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Background: percutaneous coronary intervention for symptomatic patients with chronic stable angina improves coronary artery blood flow and hence the left ventricular perfusion. Transthoracic echocardiography that is simple, non-invasive and cost effective technique, can provide an efficient procedure for measuring coronary sinus blood flow. Objectives: to assess coronary sinus blood flow (CSBF) and global LV perfusion in the coronary sinus using 2 D and Doppler transthoracic echocardiography in patients with chronic stable angina before and after Percutaneous Coronary Intervention. Patients and methods: Ninety-two (92) patients with stable chronic coronary artery disease chosen after admission for diagnostic (and/or therapeutic) catheterization have been enrolled in the current study at the Department of Catheterization and Echocardiography in Baghdad teaching hospital. After admission for coronary angiography, 63 patients had positive coronary lesions and proceeded to percutaneous coronary intervention (PCI). Fifty 50 normal healthy adults with no coronary artery disease CAD or CAD risk factors served as the control group. Standard 2D and Dopplerechocardiography was performed and CSBF, CSVTI, CSPG LV mass and LV perfusion were registered. Results: Basic parameters were the same between the two groups (P˃0.05). Controls had significantly higher CSBF, global LV perfusion and lower LV mass than the cases group (3.04±0.7 mL/min/gm, 501.64±63.8 mL/min and 99.97±9.4gm/m2 in controls vs 2.11±1mL/min/gm, 223.15±55.7 mL/min and 195.74±68.6 gm/m2 in the cases group). The positive group also showed significant increase in CSBF 438.09±89.9 ml/min (p value less than 0.05) after successful PCI. The same applied for the global LV perfusion which increased to 2.537±1.06 mL/min/gm. Conclusion: This study revealed that the transthoracic echocardiographicmeasurement of the coronary sinus bloodflow is a valuable tool to assess the results obtained by angiography and it can be used as a practical and reproducible method for observing the changesin cardiac perfusion before and after percutaneous coronary intervention in patients with chronic stable angina.

Background Recent studies using stress‐rest perfusion cardiovascular magnetic resonance ( CMR ) demonstrated a close correlation between myocardial ischemia and reduced fractional flow reserve ( FFR ). However, its diagnostic concordance may be reduced in patients with multivessel disease. We sought to evaluate the concordance of adenosine stress‐rest perfusion CMR for predicting reduced FFR , and to determine the additive value of measuring global coronary flow reserve ( CFR ) in the coronary sinus in multivessel disease. Methods and Results Ninety‐six patients with angiographic luminal narrowing >50% underwent comprehensive CMR study and FFR measurements in 139 coronary vessels. FFR CFR was quantified as the ratio of stress‐rest coronary sinus flow measured by phase‐contrast cine CMR . In 25 patients with single‐vessel disease, visual assessment of perfusion CMR yielded high diagnostic concordance for predicting flow‐limiting stenosis, with the area under receiver operating characteristic curve of 0.93 on a per‐patient basis. However, in 71 patients with multivessel disease, perfusion CMR underestimated flow‐limiting stenosis, resulting in the reduced area under receiver operating characteristic curve of 0.74. When CFR of P =0.002). Conclusions Visual analysis of stress‐rest perfusion CMR has limited concordance with FFR in patients with multivessel disease. Multiparametric CMR integrating stress‐rest perfusion CMR and flow measurement in the coronary sinus is useful for detecting reduced FFR in multivessel disease.

Aims and Objectives: Physiologically coronary sinus (CS) drains the left coronary artery (LCA) territory. Stenosis of the branches of LCA may decrease the coronary sinus blood flow (CSBF). Any intervention that aims at restoring the flow of the stenosed vessel increases coronary artery flow that should consequently increase the CSBF. Hence, this study was undertaken to assess the CSBF before and after each branch of LCA to determine the adequacy of surgical revascularization in patients undergoing elective off pump coronary artery bypass grafting (OPCAB) using transesophageal echocardiography (TEE). Materials and Methods: Thirty consecutive patients scheduled for elective OPCAB were enrolled. CSBF was assessed before and after each branch of LCA revascularization using TEE. Left internal mammary artery (LIMA) Doppler was also obtained post LIMA to left anterior descending (LAD) grafting. Results: Hemodynamic and echocardiographic variables were compared by means of Student′s t-test for paired data before and after revascularization. The CSBF per beat (1.28 ± 0.71), CSBF per minute (92.59 ± 59.32) and total velocity time integral (VTI) (8.93 ± 4.29) before LAD grafting showed statistically significant increase to CSBF per beat (1.70 ± 0.89), CSBF per minute (130.72 ± 74.22) and total VTI (11.96 ± 5.68) after LAD revascularization. The CSBF per beat (1.67 ± 1.03), CSBF per minute (131.91 ± 86.59) and total VTI (11.00 ± 5.53) before obtuse marginal (OM) grafting showed statistically significant increase to CSBF per beat (1.91 ± 1.03), CSBF per min (155.20 ± 88.70) and total VTI (12.09 ± 5.43) after OM revascularization. In 9 patients, color flow Doppler of LIMA could be demonstrated which showed diastolic predominant blood flow after LIMA to LAD grafting. Conclusion: Demonstration of CSBF was simple and monitoring the trend of CSBF values before and after each graft of LCA territory will guide to determine the adequacy of surgical revascularization.

Objective: Epidural anesthesia is a central neuraxial block technique with many applications. It is a versatile anesthetic technique, with applications in surgery, obstetrics and pain control. Its versatility means it can be used as an anesthetic, as an analgesic adjuvant to general anesthesia, and for postoperative analgesia. Off pump coronary artery bypass (OPCAB) surgery triggers a systemic stress response as seen in coronary artery bypass grafting (CABG). Thoracic epidural anesthesia (TEA), combined with general anesthesia (GA) attenuates the stress response to CABG. There is Reduction in levels of Plasma epinephrine, Cortisol and catecholamine surge, tumor necrosis factor-Alpha( TNF ά), interleukin-6 and leucocyte count. Design: A prospective randomised non blind study. Setting: A clinical study in a multi specialty hospital. Participants: Eighty six patients. Material and Methods/intervention: The study was approved by hospital research ethics committee and written informed consent was obtained from all patients. Patients were randomised to receive either GA plus epidural (study group) or GA only (control group). Inclusion Criteria (for participants) were -Age ≥ 70 years, Patient posted for OPCAB surgery, and patient with comorbidities (diabetes mellitus, chronic obstructive pulmonary disease, cerebrovascular disease, peripheral vascular disease, renal dysfunction). Serum concentration of Interlukin: - 6, TNF ά, cortisol, Troponin - I, CK-MB, and HsCRP (highly sensitive C reactive protein), was compared for both the group and venous blood samples were collected and compared just after induction, at day 2, and day 5 postoperatively. Time to mobilization, extubation, total intensive care unit stay and hospital stay were noted and compared. Independent t test was used for statistical analysis. Primary Outcomes: Postoperative complications, total intensive care unit stay and hospital stay. Secondary Outcome: Stress response. Result: Study group showed decreased Interlukin - 6 at day 2, TNF ά at day 2 and 5,troponin I at day 5, and decreased total hospital stay ( p < 0.05). Conclusion: Thoracic epidural anesthesia decreases stress and inflammatory response to surgery and decreases hospital stay. However a large multicentre study may be needed to confirm it.

Cardiac hydatidosis is rare presentation of body hydatidosis. Incidence of cardiac involvements range from 5% to 5% of patients with hydatid disease. Most common site of hydatid cyst in heart is interventricular septum and left ventricular free wall. Right ventricular free wall involvement by cyst that ruptured to pericardial cavity is very rare presentation of hydatid cyst. Cardiac involvement may have serious consequences such as rupture to blood steam or pericardial cavity. Both the disease and its surgical treatment carry a high complication rate, including rupture leading to cardiac tamponade, anaphylaxis and also death. In the present report, a 43-year-old man with constrictive pericarditis secondary to a pericardial hydatid cyst is described.

Background: Standard methods for the measurement of myocardial perfusion are invasive and require cardiac catheterization or the use of radioisotope dyes. The coronary sinus blood flow (CSBF) is an appropriate criterion for the efficacy of myocardial perfusion. This study sought to measure CSBF via transthoracic echocardiography (TTE) in patients with acute myocardial infarction (AMI) and to assess its relation with left ventricular ejection fraction (LVEF), wall motion scoring index (WMSI), and in-hospital mortality. Methods: This case-control study evaluated 20 patients (pts) with anterior AMI and 20 healthy individuals as controls over a 6-month period (in 2005) in Madani Heart Center in Tabriz (Iran). All the patients received the same drugs for AMI treatment (e.g. fibrinolytic). CSBF and WMSI, having been obtained via TTE, were compared between the two groups. Results: Baseline variables were similar between the two groups (P>0.05). CSBF in the AMI group was 287.8±128 ml/min and in the control group was 415±127 ml/min (P=0.001). There was a significant correlation between CSBF and LVEF (r=0.52, P=0.01), between CSBF and WMSI (r=-0.77, P=0.0001), and between CSBF and in-hospital mortality (r=0.58, P=0.03). Conclusion: Our study demonstrated a good correlation between CSBF measured with 2D-doppler TTE and LVEF, WMSI, and in-hospital mortality.

We describe an incident of development of acute pulmonary edema after the device closure of a secundum atrial septal defect in a 52-year-old lady, which was treated with inotropes, diuretics and artificial ventilation. Possibility of acute left ventricular dysfunction should be considered after the defect closure in the middle-aged patients as the left ventricular compliance may be reduced due to increased elastic stiffness and diastolic dysfunction. Baseline left atrial pressure may be > 10 mmHg in these patients. Associated risk factors for the left ventricular dysfunction are a large Qp:Qs ratio, systemic hypertension, severe pulmonary hypertension and paroxysmal atrial fibrillation.