High AST/ALT Ratio Is Associated with Cardiac Involvement in Acute COVID-19 Patients.

Background and Objectives: We aimed to assess the effect of AST/ALT ratio on echocardiographic and cardiac magnetic resonance imaging (CMRI) parameters after COVID-19 patients recover. Materials and Methods: 87 patients with COVID-19 were included in the study. The patients were hospitalized with COVID-19 pneumonia, but the patients did not need intensive care unit follow-up or non-invasive mechanical ventilation support. After a discharge and two weeks following the positive swab test result, patients were considered eligible if they had any symptoms. Transthoracic echocardiography (TTE) was performed within 24 h prior to CMRI. The median value of AST/ALT ratio was found, and the study population was divided into two subgroups based on the median AST/ALT ratio value. The clinical features, blood test, TTE and CMRI results were compared between subgroups. Results: C-reactive protein, D-dimer and fibrinogen were found to be significantly higher in patients with high AST/ALT ratio. LVEF, TAPSE, S', and FAC were significantly lower in patients with high AST/ALT ratio. LV-GLS were significantly lower in patients with high AST/ALT ratio. In CMRI, native T1 mapping signal, native T2 mapping signal and extracellular volume raised significantly in patients with high AST/ALT ratio. Right ventricle stroke volume and right ventricle ejection fraction were significantly lower in patients with high AST/ALT ratio, but right ventricle end systolic volume was significantly higher in patients with high AST/ALT ratio. Conclusion: High AST/ALT ratio is related to impaired right ventricular function parameters with CMRI and echocardiography after recovery from acute COVID-19. Assessment of AST/ALT ratio at hospital admission may be used to assess the risk of cardiac involvement in COVID-19 disease, and these patients may require closer follow-up during and after the course of COVID-19.

Neuroprotective effect of alpha-lipoic acid and methylprednisolone on the spinal cord ischemia/reperfusion injury in rabbits.

OBJECTIVE: The aim of this study is to investigate the putative neuroprotective effect of alpha-lipoic acid (LA) on spinal ischemia/reperfusion (I/R) injury in rabbits. METHODS: Thirty-five adult female New Zeland rabbits, weighing 2,000-3,500 g (mean: 2,800), were divided randomly into five groups of seven rabbits each (n: 7) as Group 1: sham, only laparotomy; Group 2 (I/R): I/R; Group 3 (LA): I/R and 100 mg/kg of LA; Group 4 (MP): I/R and 30 mg/kg of methylprednisolone (MP); and Group 5 (LA + MP): I/R and 100 mg/kg of LA plus 30 mg/kg of MP. RESULTS: A statically significant effect of LA, MP, and LA plus MP on lowering malondialdehyde levels both in the blood and in the cerebrospinal fluid (CSF) has been observed. Nitric oxide is significantly decreased in the blood and spinal cord tissues, and also in the CSF but it is not significant. Superoxide dismutase, catalase, and glutathione levels were increased by LA administration. CONCLUSION: LA exhibits antioxidant efficacy in spinal cord I/R injury, but it cannot decrease the oxidative stress. The histopathological result of the present study also demonstrated that LA has neuroprotective effect in spinal cord injury.

The effect of lidocaine and amiodarone on prevention of ventricular fibrillation in patients undergoing coronary artery bypass grafting.

OBJECTIVE: Ventricular fibrillation is common after aortic declamping in patients undergoing open heart surgery. This situation has a negative impact on morbidity and mortality. The aim of this prospective study was to compare the effect of administering lidocaine versus amiodarone before aortic declamping during elective coronary bypass grafting, paying close attention to when the initial effect of amiodarone sets in. METHODS: In this double blind, prospective, randomized, controlled study, 86 patients who were candidates for elective coronary artery bypass grafting were recruited into three groups: group lidocaine (group L, n=29); group amiodarone (group A, n=27); and group placebo (group P, n=30). Group L patients received 1.5 mg/kg of lidocaine 2 minutes before aortic declamping and group A patients received 300 mg of amiodarone intravenously 15 minutes before release of the aortic cross clamp. The primary endpoints were the incidence of ventricular fibrillation and the number of shocks required to terminate ventricular fibrillation. RESULTS: The frequency of ventricular fibrillation occurrence was significantly higher in group P (70%) when compared with group A (37%) and group L (38%) (P=.017). There was no statistically significant difference between the amiodarone and the lidocaine groups regarding ventricular fibrillation. However, when ventricular fibrillation occurred, the percentage of patients requiring electrical defibrillation was significantly higher in both group L and group P when compared with group A (P=.023). CONCLUSION: We suggest that during coronary arterial bypass surgery, administration of an amiodarone regime before release of the aortic cross clamp, paying particular attention to the start of the initial effect of amiodarone, is no more effective than lidocaine for prevention from arrhythmia; however, amiodarone reduces the need for electrical defibrillation.

Assessment of right ventricular sequelae by speckle tracking echocardiography in recovered COVID-19 patients.

BACKGROUND: TTE is the main modality used to assess RV function, but conventional TTE parameters have limited diagnostic value because they may fail to detect early abnormalities in RV systolic function. Due to its ability to detect subclinical impairment of cardiac function, 2D STE has been widely used to investigate RV function. In this study, we aimed to investigate whether there are sequelae of RV function in recovered COVID-19 patients with pulmonary involvement. METHODS: This is a prospective observational cohort study of 57 healthy volunteers and 54 patients. Participants had no history of chronic illness and no evidence of respiratory or cardiac symptoms. The patients had been hospitalised with COVID-19 with pulmonary involvement but did not require intensive care unit follow-up or non-invasive mechanical ventilation support. TTE was performed. Demographic and clinical characteristics and laboratory test results were collected. RESULTS: LVEF, TAPSE, St and FAC were significantly lower in the patient group. LV-LS 3-chamber, LV-GLS, RV-FWS, RV-GLS were significantly lower in the patient group. CONCLUSIONS: RV-LS and LV-GLS were shown to decrease in the patient group. Although no obvious pathological values were observed in RV parameters on conventional echocardiography, TAPSE, St and FAC values were lower in the patient group.

Cineangiographic intraoperative evaluation of venous grafts during coronary bypass surgery.

BACKGROUND AND OBJECTIVE: Evaluation of graft patency is an important component of coronary bypass surgery. In the present study, intraoperative cineangiography was performed in a cardiovascular hybrid operating room to evaluate anastomosis quality and patency of coronary venous grafts. METHOD: This prospective study evaluated coronary bypass grafts in 34 patients between January 2012 and June 2012. Radiopaque material was administered into the grafts through a vessel cannula before the proximal anastomosis. Then, cineangiographic images were obtained using a mobile C-arm cineangiography system. The myocardial perfusion scintigraphy (MPS) of the patients was compared between preoperative and first month postoperative periods to assess graft function. RESULTS: The localization of the grafts in the target vessel, structural status of the grafts, anastomosis line, and availability of the target vessel were easily evaluated. Angiographic defects were detected in two grafts (3%, n = 60) in two patients (6%, n = 34). Staining was observed in the distal myocardial segments of the saphenous vein grafts following the administration of radiopaque material. The procedure took eight minutes, on average (range, 5-14 minutes), and a mean of 15 mL (range, 10-35 mL) of opaque material was used. None of the patients developed intraoperative myocardial infarction, postoperative complications, or contrast material-induced renal failure. No mortality was observed. The distal myocardial segments of saphenous vein grafts were detected to be perfused 92% normally, 5% reversibly defective, and 3% irreversibly defective with postoperative MPS controls. CONCLUSION: Cineangiographic graft evaluation in a hybrid operating room is a practical, safe, noninvasive, easily available, and easily applicable method.

Dilated sinuses of Valsalva subsequent to type A dissection surgery: Is reoperation inevitable?

Background: This study aims to investigate the dilation of sinus valsalva in patients who underwent aortic repair due to type A aortic dissection and to evaluate its progression. Methods: Between January 2004 and December 2019, a total of 68 patients (50 males, 18 females; mean age: 54.2±10.1 years; range, 30 to 82 years) who underwent root-preserving surgery and followed for at least one year in the outpatient setting were retrospectively analyzed. The patients were divided into two groups according to dilatation during follow-up. Group 1 (n=32) included patients with dilatation and Group 2 (n=36) included patients without dilatation. The sinus of Valsalva diameters were measured using pre- and postoperative computed tomography angiography. Results: The mean follow-up was 4.9±3.1 (range, 1 to 4) years. Sinus of Valsalva dilatation was observed in 47% of the patients during follow-up. Preoperative sinus of Valsalva diameter was a risk factor for aneurysmatic dilatation. A diameter of ≥4.05 cm was calculated as a cut-off value for developing dilatation requiring reoperation. Conclusion: Follow-up using postoperative echocardiography or computed tomography angiography is of utmost importance for the assessment of development of sinus of Valsalva dilatation which requires reoperation in patients without intervention to the aortic root.

Cardiac magnetic resonance T2* mapping in patients with COVID-19 pneumonia is associated with serum ferritin level?

The coronavirus disease of 2019 (COVID-19)-related myocardial injury is an increasingly recognized complication and cardiac magnetic resonance imaging (MRI) has become the most commonly used non-invasive imaging technique for myocardial involvement. This study aims to assess myocardial structure by T2*-mapping which is a non-invasive gold-standard imaging tool for the assessment of cardiac iron deposition in patients with COVID-19 pneumonia without significant cardiac symptoms. Twenty-five patients with COVID-19 pneumonia and 20 healthy subjects were prospectively enrolled.Cardiac volume and function parameters, myocardial native-T1, and T2*-mapping were measured. The association of serum ferritin level and myocardial mapping was analyzed. There was no difference in terms of cardiac volume and function parameters. The T2*-mapping values were lower in patients with COVID-19 compared to controls (35.37 [IQR 31.67-41.20] ms vs. 43.98 [IQR 41.97-46.88] ms; p < 0.0001), while no significant difference was found in terms of native-T1 mapping value(p = 0.701). There was a positive correlation with T2*mapping and native-T1 mapping values (r = 0.522, p = 0.007) and negative correlation with serum ferritin values (r = - 0.653, p = 0.000), while no correlation between cardiac native-T1 mapping and serum ferritin level. Negative correlation between serum ferritin level and T2*-mapping values in COVID-19 patients may provide a non-contrast-enhanced alternative to assess tissue structural changes in patients with COVID-19. T2*-mapping may provide a non-contrast-enhanced alternative to assess tissue alterations in patients with COVID-19. Adding T2*-mapping cardiac MRI in patients with myocardial pathologies would improve the revealing of underlying mechanisms. Further in vivo and ex vivo animal or human studies designed with larger patient cohorts should be planned.

A rare complication: aorta-cutaneous fistula with abundant bleeding.

Pseudoaneurysm and aorto-cutaneous fistula following surgical procedures of the aorta are rare complications with potentially catastrophic results that require rapid diagnosis and urgent surgical treatment. We performed a successful life-saving operation using hypothermic circulatory arrest with femoral artery and vein cannulation. The patient had undergone open heart surgery in our clinic twice, and there was active and abundant bleeding from aorta-cutaneous fistula that occured 5 years after the last surgery.

The association between QT interval changes and the treatment protocols of COVID-19 patients.

OBJECTIVE: This study aimed to investigate the QT, QTc, and QTc dispersion changes that may occur with the use of hydroxychloroquine (HCQ), favipiravir, and moxifloxacin in combination or alone in COVID 19 patients. METHODS: This study was retrospectively conducted on 193 inpatients diagnosed with COVID-19. We divided the patients into four separate groups due to their medications as, group-1: favipiravir, group-2: favipiravir + HCQ, group-3: favipiravir + moxifloxacin, and group-4: favipiravir + moxifloxacin + HCQ. We recorded their pre and post-treatment QT parameters of each group and evaluated the changes of these parameters with the SPSS statistical program. RESULTS: The mean age of the patients was 63.1±17.7. In group 1 and 2, although there were slight changes in QT parameters, these results were not statistically significant. In group 3, significant increases in QT and QTc dispersion occurred (p=0.005 and p=0.018). In the 4th group where the triple therapy was applied, there was a significant increase only in the QTc values (p=0.027). When we compared the changes of QT parameters for each group, a significant difference was found in ΔQTc dispersion, and post hoc analysis showed that it was due to changes in the third group (p=0.047). CONCLUSION: We thought that, if there is a COVID-19 infection with an additional bacterial infection, and if there is a need of using moxifloxacin alone or together with HCQ, additional risk factors that may cause QT interval prolongation should be reviewed and ECG monitoring of the patients should be performed during the treatment period.

Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis: The Multicenter HATTUSHA Study.

BACKGROUND: Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES: This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS: A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS: The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS: Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT.

Investigation of the Effect of Asthma on Mortality and Morbidity After Coronary Artery Bypass Surgery.

OBJECTIVES: No studies have been specifically conducted on asthma patients undergoing cardiac surgery for assessing mortality and morbidity. Distinct effects of cardiac surgery lead to negative effects on respiratory functions, putting patients with existing lung diseases under an increased risk. We aimed to investigate whether asthma patients are under higher risk for mortality and possible complications after coronary artery bypass graft (CABG) surgery than patients without asthma. MATERIALS AND METHODS: The study included patients who underwent elective CABG surgery at our hospital between November 2014 and November 2015. Patients with a history of asthma were verified with physical examination and spirometric measurements by a single. The asthma group was compared with the controls in terms of mortality and morbidities. RESULTS: Asthma patients were extubated later than control patients (p=0.028); however, prolonged intubation (longer than 24 h) frequency was not different (p>0.05). Asthma patients required longer stay in the intensive care unit (ICU) (p=0.003) than controls. The incidence of perioperative asthma exacerbations was significantly lower in patients in whom asthma was previously well-controlled. The incidence of postoperative sibilant rhonchi was lower in patients in whom asthma was under control than in those in whom asthma was partially controlled (p=0.020). CONCLUSION: Asthma is associated with longer ICU stay and asthma-related pulmonary complications after CABG surgery. Preoperative evaluation of asthma patients scheduled for CABG surgery requires consideration of the control status of asthma. Studies with more controls are needed to provide further evidence on the topic.

Advantages of autologous blood transfusion in off-pump coronary artery bypass.

BACKGROUND: In this randomized controlled study, we investigated the effects of autologous Hemobag blood transfusion (AHBT) and allogenic blood transfusion (ABT) in off-pump coronary artery bypass (OPCAB) surgery. METHODS: Sixty patients who underwent surgery between February 2008 and August 2008 were randomized into 2 groups. The AHBT group (n = 30) consisted of patients who received autologous Hemobag blood transfusion, and the ABT group (n = 30) consisted of patients who received allogenic blood transfusion. All patients underwent OPCAB via sternotomy. The time to extubation, chest tube drainage volume, postoperative white blood cell counts, amount of blood transfusion, sedimentation rate, C-reactive protein concentration, postoperative temperature, and the presence of atelectasis were recorded in the intensive care unit. RESULTS: Intraoperative bleeding and fluid resuscitation were similar in the 2 groups (P > .05); however, there were significant decreases in postoperative blood loss, extubation period, postoperative white cell counts, sedimentation rate, incidence of atelectasis, C-reactive protein, and fever in the AHBT group compared with the ABT group (P < .05). The rate of atrial fibrillation in the AHBT group tended to be lower than in the ABT group. CONCLUSION: Autologous blood transfusion in OPCAB may be beneficial in certain cardiac surgery patients; however, these beneficial effects require further study to be proved.

Gastrointestinal ischemia related mortality in patients undergoing off- or on-pump coronary artery bypass grafting.

OBJECTIVE: Gastrointestinal ischemia (GII) after heart surgery is a rare but devastating condition. The aim of this study was to compare the occurrence of GII after coronary artery bypass grafting (CABG) performed off-pump (OPCAB) vs on-pump (ONCAB). METHODS: We retrospectively evaluated 2625 adult patients who underwent isolated coronary artery surgery during a 6-year period. The OPCAB group included 658 patients and the ONCAB group 1967 patients. Patients were evaluated, and GII, morbidity, and mortality in the 2 groups were compared. RESULTS: GII developed in 0.4% (7 of 1967) patients in the ONCAB group and in 0.2% (1 of 658) patients in the OPCAB group (P = .28). Mortality rates due to GII were 0.2% (4 of 1967) in the ONCAB group, and no deaths occurred in the OPCAB group (P < .04). Postoperative atrial fibrillation incidence with GII was 100% (7 of 7) in ONCAB group and 0% (0 of 1) in the OPCAB group (P < .01). CONCLUSIONS: Compared to ONCAB, the OPCAB procedure has lower GII related mortality rates, which is an important cause of morbidity and mortality in the postoperative period of CABG surgery.

Repair of the inferior vena cava with autogenous peritoneo-fascial patch graft following abdominal trauma: a case report.

Abdominal vascular injuries are among the most challenging and lethal injuries in traumatized patients. Inferior vena cava is the most frequently injured vein during the blunt or penetrating trauma. The primary repair, end to end anastomosis, endovascular stenting, or graft interposition with autogenous or synthetic materials should be considered in selected cases. However, in cases the synthetic graft was preferred, intestinal contaminations due to small or large bowel perforation accompanying the trauma have been cited as a limiting factor for the use of such grafts as in the current case. However, a previous history of lower leg variceal surgery prevents the use of great saphenous vein as a graft. So in the present case, the authors report a patient with inferior vena cava injury repaired with autogenous peritoneo-fascial graft. The authors have used APF graft in traumatic inferior vena cava injury for the first time.

Off-pump coronary artery bypass grafting surgery in early stage myocardial infarction treatment.

We evaluated the surgical results of off-pump coronary artery bypass grafting (OPCAB) performed within the first 12 h of infarction in patients with acute myocardial infarction. From January 2005 to January 2007, emergency coronary artery bypass grafting without cardiopulmonary bypass was performed in 56 patients with acute coronary syndromes. The mean age was 62.9 (range, 51-86) years. All patients underwent OPCAB via sternotomy. An average of 2.5 +/- 1.1 grafts per patient were performed. The mortality rate was 7.1% (4 of 56 patients). One patient suffered from postoperative stroke (1.7%), and 3 (5.3%) needed hemofiltration for acute renal failure. Postsurgery elective coronary angiography (n = 21) showed no significant stenosis. These results indicate that emergency OPCAB can be applied to patients with acute myocardial infarction with low morbidity and mortality and excellent early results.

Preoperative prophylaxis can decrease rates of atrial fibrillation in open heart surgery: a retrospective study.

BACKGROUND: We investigated the effects of preoperative administration of beta-blockers on the incidence of atrial fibrillation (AF) after cardiothoracic surgery and the resulting morbidity and mortality. METHODS: We retrospectively evaluated 181 patients who underwent operations between May 2004 and December 2007. We divided the patients into 2 groups according to their preoperative use beta-blockers. Group A (n = 89) consisted of patients who did not receive beta-blockers, and group B (n = 92) consisted of patients who received 50 mg metoprolol succinate daily. All patients underwent on-pump coronary artery bypass grafting (CABG) via sternotomy. RESULTS: Atrial sizes and the baseline clinical and laboratory data were similar for the 2 groups. The 2 groups were also similar with respect to the numbers of grafts per patient, preoperative ejection fractions, cross-clamp times, cardiopulmonary bypass times, and postoperative inotrope use (P > .05). AF occurred in 39 (21.5%) of the 181 patients after the operation. Postoperative AF occurred in 30 (33.7%) of the group A patients and in 9 patients (9.7%) in group B (P < .05). CONCLUSION: Postoperative AF increases the rates of morbidity and mortality and the length of hospital stay after CABG. The prophylactic use of beta-blockers decreases the rate of postoperative AF and thus AF-related complications.

IABP-Related vascular complications: who is responsible--the patient, the surgeon or the sheath? Part I: sheath-related complications.

INTRODUCTION: An intra-aortic balloon pump (IABP) is frequently used as a mechanical support during the treatment of low cardiac output syndrome. The use of a sheath during IABP treatment can be associated with ischaemic complications in the extremities. The aim of our study was to determine the isolated role of sheaths in the development of vascular complications following IABP catheterisation. METHODS: We evaluated a total of 81 patients who had received an IABP for haemodynamic stability, between January 2003 and October 2007, following cardiovascular surgery. To eliminate surgical-related variables, only patients with IABPs and size 8.5 or 9 French catheters (inserted by experienced cardiovascular surgeons using the percutaneous Seldinger technique) were included in the study. To eliminate patient-related variables, patients with a known risk factor for either thrombosis, embolus or peripheral arterial disease were excluded from the study. RESULTS: The patients were divided into two groups: Group 1 (sheathed catheter group; n=42), Group 2 (sheathless catheter group; n=39). Ischaemic complications were observed in a total of five patients. Four of these patients were from Group 1 and one was from Group 2. CONCLUSION: Sheathed catheterisation was found to increase the risk of vascular complications in patients who underwent IABP application. Therefore sheathless catheterisation is recommended for IABP application.

Congenital coronary artery fistula as a cause of angina pectoris.

Coronary arteriovenous fistula is an uncommon anomaly, representing an incidental finding in 0.1% to 0.2% of coronary angiograms. A 46-year-old man presented with a five-month history of palpitation and atypical stabbing chest pain on exertion and/or at rest. The electrocardiogram showed normal sinus rhythm, incomplete right bundle branch block with normal axis, and borderline left atrial abnormality. Echocardiography showed normal left ventricular function, mild left ventricular hypertrophy, moderate left atrial enlargement with mild mitral insufficiency, and moderate right atrial enlargement with mild-moderate tricuspid valve regurgitation. During exercise test, frequent ventricular ectopic beats were noted and the patient complained of atypical chest pain. Scintigraphy showed an ischemic defect in the inferior wall of the left ventricle. On coronary angiography, the right coronary artery and left anterior descending artery were normal, but the circumflex coronary artery was connected to the pulmonary artery through a congenital fistula. The patient refused any further intervention for fistula closure.

Can leg pain be the sole presenting symptom of infective endocarditis? A case report.

Infective endocarditis is a serious septic disease that can be life threatening unless effective therapy is instituted following the correct diagnosis. The complication of septic embolism and mycotic aneurysm in patients with infective endocarditis may increase morbidity and mortality. We present a case of peroneal artery aneurysm with coincident double native heart valve endocarditis in a patient.

An atypically localized atrial myxoma: a case report.

Atypical cardiac myxomas are rare occurrences and may present with a variety of clinical manifestations depending on the location and morphology. A 46-year-old woman had a 4 x 3 x 2-cm myxoma originating from the superior wall of the left atrium, found by echocardiography and multislice tomography. The tumor was successfully treated by surgical excision. The resected tumor was a well-defined encapsulated mass with a narrow-base stalk originating from the right wall of the left atrium in between the right upper and lower pulmonary vein. The patient recovered without complication and was discharged 6 days after the operation. At 1-year follow-up, echocardiography revealed normal cardiac function without reccurence in terms of mass. Although up to 80% of myxomas are localized in the left atrium, of which 75% involve in the interatrial septum, it should not be forgotten that myxomas can appear in an atypical localization, as occurred in our case.