Search

Background: Delirium is common after cardiac surgery and is independently associated with increased morbidity, mortality, prolonged hospital stays, and higher costs. Cobalamin (vitamin B12) deficiency is a common cause of neuropsychiatric symptoms and affects up to 40% of elderly people. The relationship between cobalamin deficiency and the occurrence of delirium after cardiac surgery has not been examined in previous studies. We examined the relationship between cobalamin deficiency and delirium in elderly patients undergoing coronary artery bypass grafting (CABG) surgery. Material and methods: A total of 100 patients with cobalamin deficiency undergoing CABG were enrolled in this retrospective study. Control group comprised 100 patients without cobalamin deficiency undergoing CABG. Patients aged 65 years or over were included. Diagnosis of delirium was made using Intensive Care Delirium Screening Checklist. Delirium severity was measured using the Delirium Rating Scale-revised-98. Results: Patients with cobalamin deficiency had a significantly higher incidence of delirium (42% vs 26%; P=0.017) and higher delirium severity scores (16.5±2.9 vs 15.03±2.48; P=0.034) than patients without cobalamin deficiency. Cobalamin levels were significantly lower in patients with delirium than patients without delirium (P=0.004). Delirium severity score showed a moderate correlation with cobalamin levels (ρ=-0.27; P=0.024). Logistic regression analysis demonstrated that cobalamin deficiency was independently associated with postoperative delirium (OR 1.93, 95% CI 1.03-3.6, P=0.038). Conclusion: The results of our study suggest that cobalamin deficiency may be associated with increased risk of delirium in patients undergoing CABG. In addition, we found that preoperative cobalamin levels were associated with the severity of delirium. This report highlights the importance of investigation for cobalamin deficiency in patients undergoing cardiac surgery, especially in the elderly. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article "Value of serial platelet indices measurements for the prediction of pulmonary embolism in patients with deep venous thrombosis" by U. Sevuk and colleagues in the August 2015 issue along with the author's reply.

Background: The aim of this study was to assess the efficacy and applicability of on-pump beating heart aortic valve replacement with retrograde coronary sinus (CS) warm blood perfusion. Methods: The prospective study included 14 consecutive patients who underwent aortic valve replacement with mechanical prosthesis using retrograde CS perfusion. The operative variables and early outcome of this procedure are presented. Results: Retrograde CS perfusion and venting the heart from the pulmonary vein provided good visualization of the operative field and performance of the operations without any difficulty. Partial oxygen pressures of CS perfusion blood and the returning blood from the coronary ostia were 288.5 ± 34.4 and 39.6 ± 4.6 mmHg, respectively. Postoperative peak creatine kinase-MB and troponin T values were mean 77.0 ± 63.6 IU/L and mean 0.8 ± 0.7 ng/mL, respectively. No mortality or major complication was observed and all the patients were discharged from the hospital in good condition. Conclusions: On-pump beating heart aortic valve replacement with retrograde CS warm blood perfusion is a good surgical option, and has the advantage of maintaining physiologic condition of the heart throughout the procedure. [ABSTRACT FROM AUTHOR]

Obesity-associated alterations in coagulation and fibrinolytic factors in favor of thrombosis are well known. Observations suggest that leptin, a recently discovered obesity gene product, in addition to being a satiety factor, induces platelet aggregation, accelerates formation of firm thrombi, and is associated with abnormal fibrinolysis. The authors studied the influence of plasma leptin concentrations on admission within 6 hours of acute myocardial infarction (MI) on the outcome of thrombolytic therapy (TT). Forty-one patients with acute MI who underwent TT were enrolled into the study. Levels of plasma leptin were determined with radioimmunoassay method in samples obtained just before initiation of TT. Patients were initially classified according to the admission plasma leptin concentrations, and it was observed that failure of reperfusion therapy with streptokinase was significantly higher in patients with admission plasma leptin concentrations ≥14 ng/mL (group 2) as compared to patients with admission plasma leptin concentrations < 14 ng/mL (group 1). Final failure of TT, identified both by reinfarction and absence of early reperfusion as assessed noninvasively, was observed in 11 patients (39%) in group 1 and in 10 patients (77%) in group 2 (p=0.025). Left ventricular ejection fraction was slightly but significantly higher in group 1 than in group 2 (p = 0.031). High plasma leptin concentrations on admission in patients within 6 hours after the onset of acute MI are associated with less TT efficacy. The authors suggest that admission leptin levels may play a role in the management of patients with acute MI. [ABSTRACT FROM AUTHOR]

Background: To evaluate whether postoperative administration of intravenous low-dose amiodarone and magnesium sulfate (MgSO4) combination would reduce the incidence of atrial fibrillation following coronary artery bypass grafting (CABG) in normomagnesemic high-risk patients for postoperative atrial fibrillation (POAF). Methods: A total of 136 patients undergoing elective CABG and had ≥3 risk factors for POAF were prospectively randomized to one of three groups, to receive a single dose of amiodarone (5 mg/kg) and MgSO4 (1.5 g) (combination group, n = 44), or an equal dose of amiodarone (amiadorone group, n = 44) or equal volumes of saline (control group, n = 48) at early postoperative period. Continuous electrocardiographic (ECG) monitorization was performed for first 48 hours and an ECG was recorded every 8 hours later. POAF longer than 30 minutes or for any length requiring treatment, and the drug-related side effects were recorded. Results: The study population showed a homogeneous distribution regarding risk factors for POAF and there was no significant difference in patient characteristics, echocardiographic variables, or operative variables among three groups. POAF developed in 4 patients in combination group, in 16 patients in amiodarone group and in 16 patients in control group, representing a 24% relative risk reduction between the combination group and control group (p = 0.023). No statistically significant difference regarding incidence of POAF was observed between amiodarone and control groups. Conclusions: Combined prophylactic therapy with amiodarone and MgSO4 at the early postoperative period without a maintenance phase is an effective, simple, well-tolerated, and possibly cost-effective regimen to prevent POAF in normomagnesemic, high-risk patients. [ABSTRACT FROM AUTHOR]

Continuous-wave (CW) Doppler recording of mitral regurgitation (MR) is a reflection of the left ventriculoatrial pressure gradient. Accordingly, this jet may yield information about pulmonary artery wedge pressure (PAWP). In this study, we derived and then evaluated a novel method for prediction of PAWP. Patients (n= 80) with moderate to severe MR and left ventricular dysfunction were included in the study. Transthoracic echocardiography was performed in patients during pulmonary artery pressure monitoring. A satisfactory CW Doppler recording of MR was obtained in 63/80 (78%). On the late descending portion of the CW recording, the time from a velocity of 4 m/sec to the end of the jet was defined as t1, and from 3 m/sec to the end of the jet as t2. Mathematical derivation of t1/t2 as a predictor of PAWP, was performed based on Weiss' derivation. If t1/t2 was<1.30, the PAWP was normal. If t1/t2>1.44, the PAWP was>16 mmHg. With this new mathematical derivation, it appears that the downslope of the CW Doppler MR waveform may be able to distinguish a normal from elevated PAWP.(ECHOCARDIOGRAPHY, Volume 21, November 2004) [ABSTRACT FROM AUTHOR]

A 42-year-old woman with Behçet's disease and pericardial effusion for 14 years presented with acute myocardial infarction and received thrombolytic therapy. Coronary angiography showed total occlusion of the left anterior descending artery. Subsequently, the left internal mammary artery was grafted to the left anterior descending artery. Approximately one year after bypass surgery, digital subtraction angiography of the left subclavian artery, performed because of chest and left arm pain, showed total occlusion of the left subclavian artery. Retrograde flow from the left vertebral artery filled the distal portion of the left subclavian artery. In conclusion, patients with Behçet's disease should be investigated closely for involvement of other arteries when one vessel's involvement has been detected. We also recommend that free arterial grafts be used for any coronary surgical intervention, because of the risk of occlusion associated with the vasculitis of Behçet's disease. [ABSTRACT FROM AUTHOR]

Background: Recent evidence has demonstrated that inflammation plays a major role in the initiation and progression of atheroma plaques. C-reactive protein (CRP) is shown to have prognostic significance in acute coronary syndromes. We investigated the influence of CRP levels before thrombolytic therapy on infarct-related artery (IRA) patency and the degree of residual stenosis. Methods: 45 consecutive patients with a first attack of acute myocardial infarction (MI) who underwent streptokinase therapy and subsequently coronary angiography were enrolled into the study. Patients were divided into 2 groups according to the level of CRP on admission. Results: Serum CRP levels were ≥0.5 mg/dL in 26 patients (Group-I) and <0.5 mg/dL in 19 patients (Group-II). The patency of IRA (TIMI-2 and 3) evaluated at 90th minute after the initiation of thrombolytic therapy was similar between the two groups (62% vs. 68%, p>0.05). However, the presence of TIMI-3 flow was significantly lower and TIMI-2 flow was higher in Group-I as compared to Group-II (12% vs. 53%, p=0.003 and 50% vs. 16%, p=0.018 respectively). Additionally, among patients with patent IRA, the degree of residual stenosis was significantly higher in Group-I (80±14% vs. 68±15%, p=0.032). Conclusion: High serum CRP levels on admission in patients within 6 hours after the start of acute ST-segment elevation MI are associated with lower TIMI flow grades and higher residual stenosis of IRA after intravenous streptokinase. Our observations imply that patients with higher CRP levels on admission require closer follow-up during and after acute MI. [Copyright &y& Elsevier]

The purpose of this study was to assess the long-term effects of octreotide therapy on in-stent restenosis at 6-month follow-up coronary angiography and the clinical events after stenting. A randomized, double-blind, placebo-controlled trial was conducted to assess the effects of octreotide on restenosis after stenting. The patients (n = 148) received either subcutaneous octreotide or placebo 1 h before the stenting procedure and then every 8 h for 3 weeks. Percent diameter stenosis was interpreted before and after stenting, and on a 6-month follow-up coronary angiogram by quantitative coronary angiography. The mean percent diameter stenosis of the octreotide group was significantly lower than that of the placebo group on the 6-month follow-up coronary angiograms (18.8% ± 14.2% vs 35.0% ± 19.2%, respectively; P = 0.001). The restenosis rate of the octreotide group was statistically lower than that of the placebo group (11.8% vs 26.4%, respectively; P ≪ 0.05). With regard to major cardiovascular events, there was no significant difference between the octreotide and placebo groups. The administration of octreotide for treatment of in-stent restenosis results in a relatively low long-term angiographic restenosis rate and no significant acute effects on cardiovascular clinical events. [ABSTRACT FROM AUTHOR]

Reports a study which investigated the relationship between noninvasive reperfusion criteria and pulsed tissue Doppler (PTD) parameters in patients receiving thrombolytic therapy after acute myocardial infarction (MI). Role of PTD in the management and follow-up of patients with acute MI; Materials and methods; Results and discussion; Conclusions.

In the presence of multiple concomitant occlusive and aneurysmal diseases, selection of the brain protection method is a primary concern. A case with a disease triad of stenotic lesions in internal carotid arteries, coronary artery atherosclerosis, and an ascending-arcus aorta aneurysm is presented. We simultaneously performed right carotid endarterectomy, coronary artery bypass grafting, and graft replacement of the ascending-arcus aorta. Brain protection was achieved with continuous right brachial artery antegrade selective cerebral perfusion under moderate hypothermia, following carotid endarterectomy. The operative technique is detailed and antegrade selective cerebral perfusion following the carotid endarterectomy for aneurysmal surgery is discussed. [ABSTRACT FROM AUTHOR]

The article focuses on multidetector computed tomographic (MDCT) angiography. A case is presented in which the quality of coronary angiographic images was considered superior than MDCT angiographic images in evaluating the dissection in a patient's right coronary artery. MDCT angiography is described as a noninvasive diagnostic cardiac imaging method that is particularly useful for inspecting the coronary arteries. It is claimed that a MDCT diagnosis of dissection should be confirmed by use of coronary angiography.

In this report we describe a patient with the left circumflex coronary artery originating from the distal right coronary artery as a terminal extension of it. Other origin anomalies related to the circumflex coronary artery may be associated with sudden death and adverse cardiac events, but no data are available about the clinical consequences of this rare anomaly. We also report the clinical follow-up of this patient over a 13-year period, with anomalous circumflex coronary artery arising as a terminal extension of the right coronary artery. [ABSTRACT FROM AUTHOR]