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Iranian Heart Journal - Volume:18 Issue: 2, Summer 2017

Iranian Heart Journal
Volume:18 Issue: 2, Summer 2017

  • تاریخ انتشار: 1396/05/07
  • تعداد عناوین: 8
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  • Mohsen Ziyaeifard_Rasoul Azarfarin_Ali Sadeghpour Tabaee_Hooman Bakhshandeh Abkenar_Mostafa Alavi_Mostafa Fatahi *_Samad E. J Golzari Pages 6-16
    Background
    Conventional ultrafiltration (CUF) and modified ultrafiltration (MUF) are routinely used in pediatric cardiac operations to reduce fluid retention in the body. Further amounts of fluids can usually be retracted through MUF than CUF. The aim of this study was to evaluate the effects of MUF on arterial blood gas in children after cardiopulmonary bypass (CPB).
    Methods
    Forty-two patients that underwent cardiac surgery with CPB were divided into 2 groups of CUF MUF (n=21) and CUF (n=21). Arterial blood gas, chest tube drainage, blood transfusion, and dysrhythmias were assessed before the induction of anesthesia, at the start of CPB, at the end of CPB, at the end of MUF, on intensive care unit admission and 2, 4, 6, 8, 10, 12, 24, and 48 hours after surgery.
    Results
    Our study showed statistically significant differences at the end of MUF between the CUF MUF and CUF groups regarding the levels of hematocrit (P=0.02), PO2 (P
    Conclusions
    The administration of CUF MUF was effectively able to decrease bleeding and reduce transfusion requirement. Additionally, it significantly augmented the parameters of arterial blood gas after surgery. (Iranian Heart Journal 2017; 18(2):6-16)
    Keywords: Cardiopulmonary bypass, Ultrafiltration, Arterial blood gas, Electrolyte
  • Behshad Naghshtabrizi *, Shahram Homayounfar, Manoochehr Karami, Maryam Tazang Pages 17-22
    Background
    The predisposing factors of coronary artery disease (CAD) include hypertension, diabetes mellitus, hyperlipidemia, smoking, and positive family history. Yet, new risk factors that can lead to CAD in early ages have been investigated in recent studies. The present study aimed to evaluate the role of a number of suggested risk factors in the previous studies—including serum levels of homocysteine, fibrinogen, and lipoprotein (a)—in patients suffering early CAD in Iran.
    Methods
    This descriptive cross-sectional study was conducted on 50 patients with the 1st presentation of CAD without any previous treatment. CAD was confirmed by ive coronary angiography, and all the major risk factors were negative. The serum levels of the above-mentioned factors were measured. Then, the data were analyzed using SPSS, version 20. A P value less than 0.05 was considered statistically significant.
    Results
    The study participants comprised 34 males aged 45 years or below and 16 females aged 55 years or below. The mean serum levels of homocysteine, fibrinogen, and lipoprotein (a), which were measured and compared to normal levels, were 13.22 mg/dL (P=0.305), 4.019 g/L (P=0.305), and 2.341 µmol/L (P
    Conclusions
    The findings of this study revealed lipoprotein (a) as an independent risk factor in premature CAD in the Iranian population. However, this was not the case regarding homocysteine and fibrinogen. The acceptance or rejection of this hypothesis requires more extensive studies with larger sample sizes.
    Keywords: Coronary artery disease, Homocysteine, Fibrinogen, Serum Lp(a)
  • Farahnaz Nikdoust, Mehdi Abedini, Abdolhussein Tabatabaei * Pages 23-29
    Background
    Cardiac involvement is common and usually silent in patients with systemic lupus erythematosus (SLE). Echocardiography can be a valuable diagnostic method for the detection of cardiac diseases in such patients. We sought to determine the frequency of the different types of cardiac conditions detected by echocardiography in SLE.
    Methods
    In this analytic cross-sectional study, 50 patients with SLE were consecutively included. The patients underwent transthoracic 2D, color Doppler, and tissue Doppler imaging echocardiography.
    Results
    Left ventricular (LV) systolic dysfunction was diagnosed in 9 (18%) patients and LV diastolic dysfunction was seen in 8 (16%). Tricuspid regurgitation (TR) was the most common valvular disease in that it was diagnosed in 29 (58%) patients, followed by mitral regurgitation (MR), detected in 27 (54%) patients. Six (12%) patients had regional wall motion abnormalities. Pulmonary artery hypertension was seen in 25 (50%) patients.
    Conclusions
    Valvular diseases, especially MR and TR, were common among our patients with SLE. Further, LV systolic and diastolic dysfunction was detected in about one-fifth of the patients. As cardiac involvement was common, we think that future studies should focus on 2 issues: firstly, long-term prognosis of subclinical echocardiographically-detected cardiac diseases and secondly, introduction of screening echocardiography into the routine care of patients with SLE.
    Keywords: Systemic lupus erythematosus, Echocardiography, Tissue Doppler, Myocardial contraction, Mitral regurgitation, Tricuspid regurgitation
  • Mohammad Golitaleb, Faranak Kargar, Farzaneh Gol Aghai, Mehdi Harorani, Ali Jadidi, Homan Bakhshande Abkenar, Mehrdad Haghazali * Pages 30-35
    Background
    Postoperative hyperbilirubinemia is one of the complications of cardiopulmonary bypass. The purpose of this study was to investigate the incidence and nature of postoperative jaundice in patients undergoing cardiac surgery, to analyze the determinants, and to identify the clinical significance of this complication with regard to the associated morbidity and mortality.
    Methods
    This prospective, descriptive study was conducted on 600 patients between 2014 and 2015 in Rajaie Cardiovascular, Medical, and Research Center, Tehran, Iran. Six hundred adult patients candidated for open heart surgery were divided into 3 groups. Group A comprised 200 patients who underwent coronary artery bypass grafting (CABG), Group B 200 patients who underwent aortic valve replacement (AVR) CABG, and Group C 200 patients who underwent mitral valve replacement (MVR) CAB. Aminotransferases (ALT and AST), alkaline phosphatase, and both types of bilirubin (total bilirubin and indirect bilirubin) were determined at admission. Liver function tests were conducted preoperatively, immediately after surgery, and on the 1st, 3rd, and 7th postoperative days. These data were categorized and analyzed. The presence of jaundice was associated with elevated serum bilirubin levels above 3 mg/dL.
    Results
    Hyperbilirubinemia developed in 150 (25%) patients. The incidence of postoperative jaundice was higher in the patients who underwent MVR CABG than in those who underwent CABG and AVR CABG. Hyperbilirubinemia was correlated with prolonged cardiopulmonary bypass time (P
    Conclusions
    Although hyperbilirubinemia seems to be multifactorial, the type of surgery, cardiopulmonary bypass time, aortic cross-clamp time, hypotension during the pump, and number of blood transfusions seem to determine the incidence of jaundice.
    Keywords: Jaundice, Open cardiac surgery, Liver function, Liver enzyme change
  • Farshad Shakerian, Mohammad Ali Sadr-Ameli, Maryam Alsadat Mousavi, Hamid-Reza Sanati, Ata Firouzi, Ali Zahedmehr, Reza Kiani, Mahdyie Doaee, Akbar Nikpajouh * Pages 36-42
    Background
    Diabetes is the cause of 25% of all the cases of coronary artery disease and myocardial infarction (MI). One of the best interventions for coronary artery occlusion treatment is percutaneous coronary intervention (PCI). In PCI, myocardial area size, lesion morphology, cardiac function, renal failure, and other comorbidities are very important. Evaluation of the periprocedural MI prevalence is significant for comparing diabetic and nondiabetic patients.
    Methods
    This cross-sectional study was done in Rajaie Cardiovascular, Medical, and Research Center by convenience sampling in 2009. PCI was performed on 605 patients, comprising 171 diabetic and 434 nondiabetic patients. Our information form included the type of contrast, arterial access, diabetic type, blood glucose control, lab tests, and number of coronary artery lesions. The incidence of postprocedural MI was evaluated by the measurement of CK-MB. The data were then entered into SPSS before they were described and analyzed. The χ2 test and the t-test were employed for data evaluation.
    Results
    The incidence of post procedural MI was 2.9% in the diabetics and 2.5% in the nondiabetics. Moreover, 71.7 % of the patients were diabetic and 28.3% were nondiabetic. The blood glucose level was controlled in 12.6% of the study population, while it was not controlled in 87.4%. The P value for the comparison of periprocedural MI between the diabetic and nondiabetic patients was 0.788. All of the 5 diabetic patients with periprocedural MI belonged to the uncontrolled blood glucose group. The highest frequency of MI was in the patients with 3-vessel PCI (P=0.027).
    Conclusions
    No significant statistical difference was observed regarding postprocedural MI between the diabetic and nondiabetic patients. Preprocedural MI was more frequent in the patients with 3-vessel PCI. PCI is a safe procedure with a low incidence rate of postprocedural MI.
    Keywords: Myocardial infarction, Stent, troponin, Arterial access, Coronary artery disease, Percutaneous coronary intervention
  • Amir Hossein Yazdi, Ehsan Khalilipur *, Ali Zahedmehr, Saeed Amiri Pouya, Maryam Pakrou, Mohammad Ali Ghaznavi, Amir Mikaelvand, Mostafa Rouzitalab Pages 43-49
    Background
    Although primary percutaneous intervention (PCI) is the preferred reperfusion strategy in patients with STEMI, not all patients are good candidates for PCI—mainly because of a delay in requesting medical care and longer 1st medical contact to balloon time. The objective of this study was to compare the efficacy and side effects of 2 known fibrinolytic therapies, streptokinase (SK) and tenecteplase (TNK).
    Methods
    This descriptive, analytic cross-sectional study recruited patients not amenable to primary PCI. a total of 142 patients recruited, 88 patients received SK and the other 54 patients received TNK. Thereafter, the efficacy of the agents, their side effects, territory of the culprit vessel, minor and major bleeding, relation to diabetes mellitus, and mortality in the index hospitalization were compared.
    Results
    Patients who were administered SK showed a 2.09-mm ST elevation after the drug administration as opposed to 1.95 mm in the TNK group (P=0.340). Minor bleeding was reported in 22.7% of the SK group and 24.1% in the TNK group. Major bleeding in the SK and TNK groups was 11.1% and 5.7%, respectively, with no significant difference. In the patients’ index admission, death due to STEMI occurred in 10 (11.4%) patients in the SK group and 8 (14%) patients in the TNK group; the difference did not constitute statistical significance.
    Conclusions
    The results of our study showed that SK and TNK were similar in terms of major complications, mortality rates, and efficacy. Thus, if TNK is not available, SK would be a reasonable choice.
    Keywords: ST elevation MI, Primary PCI, Fibrinolytic therapy, Streptokinase, Tenecteplase
  • Hamid Hoseinikhah, Mohammad Abbasi Teshnisi, Shima Sheybani, Narges Imanirad, Ali Pirzadeh, Aliasghar Moeinipour * Pages 50-52
    We describe a 62-year-old woman, a known case of advanced renal cell carcinoma with the extension of the tumor up to the involvement of the inferior vena cava (IVC) and the right atrium (RA). The patient complained of gross hematuria and peripheral edema. Echocardiography revealed near total occlusion of the IVC with a tumor at the site of the orifice of the RA in addition to a mobile mass in the RA protruding across the tricuspid valve. The patient underwent a successful surgical resection of the tumor at the IVC and RA junction under cardiopulmonary bypass. Patient had uneventful recovery and discharged 1 week later.
    Keywords: Renal cell carcinoma, Cardiac metastasis, Cardiac surgery
  • Mohammad Abbasi Tashnizi, Aliasghar Moeinipour, Nahid Zirak, Atefeh Ghorbanzadeh, Babak Manafi, Mohammad Ali Roohi Golkhatmi, Shima Sheybani * Pages 53-57
    Background
    Although an extremely rare clinical condition, the pseudoaneurysm of a saphenous vein graft the ascending aorta may occur several months following coronary artery bypass graft surgery.
    Methods
    This paper describes a 48-year-old male patient with a history of addiction, who underwent coronary artery bypass graft surgery. The patient was referred to the emergency department 20 days after his surgery with a number of symptoms such as fever, weakness, tachycardia, tachypnea, zero Richmond Agitation Sedation Scale )RASS(, and low hemoglobin level. He was then admitted for a sepsis workup. A combined regimen of ciprofloxacin, vancomycin, and meropenem was prescribed after a positive Pseudomonas aeruginosa blood culture.
    Results
    Computed tomography angiography showed a pseudoaneurysm in the upper and anterior mediastinum. Reoperation was planned for surgical removal, followed by right femoral arterial, venous cannulation and deep hypothermic circulatory arrest (18–20 °C), all of which yielded a favorable outcome.
    Conclusions
    Rapid and accurate diagnosis and surgical correction are life-saving for pseudoaneurysms of the ascending aorta post coronary artery bypass graft surgery.
    Keywords: Coronary artery bypass graft surgery, Pseudoaneurysm of aorta, Saphenous vein graft, Reoperation