Journal of Cardio -Thoracic Medicine
Volume:3 Issue: 3, Summer 2015

B-type natriuretic peptide (BNP) level is known to increase in patients with rheumatic mitral stenosis. In this systematic review, we aimed to discuss the possible association between plasma BNP level and the success rate of percutaneous transvenous mitral commissurotomy. PubMed and Scopus databases were searched systematically, using the following key terms: “B-type natriuretic peptide” OR “BNP” AND “percutaneous transvenous mitral commissurotomy” OR “percutaneous transluminal mitral commissurotomy” OR “PTMC” OR “percutaneous balloon mitral valvotomy” OR “PBMV”. The title, keywords and abstract of relevant articles were searched thoroughly. Among 27 articles found in these databases, 18 studies were excluded during different stages of article selection, based on the inclusion and exclusion criteria. A total of 333 patients were evaluated in the selected studies. Overall, 75 and 191 cases were male and female, respectively. Sex ratio was not specified in two studies, evaluating a total of 67 patients. The obtained results showed that BNP level may decrease after a successful PTMC. Furthermore, post-operative plasma levels of BNP and N-terminal proBNP could be considered as predictors of the success rate of PTMC. Based on the results reported in the evaluated articles, there may be an association between post-operative plasma levels of BNP family and the success rate of PTMC.

Optimum pain management immediately after surgeries can lower the possibility of pain syndrome and its following consequences. Opioids are amongst the analgesics used for postoperative pain control; however, their application can bring about several adverse effects. In this study, all the published articles regarding efficacy of Paracetamol in post-cardiac surgery pain management were systematically reviewed. Pubmed and Scopus were searched for relevant articles. The employed search strategy was as follows: (Paracetamol OR Acetaminophen OR Propacetamol) AND (pain OR analgesia) AND coronary. All the English-language articles (with no time restriction), investigating the effectiveness of Acetaminophen in comparison with other analgesics or placebo, were included in the study. All the articles examining the efficacy of Paracetamol in combination with other analgesics were excluded from the search results. On the whole, our electronic search retrieved 192 articles from PubMed and 365 articles from Scopus. After screening the titles, abstracts, and full texts of the search results, only 5 English-language articles met our inclusion criteria. Although Paracetamol demonstrated considerable efficacy in minimizing application of post-operative opioids, its strength in soothing post-operative pain is not significantly different from opioids. Further, conducting randomized-controlled-trials with large sample size are necessary to accurately reveal the efficacy of Paracetamol in curtailing application of opioids in post cardiac surgeries.

Gastro-esophageal reflux disease (GERD) regularly occurs when stomach acid moves up from the stomach into the esophagus. GERD might be associated with chronic asthma symptoms such as coughing and breathlessness. According to several studies on children and adults, GERD is proven to have a close relationship with asthma. Medication treatment via proton-pump inhibitors (PPIs), such as Omeprazole, H2 receptor blockers (Ranitidine), and other antireflux medications, is appropriate for ameliorating GERD and asthma. Moreover, surgery is another useful approach to GERD and asthma treatment. In this regard, Nissen fundoplication (laparoscopic) is a principal surgery method. Medical and surgical antireflux therapies are recognized as effective methods in the treatment of GERD-associated asthma. Our review included studies that evaluated treatment of GERD-associated asthma. These studies accentuated the critical role of acid reflux suppression in relieving the patients suffering from a difficult to control asthma.

Gastric drainage disorder is one of the complications of gastric pull-up and esophagectomy after surgery which might lead to esophageal cancer and benign strictures. The aim of this study was to determine the role of pyloromyotomy on gastric drainage. In this prospective randomized controlled clinical trial study, we studied 51 patients in two matched groups from July 2008 to August 2010 in ImamRezaHospital, Tabriz,Iran. Twenty-seven patients in group one had no pyloromyotomy and 24 patients in group two had pyloromyotomy after transhiatal esophagectomy and gastric pull-up procedure. The outcomes were measured as the incidence of gastric outlet compromise which was diagnosed 12 months after esophagectomy and gastric pull-up. Regurgitation, fullness, respiratory distress, coughing and, clinical delayed gastric emptying were observed and compared in two groups by radioisotope gastric emptying scanning. A total number of 51 patients, 19 (37.25%) male and 32 (62.75%) female were studied in this research. The overall incidence of delayed gastric emptying was 19 /51 (37.25%). Pyloromyotomy did not reduce the incidence of delayed gastric emptying. There was no statistically significant difference in the length of hospital stay in study groups (group 1= 11 days versus 12 days in group 2, P=0.41). There was no statistical difference in anastomotic leak or anastomotic stricture (P= 0.72). Mortality was two (one patient, 3.7%, in group 1 and one patient, 4.2%, in group 2). The incidences of regurgitation and increased gastric emptying were not statistically different in two groups. Pyloromyotomy could not reduce the incidence of delayed gastric emptying after transhiatal esophagectomy, and vagotomy.

This study aimed to evaluate the effects of four-time inflation of the stent balloon at nominal pressure on optimal stent expansion in resistant lesions. This interventional study was conducted on 39 patients with coronary artery lesions, in whom Zotarolimus-eluting stents (N=20), Paclitaxel-eluting stents (N=11) and other stents (N=8) were deployed four times at nominal inflation pressure and increased inflation times (5, 15, 30 and 45 seconds). After the deployments, enhanced stent visualization imaging technique (IC stent) was used to assess stent placement and artery expansion. In this study, early success rate was estimated at 79.5% using the enhanced stent visualization imaging technique. In addition, major adverse cardiac event (MACE) was determined at 2.6%. Also, conventional methods resulted in lower success rate and higher MACE in resistant lesions. According to the results of this study, four-time stent balloon inflation at nominal pressure could allow adequate stent expansion in resistant lesions leading to lower MACE.

Left ventricular ejection fraction (LVEF) is considered to be the single most important prognostic factor in patients with previous myocardial infarction. LVEF is not improved in all patients after coronary artery bypass grafting (CABG). This study aimed to assess the possibility of prediction of LVEF changes after CABG using myocardial perfusion gated signle photon emission computed tomography (GSPECT). Overall, 48 patients with mean LVEF of 30.2% (±4.7) underwent Echocardiography and GSPECT after injection of Tc-99m-MIBI at rest. Myocardial uptake was evaluated in 17 myocardial segments and was compared with age and gender matched normal data pool. The risks and benefits of CABG were explained to the patients and 16 cases (15 male and 1 female) with the mean age of 61.1 years (±10.8) accepted to undergo off-pump CABG. All the patients were followed-up for at least six months and echocardiography and GSPECT were repeated at the end of follow up. The mean LVEF was increased from of 31.1% (±3.5) to 34.5% (±3.6) after surgery (P<0.001). Delta LVEF was defined as ΔLVEF=LVEF (before CABG) - LVEF (after CABG). ΔLVEF was within the range of 0-8% with the mean of 3.4% (±2.5). The number of non-viable myocardial segments was not significantly different between patients with ΔLVEF ≥ 5% and those with smaller changes. Myocardial perfusion was estimated for all segments, and the mean global uptake was defined by adding the mean uptake in all segments, divided by 17. The mean global uptake was 53.1% in our patients. Regression analysis revealed that ΔLVEF after CABG can be predicted reliably using the following formula: ΔLVEF= -33.8 + (0.77 × mean global uptake) (P<0.01). Our study showed that change of LVEF after CABG can be predicted reliably using mean global uptake in preoperative myocardial perfusion SPECT at rest.

Primary neuroendocrine carcinoma (NEC) of the mediastinum is a rare type of carcinoma. According to the literature, only five cases of this condition have been reported so far. In this paper, we present a rare case of mediastinal NEC of unknown primary site. The patient was a 34-year-old man with mediastinal NEC, who presented with chronic dry cough and a right-sided mediastinal mass one year prior to hospital admission (winter 1391). His condition was confirmed by cervical lymph node biopsy. The patient refused to undergo chemotherapy treatment. During the hospital admission, the patient presented with severe dyspnea and signs of superior vena cava syndrome. Contrast-enhanced CT scan of the chest revealed a large heterogeneous mass extended from the right superior mediastinum to the right lung base with the encasement of the superior vena cava. After radiotherapy, the patient′s symptoms subsided and he underwent etoposide and cisplatin chemotherapy. After a 20-month patient follow-up, the subject remained alive and symptom-free.

Right atrial dilation due to left heart disease is a common complication among adults. The present review aimed to describe a case of massively dilated right atrium in a female patient presenting with valvular heart disease and no atrial fibrillation. The results of chest X-ray revealed a large opacity filling the lower right hemithorax, falsely interpreted as a mediastinal mass. During the transesophageal echocardiography, severe enlargement of the right atrium was detected, and open mitral and tricuspid valve replacements were performed successfully.