Effect of sequential coronary artery bypass venous grafting on right ventricular functions assessed by tissue Doppler echocardiography.

BACKGROUND: Coronary artery bypass graft surgery is a well-known and proven method of treatment for coronary artery disease. A modification of this method is complete revascularisation of the right ventricle by sequential bypass grafting of the right coronary artery, the effects of which on ventricular function need to be clarified. We sought to determine the effect of the sequential bypass graft method on right ventricular (RV) function utilising tissue Doppler echocardiography. METHODS: A total of 35 coronary artery disease patients (group A: 20 sequential grafts; group B: 15 individual grafts) were enrolled. Patients were examined pre-operatively with tissue Doppler echocardiography for RV function, and again postoperatively after the first month. RESULTS: Pre-operatively, there were no significant differences with regard to demographics or basal echocardiographic findings. On the other hand, postoperative right ventricular diastolic function was found to have improved significantly as the right ventricular E wave and E/A increased (9.5 ± 1.6 vs 7.6 ± 2.7 cm/s, p = 0.009 and 1.4 ± 0.2 vs 0.9 ± 0.2, p ≤ 0.01, respectively), while the A wave and isovolumic relaxation times (6.8 ± 2.1 vs 8.3 ± 3.4 cm/s, p < 0.03 and 55.2 ± 11.9 vs 87.2 ± 16.2 ms, p < 0.001, respectively) decreased. Although the S-wave peak amplitude decreased in group A patients, it did not reach statistical significance. CONCLUSIONS: Sequential, but not single, complete revascularisation of the right coronary artery appeared to improve the diastolic function of the right ventricle.

Type I plasminogen activator inhibitor 4G allele frequency is associated with chronic venous insufficiency.

Chronic venous insufficiency (CVI) is a common disease associated with poor quality of life. Genetic polymorphisms causing coagulation abnormalities may account for some of the CVI pathogenesis. Type I plasminogen activator inhibitor (PAI-1) is responsible for fibrinolytic system regulation, and plasma levels of PAI-1 are strongly correlated with PAI-1 4G/5G gene polymorphism. The association between PAI-1 4G/5G gene polymorphism and CVI was investigated. In 34 consecutive patients with clinically overt CVI, the PAI-1 4G/4G polymorphism was detected in three cases (8.8%); the 4G/5G polymorphism was detected in 28 (82.4%). In 34 age- and sex-matched controls, the PAI-1 4G/4G polymorphism was detected in one case (2.9%) and the 4G/5G polymorphism was detected in 14 cases (41.2%). The PAI-1 4G allele was found significantly more frequently in CVI patients than in controls. The 4G allele was associated with a 3.25-fold increase in CVI risk. Thus, a relationship between CVI and the PAI-1 4G allele is apparent.

Vascular graft infection by Staphylococcus aureus: efficacy of linezolid, teicoplanin and vancomycin systemic prophylaxis protocols in a rat model.

OBJECTIVE: We investigated experimentally the in vivo prophylactic efficacies of linezolid, teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA). MATERIALS AND METHODS: Dacron grafts (1 cm(2)) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 x 10(7) colony-forming units (CFU)/ml. Ten of these rats constituted the contaminated, untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III), teicoplanin (group IV) and vancomycin (group V), respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated. RESULTS: The bacterial count decreased in the rats from the groups treated with linezolid, teicoplanin and vancomycin. The linezolid and teicoplanin groups, however, showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated, untreated group, as expected. CONCLUSIONS: Single-dose linezolid, teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin.

Reduced P-selectin in hearts pretreated with fluvastatin: a novel benefit for patients undergoing open heart surgery.

OBJECTIVE: P-selectin is an adhesion molecule that plays a role in the pathogenesis of atherosclerosis. The aim of this study was to assess whether or not the treatment with fluvastatin for 3 weeks preoperatively would reduce the levels of circulating P-selectin in patients with coronary heart disease undergoing coronary artery bypass grafting surgery (CABG). MATERIALS AND METHODS: Forty-six patients referred to CABG operation were included in the study. The patients were randomized into two groups (1:1): one treated with fluvastatin (80 mg/day, fluvastatin group, n = 23), and the other one treated with placebo (placebo group, n = 23) for three weeks before surgery. All patients underwent CABG using CPB. Blood samples were collected at baseline (the day before surgery), before and after aortic cross-clamping (ACC), at postoperative 0 h (the end of surgical intervention), and at 4, 12, and 24 hours postoperatively. Concentrations of soluble P-selectin (sP-selectin) were analyzed. RESULTS: The sP-selectin values measured in the fluvastatin group were significantly lower than the values measured in the placebo group. There was less use of intraoperative inotropic agents in the fluvastatin group ( P < 0.015) and the difference in the length of ICU and hospital stay showed a significantly shorter stay for the fluvastatin group. CONCLUSIONS: Pretreatment with fluvastatin seemed to reduce P-selectin levels compared to patients given placebo, and hence, we think that pretreatment with a statin, fluvastatin in our study, might reduce the perioperative cardiac injury caused by cardiopulmonary bypass-induced inflammatory changes. We believe that routine preoperative use of fluvastatin should be carefully considered.

Vascular Graft Infection by Staphylococcus Aureus : Efficacy of Linezolid; Teicoplanin and Vancomycin Systemic Prophylaxis Protocols in a Rat Model : Cardiovascular Topics

Objective : We investigated experimentally the in vivo prophylactic efficacies of linezolid; teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA). Materials and methods : Dacron grafts (1 cm2) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 x 107 colony-forming units (CFU) / ml. Ten of these rats constituted the contaminated; untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III); teicoplanin (group IV) and vancomycin (group V); respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated. Results : The bacterial count decreased in the rats from the groups treated with linezolid; teicoplanin and vancomycin. The linezolid and teicoplanin groups; however; showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated; untreated group; as expected. Conclusions : Single-dose linezolid; teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin

Vasorelaxant effect of opioid analgesics on the isolated human radial artery.

BACKGROUND AND OBJECTIVE: Arterial grafts are prone to vasospasm. Opioid analgesics are commonly used in the perioperative course of cardiac surgical procedures. Therefore, we investigated the direct effects of morphine, meperidine, fentanyl and remifentanil on the human radial artery. METHODS: Radial artery segments, obtained from 20 patients, were precontracted with phenylephrine. Using the organ bath technique, the endothelium-independent vasodilatation was tested in vitro by addition of cumulative concentrations of morphine, meperidine, fentanyl and remifentanil in separate organ baths, in the presence or absence of naloxone. Indomethacin and NG-nitro-L-arginine methyl ester was added to all organ bath in order to determine the effects of prostaglandins and nitric oxide, respectively. RESULTS: Morphine (10(-8) - 10(-4) mol L-1), meperidine (10(-10) - 10(-6) mol L-1), fentanyl (10(-10) - 10(-6) mol L-1) and remifentanil (10(-8) - 10(-4) mol L-1) caused a concentration-dependent vasorelaxation in the human being artery rings. The relaxations in the presence of naloxane did not change. The maximal relaxant effects of meperidine and fentanyl were significantly greater than those of morphine and remifentanil (P < 0.05). CONCLUSIONS: These findings indicate that morphine, meperidine, fentanyl and remifentanil produce concentration-dependent and endothelium-independent relaxations in human being radial artery rings. Meperidine and fentanyl are more potent relaxant agents than morphine and remifentanil in the human being radial artery in vitro.

Sialic acid is a marker of lung injury following lower extremities ischemia/reperfusion.

OBJECTIVE: This study tests whether sialic acid is a mediator of the lung injury following lower extremity ischemia/reperfusion (I/R). Design. Prospective randomised study. MATERIALS AND METHODS: Thirty-one Sprague-Dawley rats were randomised into four groups: group 1, aorta was exposed but not clamped; group 2, aorta clamped for 3 h, followed by 1 h of reperfusion; group 3, 50 mg/kg pentoxifylline administrated before the aorta was clamped; and group 4, 1 mg/kg dexametasone administrated before the aorta was clamped. Serial arterial blood samples for blood gas, tumor necrosis factor-alpha (TNF-alpha), and total SA (TSA) assay were obtained. The lungs were removed and histologically examined for evidence of injury. RESULTS: Groups 2, 3, and 4 had significantly higher peak serum TSA concentrations compared with groups 1 (group 1 vs. 2, p=0.001; group 1 vs. 3, p=0.002; group 1 vs. 4, p=0.001). Group 3 had lower peak serum TSA concentration. Groups 2 and 4 had significantly higher peak serum TNF-alpha concentrations (p=0.0001) compared with groups 1 and 3. Group 3 had lower peak serum TNF-alpha concentration. Lower TSA and TNF-alpha levels are associated with lesser degrees of lung injury. CONCLUSIONS: TSA and TNF appear during events that lead to lung injury following lower extremity I/R.

Stab wound of the cervical spinal cord and ipsilateral vertebral artery injury.

Stab wound of the cervical spinal cord with ipsilateral vertebral artery injury is rare. We report a case of a penetrating injury by scissors to the cervical spinal cord and right vertebral artery. The management is discussed and literature reviewed.

Sialic acid is an indicator of inflammation due to cardiopulmonary bypass but not myocardial damage.

BACKGROUND: The aim of the present study was to investigate whether serum sialic acid is associated with the inflammatory response of cardiopulmonary bypass (CPB) or not, since cardiopulmonary bypass is known to produce a systemic inflammatory syndrome. METHODS: In 20 patients in whom elective coronary bypass grafting was done, arterial and coronary sinus blood sampling was done simultaneously. The timing of samplings was 8-10 min after the institution of CPB, just before the application of aortic clamping (T1) and 2 min after cross clamp removal (T2), when there was coronary circulation, but no myocardial activation. RESULTS: Sialic acid, CK-MB, lactate levels were significantly higher at T2 than those at T1 for both arterial and coronary sinus samples. Increase at T2 time point for SA, CK-MB and lactic acid at coronary sinus were closely correlated with the systemic increase of these substances also. Actually, increase of systemic and coronary sinus CK-MB levels was also correlated with the duration of aortic cross-clamping and cardiopulmonary bypass. Probably due to consumption, a negative correlation with the decrease of fibrinogen at coronary sinus was found with the duration of aortic cross-clamping. CONCLUSIONS: Our study showed a strong and consistent association between serum SA concentration and the inflammatory process. There are previous reports that show sialic acid levels associated with ischemic insult to myocardium. We are able to show that serum TSA correlates well with some of the acute phase proteins but this was not true with ischemic markers after cardioplegic arrest.

Pericardial flap aortopexy: an easy and safe technique in the treatment of tracheomalacia.

A 5-month-old boy who had been operated for esophageal atresia and tracheoesophageal fistula was presented with recurrent life-threatening apneic spells, expiratory stridor and difficulty in feeding. Diagnosis of tracheomalacia was confirmed by bronchoscopy and pericardial flap aortopexy was performed. Pericardial flap aortopexy is a relatively simple procedure with minimal risk to the aorta. Minimal dissection is required and there are no sutures placed in the aortic wall, thus avoiding the risk of tears.

Lung mass due to amniotic fluid embolism--an intrathoracic complication of pregnancy.

A 29-year-old woman with right chest pain was admitted for radiographic investigation and found to have a round mass in the right lower zone. This was initially suspected to be a hydatid lung cyst but was confirmed as a cystic mass by computed tomography and duly excised. Histologic examination revealed an amniotic fluid embolism. The patient had had a stillbirth three months earlier.