Prevention of adriamycin induced heart failure by an increase in endogenous adenosine production.

Adenosine (Ado) triggers several protective mechanisms that may attenuate development of heart failure, both locally and systemically. We developed a procedure allowing sustained increase in endogenous Ado production by the combined application of Ado metabolism inhibitors and nucleotide precursors. We found that our procedure attenuate the development of heart failure induced by adriamycin.

Aortic valve replacement and perioperative management in hemodialyzed patient wth antiphospholipid syndrome.

Antiphospholipid syndrome is characterized by the presence of antiphospholipid antibodies, hypercoagulability, and prolonged phospholipid-dependent coagulation indices such as activated clotting time (ACT). Perioperative thrombotic complications are frequent among patients with antiphospholipid syndrome submitted to cardiac surgery, therefore, in these patients, heparin-protamine titration for anticoagulation monitoring is particularly recommended. We demonstrate a case of 42-year-old hemodialyzed patient with antiphospholipid syndrome, submitted to the replacement of stenotic aortic valve. In our patient celite ACT and heparin concentration during cardiopulmonary bypass did not correspond to each other. Anticoagulation based on heparin concentration assessment resulted in safe perioperative hemostatic management.

IL-8 concentration in coronary sinus blood during early coronary reperfusion after ischemic arrest.

OBJECTIVE: Activation of the inflammatory response is an important factor contributing to complications of cardiopulmonary bypass. Increased level of proinflammatory cytokine - IL-8 has been reported during coronary artery bypass grafting (CABG) operations with the use of cardiopulmonary bypass. The aim of this study was to find out whether the heart is the main source of IL-8 during early coronary reperfusion. METHODS: IL-8 concentration in coronary sinus before clamping and 5, 10, and 15 min after declamping of the aorta as well as in radial artery blood before clamping and 10 min after declamping of the aorta, was assessed in 30 patients undergoing CABG surgery. RESULTS: We observed increase in IL-8 concentration in coronary sinus blood after declamping of the aorta, however no difference between coronary sinus and arterial blood concentration was noted. The median value of IL-8 concentration in coronary sinus blood was 1.85 pg/ml before ischemia and 15.4, 20.3, and 29.3 pg/ml in 5, 10 and 15 min after aortic declamping, respectively. Our additional finding was that there was a negative correlation between IL-8 level and hemoglobin saturation with oxygen in coronary sinus blood 10 min after coronary reperfusion. CONCLUSIONS: We conclude that the heart is not the main source of IL-8 in early coronary reperfusion, although coronary reperfusion induces its release.

Influence of L-carnitine and its derivatives on myocardial metabolism and function in ischemic heart disease and during cardiopulmonary bypass.

Carnitine and its derivatives have recently been shown to protect cardiac metabolism and function in ischemic heart disease and other clinical conditions of myocardial ischemia. Potential mechanisms of this effect include an increase in glucose metabolism, a reduction of toxic effects of long-chain acyl-CoA and acyl-carnitine in myocytes, an increase in coronary blood flow and anti-arrhythmic effect. It has also been shown that propionyl-L-carnitine which penetrates faster than carnitine into myocytes is effective in inhibiting production of free radicals. Beneficial effects of carnitine supplementation have been demonstrated under a variety of clinical conditions such as acute cardiac ischemia, during extracorporeal circulation, in carnitine-dependent cardiomyopathy as well as in patients with chronic circulatory failure and in cardiogenic shock. However, further studies are required before carnitine administration could be recommended as a routine procedure in ischemic heart disease or before cardiopulmonary bypass.

Atrial fibrillation after coronary artery bypass grafting: does the type of procedure influence the early postoperative incidence?

OBJECTIVE: Atrial fibrillation (AF), the common postoperative complication, has been observed after coronary artery bypass grafting (CABG) in 7--40% of patients. Cardiopulmonary bypass (CPB), eliminated in off-pump operations (OPCABG) may decrease the incidence of AF, whereas the combination of CABG with heart valve replacement may result in more frequent postoperative atrial fibrillation. The aim of our study was to compare the early postoperative AF incidence rate during ICU stay in three groups of patients: after CABG, OPCABG, and CABG combined with valve replacement. MATERIAL AND METHODS: A prospective study of 906 consecutive patients was carried out between January 1999 and January 2000. Clinical profile of 906 patients, including factors having potential influence on postoperative AF did not showed any significant differences between the groups. The presence of arrhythmia history was the reason of excluding 85 patients from the statistical analysis. The observation was performed in each case during ICU-stay, using a HP system for continuous automated arrhythmia analysis. Early postoperative incidence of AF was recorded and compared between three groups of patients: 650 after conventional CABG, 118 after OPCABG, and 53 after CABG combined with valve replacement. Chi-square and a Mann--Whitney tests, Statistica 5.0 PL were used for the statistical analysis. RESULTS: Atrial fibrillation occurred during the postoperative ICU stay in 9.8% of patients after CABG, in 10.2% after OPCABG, and in 21% after CABG combined with valve replacement. There was no significant difference between CABG and OPCABG groups (P=0.965). The confidence interval of the odds ratio ranges from 0.5 to 1.85. Consequently, an increased risk would be possible for both methods. We observed a statistically significant increase of the early postoperative atrial fibrillation incidence rate in patients after CABG combined with valve replacement, when compared with both CABG + OPCABG groups (P=0.005). CONCLUSIONS: (1) Atrial fibrillation is a common postoperative complication after myocardial revascularization procedures which prolongs ICU stay. (2) The study did not show that the incidence of postoperative AF is influenced by the technique of coronary artery bypass grafting: with or without CPB. (3) The prevalence of postoperative AF increase when CABG is combined with valve replacement.

Stroke in young adults and children.

Data from studies of 337 children and 1606 young adults are summarized to identify the major causes of stroke in these age groups. In children under 15 years of age, stroke occurs in patients with congenital heart disease, nonatherosclerotic vasculopathies, infection, and hematologic defects like sickle cell disease. In patients 15 to 35 years of age, dissection, cardioembolism, nonatheroslerotic vasculopathies, and prothrombotic states cause a significant percentage of strokes. In adults over 35 years of age, traditional atherosclerotic risk factors predominate. Lifestyle choices (e.g., cigarette smoking, alcohol consumption, and illicit drug use) can significantly increase the rate of stroke among young adults in a community. Limited access to healthcare may increase the role of infectious disease and peripartum complications.

Atrial fibrillation after coronary artery bypass grafting without cardiopulmonary bypass.

OBJECTIVE: Atrial fibrillation is the most common complication after heart surgery. It rarely has a fatal outcome but causes patient instability, prolongs hospital stay, or even is the reason for perioperative infarction. Although conventional coronary artery bypass grafting (CABG) with cardiopulmonary bypass has excellent short-term and long-term results, the number of coronary operations on a beating heart without cardiopulmonary bypass is still growing. To reduce surgical trauma, off-pump coronary artery bypass grafting via sternotomy (OPCABG) or minimally invasive direct vision coronary artery bypass grafting (MIDCABG) via small thoracotomy are performed. The aim of this study was to estimate the frequency of atrial fibrillation in patients after myocardial revascularization without cardiopulmonary bypass. METHODS: A retrospective analysis of 48 patients undergoing myocardial revascularization without cardiopulmonary bypass was performed. Twenty-four patients underwent OPCABG and 24 were operated using the MIDCABG technique. The incidence of cardiac arrhythmias was analyzed since operation to the fourth postoperative day. Each patient had continuous ECG monitoring with option of arrhythmia analysis during ICU stay. After discharge from ICU 24-h ECG monitor studies were carried out. Surface 12-lead ECG was accomplished once a day, and additionally each time symptoms of cardiac arrhythmia occurred. Risk factors of atrial fibrillation were estimated. RESULTS: Atrial fibrillation occurred in 25% of patients after MIDCABG, in 29% after OPCABG, and in 18% after CABG with cardiopulmonary bypass. This difference has no statistical significance. Risk factors and incidence of postoperative complications were comparable in all groups. CONCLUSIONS: Atrial fibrillation is a common complication after procedures of myocardial revascularization, performed with or without cardiopulmonary bypass. The occurrence is not dependent on the type of operation.

Thermographic assessment of stellate ganglion block effectiveness during cardiosurgical procedures.

UNLABELLED: The study present thermographic assessment of the effectiveness of temporary stellate blockade performed during cardiosurgical procedures. The assumption behind this method was the increase in the temperature of upper extremity on the side of blockade, due to the broadening of arterial bed. MATERIAL AND METHOD: The study was conducted on a group of 30 patients (21 men and 9 women) operated due to coronary disease involving three vessels. Mean age of the patients was 53 years. After introduction of anaesthesia blockade were performed with 2 ml 2% lignocainum and 8 ml 0.5% bupivacaine solution using peratracheal approach. Blockade effectiveness was assessed on the basis of images obtained in thermovisual camera, comparing the temperatures of upper extremity before and within 15 minutes after performing the blockade. Free blood outflow from radial artery, its diameter and length were also evaluated. The results obtained were subject to statistical analysis. RESULTS: Twenty-three patients (76.6%) displayed the increase in the temperature of upper extremity by 1-3 degrees C. Free blood outflow from radial artery was greater in this group than in the remaining patients. CONCLUSIONS: Thermography is a useful method for the assessment of stellate blockade effectiveness. Effective blockade results in the increased blood flow in radial artery.

Administration of clemastine--H1 histamine receptor blocker in the prevention of haemodynamic disorders after protamine sulfate administration in patients subjected to coronary artery bypass grafting in extracorporeal circulation.

INTRODUCTION: Adverse effects of protamine administration after CPB: fall in arterial blood pressure and pulmonary hypertension are still a source of problems. CPB and protamine administration are both accompanied by increased histamine levels in blood. The aim of this study was to examine if clemastine can accelerate the normalisation of arterial blood pressure during the protamine administration after CPB during CABG operations. MATERIAL AND METHODS: Fifty three patients subjected to CABG operations were studied. Control group (n = 27) did not receive clemastine, Clemastine group (n = 26) received 2 mg i.v. clemastine, before CPB. After CPB were completed, patients were given protamine (heparin to protamine ratio--1:1.5) within 7 minutes, through peripheral vein. Changes in arterial blood pressure from the beginning of protamine administration to 2.5, 5, 7.5, 10, 15, and 30 minutes thereafter, as well as heart rate, CVP, doses of inotropic drugs and vasodilators were compared between the groups. RESULTS: No difference in heart rate, CVP, doses of inotropic drugs and vasodilators between the group was noted. An increase in arterial blood pressure 5, 7.5, 10, and 15 minutes after the beginning of the protamine administration were greater in clemastine group than in control group. Groups were comparable with regard to surgical procedures and doses of anaesthetic drugs. It is now known that protamine exerts a negative effect on cardiac contractility either through a decrease in coronary perfusion pressure (vasodilatation), or through a direct toxic effect on cardiac muscle. The administration of clemastine before CPB can reduce peripheral vasodilatation and capillary leak related to histamine release during CPB. In the clemastine group, faster increase in arterial blood pressure toward a physiologic range was observed. We conclude that administration of clemastine is connected with the normalization of ABP during and after protamine reversal of heparin coagulation during CABG operations.

Induction of myocardial insulin-like growth factor-I gene expression in left ventricular hypertrophy.

BACKGROUND: Left ventricular hypertrophy is a generalized adaptation to increased afterload, but the growth factors mediating this response have not been identified. To explore whether the hypertrophic response was associated with changes in local insulin-like growth factor-I (IGF-I) gene regulation, we examined the induction of the cardiac IGF-I gene in three models of systolic hypertension and resultant hypertrophy. METHODS AND RESULTS: The model systems were suprarenal aortic constriction, uninephrectomized spontaneously hypertensive rats (SHR), and uninephrectomized, deoxycorticosterone-treated, saline-fed rats (DOCA salt). Systolic blood pressure reached hypertensive levels at 3 to 4 weeks in all three systems. A differential increase in ventricular weight to body weight (hypertrophy) occurred at 3 weeks in the SHR and aortic constriction models and at 4 weeks in the DOCA salt model. Ventricular IGF-I mRNA was detected by solution hybridization/RNase protection assay. IGF-I mRNA levels increased in all three systems coincident with the onset of hypertension and the development of ventricular hypertrophy. Maximum induction was 10-fold over control at 5 weeks in the aortic constriction model, 8-fold at 3 weeks in the SHR, and 6-fold at 6 weeks in the DOCA salt model. IGF-I mRNA levels returned to control values by the end of the experimental period despite continued hypertension and hypertrophy in all three systems. In contrast, ventricular c-myc mRNA content increased twofold to threefold at 1 week and returned to control levels by 2 weeks. Ventricular IGF-I receptor mRNA levels were unchanged over the time course studied. The increased ventricular IGF-I mRNA content was reflected in an increased ventricular IGF-I protein content, as determined both by radioimmunoassay and immunofluorescence histochemistry. CONCLUSIONS: We conclude that (1) hypertension induces significant increases in cardiac IGF-I mRNA and protein that occur coordinately with its onset and early in the development of hypertrophy, (2) IGF-I mRNA levels normalize as the hypertrophic response is established, (3) in comparison to IGF-I, both c-myc and IGF-I receptor genes are differentially controlled in experimental hypertension. These findings suggest that IGF-I may participate in initiating ventricular hypertrophy in response to altered loading conditions. The consistency of these findings in models of high-, moderate-, and low-renin hypertension suggests that they occur independently of the systemic renin-angiotensin endocrine axis.