgery using cardiopulmonary bypass were included in this observational study. Perioperative variables were compared between the patients with and without PMV, as defined by an extubation time of >48 h. PMV occurred in 45 (6.1%) patients. On univariate analysis, pre-operative variables;including gender, history of chronic obstructive pulmonary disease (COPD); chronic kidney disease and endocarditis, intra-operative variables; including type of surgery, operation time,pump time, transfusion in operating room and postoperative variables; including bleeding andinotrope-dependency were significantly different between patients with and without PMV (all P<0.001, except for COPD and transfusion in operating room; P=0.004 and P=0.017, respectively). Our findings reinforce that risk stratification for predicting delayed extubation should be an important aspect of preoperative clinical evaluation in all anesthesiology settings.

Blood pressure(BP)measurement is essential for epidemiological studies and clinical decisions. It seems that tissue characters can effect on BP resultso and we try to find edema effect on BP measured by three methods of oscillometric, auscultation and arterial. Method and materials: Blood pressure of 55 children candidated for open heart surgery were measured and compared with three Arterial as standard and reference, oscillometric and auscultatory. Peripheral edema as an tissue character which defined as higher than +2 as marked edema and equal or lower than +2 considered as no edema. statistical Data expressed by Mean (95% of confidence interval(CI 95%). Comparison between two group was done by T independent test and ANOVA test for more than two groups. Mann whitney U and paired T test test used for serially comparisons of methods. P less than 0.05 is significant. 55 children aged 29.4±3.9 months, they divided to two groups 10 children with peripheral edema beyond 2+ and 45 cases without edema. Oscillometric method overestimate systolic BP the Mean (CI 95%) difference of arterial to oscillomeric was 4.8(8/-1, p 0.02) in edematous and 4.2(7/1 p 0.004) in non edematous. In diastolic BP oscillometric method underestimate -9(-1.8/-16.5, p0.03) in edematous group and 2.6(-0.7/+5,p 0.2) in non edematous. Oscillometric device standards can not cover all special clinical conditions and age groups. It underestimate diastolic BP significantly in edematous children, it was 9.2 mmHg in average as our study.

Almost one third of patients with asthma have symptomatic evidence for coexisting gastroesophageal reflux disease (GERD), which is thought to be aggravating factor in asthma at least in some cases. We investigated the impact of coexisting GERD on asthma severity and parameters of lung function. Ninety two asthma patients diagnosed according to ATS criteria were studied. After full history and physical examination, asthma severity was measured in each patient using asthma control test (ACT). GERD symptoms was verified in each patient. Impulse oscillometry(IOS) and lung volume studies (using body-plethysmography and IOS) were performed. Thedifference between total airway resistance (TAWR) indicated by resistance at 5 Hz and centralairway resistance (CAWR) as indicated by resistance at 20 Hz in oscillometry was calculated and considered as representative of resistance at peripheral airways (PAWR). The relationship between the presences of GERD symptoms, ACT score and parameters of lung function were analyzed. PAWR and TAWR were both significantly higher in asthmatic patients with GERD symptoms than patients without GERD symptoms (256.64±161.21 versus 191.68±98.64; P=0.02,and 102.73±122.39 versus 56.76±71.43; P=0.01, respectively). However, no significant difference was noted in mean values of ACT, FEV1 (forced expiratory volume in 1 sec), FVC (forced vitalcapacity), PEF (peak expiratory flow), and CAWR in these two groups. These findings suggest that the severity of asthma as measured by ACT score is notdifferent in patients with and without GERD symptoms. However, total and peripheral airway resistance measured by IOS is significantly higher in asthmatic patients with GERD symptoms.

Approximately 15 to 30% of patients undergoing percutaneous coronaryintervention (PCI) will require repeated revascularization. There is an ongoing debate concerningthe impact of prior PCI on subsequent coronary artery bypass graft (CABG) surgery. This studysought to compare immediate post-CABG complications between patients with and withoutprevious coronary stenting. A total of 556 CABG candidates including 73 patients with previous coronary stentingand 483 patients without prior stenting were enrolled in this retrospective-prospective study.Demographic information, cardiac markers (CK-MB, Troponin T), and postoperative dataincluding inotrope administration, intra-aortic balloon pump (IABP) use, bleeding, pathologicalelectrocardiography (ECG) changes, and overall complications were compared between the twogroups. The mean age of the patients in stented group was significantly higher than that inunstented group (63.49±7.71 vs. 61.37±9.80 years, p=0.05). The mean serum level of TroponinT 12 h postoperation was significantly higher in the same group (323.26±33.16 vs. 243.30±11.52ng/dL; p=0.03). Comparing the stented and unstented groups, the rates of inotrope use (17.8% vs.7.2%; p=0.003), significant bleeding (15.1% vs. 4.3%; p=0.001), and overall complications (32.9%vs. 11.6%; odds ratio: 3.74 with 95% confidence interval of 2.13-6.55, p<0.001) were significantly higher in the former group. The association between overall complications and prior stenting was independent (odd ratio: 3.06). No significant connections were found between postoperative complications and stent number or type. A positive history of previous coronary stenting significantly increases the risk of immediate post-CABG complications.

Epicardial fat volume (EFV) has been reported to correlate with the severity of coronary artery disease (CAD). Pericardial fat volume (PFV) has recently been reported to be strongly associated with CAD severity and presence. We aimed to investigate the relationship between EFV and PFV with severity of coronary artery stenosis in patients undergoing 64-slice multi-slice computed tomography (MSCT). One hundred and fifty one patients undergoing MSCT for suspected CAD were enrolled. Non-enhanced images were acquired to assess calcium score. Contrast enhanced images were used to quantify EFV, PFV and severity of luminal stenosis. Coronary artery stenosis was mild in 25 cases (16.6%), moderate in 58 cases (38.4%) and severe in 68 cases (45%). With increase in severity of coronary artery stenosis, there was significant increase in PFV, EFV as well as epicardial fat thickness in right ventricle free wall in basal view and epicardial fat thickness in left ventricle posterior wall in mid and apical view. There was significant linear correlation between PFV with coronary calcification score (r=0.18, P=0.02), between coronary artery stenosis severity and PFV (r=0.75, P<0.001), EFV (r=0.79, P<0.001), apical epicardial fat thickness in right ventricle free wall (r=0.29, P<0.001), Mid (r=0.28, P<0.001) and basal (r=0.23, P=0.004) epicardial fat thickness in left ventricle posterior wall. PFV, EFV and regional epicardial thickness are correlated with severity of CAD and could be used as a reliable marker in predicting CAD severity.

Atrial conduction time has important hemodynamic effects on ventricular filling and is accepted as a predictor of atrial fibrillation. In this study we assessed atrial conduction time in patients with non ischemic dilated cardiomyopathy (NIDCMP) and functional mitral regurgitation (MR) and aimed to determine factors predicting atrial conduction time prolongation. Sixty five patients with non ischemic dilated cardiomyopathy who have moderate to severe MR and 60 control subjects were included in the study. In addition to conventional echocardiographic measures used to asses left ventricle and MR, atrial electromechanical coupling (time interval from the onset of P wave on surface electrocardiogram [ECG] to the beginning of A wave interval with tissue Doppler echocardiography [PA]), intra- and interatrial electromechanical delay (intra and inter AEMD) were measured. The correlations between inter AEMD and left atrial (LA) size, MR volume, isovolumetric relaxation time (IVRT), deceleration time (DT), systolic pulmonary artery pressure (PAPs), E/A ratio and E/e’ were very poor. Similarly, intra AEMD was not correlated to LA size, MR volume, IVRT, DT, PAPs, E/A ratio and E/e’. However, both inter AEMD and intra AEMD had good correlation with left ventricular mass index, tenting area (TA), tenting distance (TD), coaptation septal distance (CSD), sphericity index (SI). Prolongation of inter and intra AEMDs were found to be well correlated with parameters reflecting left ventricular and mitral annular remodeling.

We aimed to determine angiography projections with lower Dose Area Product (DAP) rate by measuring the mean DAP and fluoroscopy times in coronary angiography (CAG) and percutaneous coronary intervention (PCI) and calculating DAP rate in different projections. DAP and fluoroscopy times were measured in all employed projections in real-time in 75 patients who underwent CAG or PCI by a single cardiologist in Madani Cardiovascular University Hospital (45 in CAG group and 30 in PCI group). DAP rate was calculated in both groups and in all projections. The projections with highest and lowest DAP rate were determined. Mean DAP was 436.73±315.85 dGy×cm2 in CAG group and 643.26±359.58 dGy×cm2 in PCI group. The projection 40° LAO/0° had the highest DAP rate in CAG group (28.98 dGy×cm2/ sec) and it was highest in 20° RAO/30° CR in PCI group (29.83 dGy×cm2/sec). The latter projection was also the most employed projection in PCI group. The amount of radiation dose in this study is in consistent with the previous reports. Specific angiographic projections expose patients to significantly higher radiation and they should be avoided and replaced by less irradiating projections whenever possible.

Pulmonary artery (PA) banding is a procedure associated with high morbidityand mortality rates. It however can effectively palliate several forms of congenital heart lesionswith increased pulmonary flow. Occasionally, to obtain an optimal degree of banding following operation, readjustment of the band is inevitable. We describe the technique of adjustable PA banding to prevent this problem. From June 2007 to 2008, 21 patients with congenital cardiac abnormalities including Single ventricle (1), transposition of great arteries (TGA) (4) and ventricular septal defect (VSD)(16) were operated via percutaneously adjustable PA banding in Madani Hospital (Tabriz, Iran). The mean age and the mean weight of the patients were 12±.8 months and 61±.7 kg respectively. Seventeen (81%) patients survived the operation. Cause of death was heart failurein 2 (9.5%) patients, and arrhythmia in 2 (9.5%) patients. Later, patients were followed up for 6 months. Satisfactory band gradient was achieved between 48 and 240 hours. Mean PA gradient before and 1 and 6 months after adjusting was (55.3±7.1 mmHg), (54.7±5.1 mmHg),and (53.2±5.4 mmHg) respectively. In the follow up period, there were 2 deaths, one causedby aspiration pneumonia and one caused by poor mixing. Postoperative complications wereobserved in 28.5% of the cases including cardiac (10%), pulmonary (pneumothorax, pneumonia)(10%) and infectious complications (9%). The technique of percutaneously adjustable PA banding is simple and inexpensiveand allows easy band adjustments without the need for multiple reoperations. Moreover, our assessment reveals that created gradient is constant and did not decrease with time.

We decided to investigate the effects of injecting Indomethacin on reducing complications of Patent Ductus Arteriosus (PDA) and the need for prolonged mechanical ventilation. During this randomized clinical trial, 70 premature infants with matched gestational age and birth weight were divided into case and control groups. In the study group, intravenous indomethacin started from the first 2-12 hours of birth. All patients were followed by echocardiography at the fourth day and skull ultrasound in the second week. Symptomatic PDA rate was significantly higher in the control group (25.7% vs. 0%; P≤0.001). Incidence of grade 1-3 intraventricular hemorrhage was higher in the control group and the ratio of needed time for respiratory support in the control group to the case group was approximately 2.1. Intravenous Indomethacin reduced the number of PDA cases and incidence of grade 2 and 3 intraventricular hemorrhage, without any short term side effects.

A calcified amorphous tumor (CAT) of the right atrium (RA) is an exceedingly rare non neoplastic cardiac mass. It was initially described in 1997 and only a handful of cases has been published so far. We present a case of tumor in 77-year-old male, in the RA that attached to therim of the fossa ovalis, with classic pathological and clinical findings. Under cardiopulmonary bypass (CPB) and bicaval and aortic cannulation and cardioplegic arrest, right atrial mass, was resected and septal defect was repaired with a fresh pericardial patch. Pathological exam of themass revealed CAT. The patient had an uneventful hospitalization and his blue discoloration of finger recovered normally.

We have read with a great interest the published article by Ghaffari et al. entitled with “The predictive value of total neutrophil count and neutrophil/lymphocyte ratio in predicting in-hospital mortality and complications after STEMI”. Authors have suggested that complete blood count (CBC) test might help to identify ST elevation myocardial infarction (STEMI) patients and higher neutrophil count had the best predictive value for both mortality and heart failure. We believe some points should be discussed.