RESUMEN
A number of elective coronary artery bypass graft (CABG) surgery patients have impaired underlying left ventricular function (poor ejection fraction). This study was performed to compare the effect of postoperative oral carvedilol versus metoprolol on left ventricular ejection fraction (LVEF) after CABG compared with metoprolol. In a double-blind clinical trial, 60 patients with coronary artery disease, aged 35 to 65 years, who had an ejection fraction of 15% to 35% were included. Either carvedilol or metoprolol was administered the day after CABG. The patients were evaluated by the same cardiologist 14 days before and 2 and 6 months after elective CABG. The results demonstrated better improvements in LVEF in the carvedilol group. No difference regarding postoperative arrhythmias or mortality was detected. The results suggest that carvedilol may exert more of an improved myocardial effect than metoprolol for the low ejection fraction patients undergoing CABG in the early postoperative months.
Asunto(s)
Antagonistas Adrenérgicos beta/farmacología , Carbazoles/farmacología , Puente de Arteria Coronaria , Metoprolol/farmacología , Propanolaminas/farmacología , Volumen Sistólico/efectos de los fármacos , Adulto , Anciano , Carvedilol , Método Doble Ciego , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
A 4-month-old boy was admitted to our hospital following an unsuccessful attempt at interventional repair of aortic coarctation via the right carotid artery, which seemed to have given rise to the formation and growth of a cervical mass overlying the entry site. Despite the initial anticipation of difficulty during intubation due to the pressure effect of the mass, anesthesia progressed uneventfully, the mass, which was a hematoma, was evacuated, and the coarctation was repaired. The patient was discharged after the operation. At three weeks' follow-up, there was no significant lesion in the neck and transthoracic echocardiography demonstrated no residual coarctation.
RESUMEN
QT-interval prolongation has been shown to predict mortality in coronary artery disease and heart failure. To assess the prognostic value of QT interval for death due to low cardiac output after coronary artery bypass grafting, the QT interval was measured in 3 consecutive beats on the preoperative electrocardiogram (leads II and V(4)) in 30 patients who died perioperatively due to heart failure and a control group of 168 randomly matched hospital survivors during the same 3-year period. Mean corrected QT interval was significantly longer in the patients who died compared to the control group (480.7 +/- 96.2 vs. 425.4 +/- 21 ms). Among the variables evaluated, QT prolongation was the only independent predictor of perioperative death. In patients admitted for coronary artery bypass grafting, QT interval measurement is a simple clinical tool that may identify patients with a greater probability of a troublesome operative course.