Multidisciplinary Cardiovascular Annals
Volume:9 Issue: 2, Jul 2018

Context: Bradykinin as a principal active agent of kallikrein-kinin can mediate the powerful cardioprotective mechanism. Both the bradykinin and angiotensin converting enzyme inhibitors (ACE-I) can stimulate this protective pathway through the B2 kinin receptors. We performed a systematic review to determine the effects of bradykinin on cardiac biomarkers and outcomes after surgery or coronary intervention. Evidence Acquisition: We searched the PubMed, Cochrane CENTRAL, and Scopus databases up to the end of August 2017. Only randomized controlled trials were included. From a total of 1081 citations, 8 RCTs totaling 268 patients were included for review. Bradykinin could reduce the blood pressure and cause a slight increase in heart rate. But these changes were not significant in comparison to control groups. The major effect of bradykinin or ACE-I on cardiac biomarkers were related to creatine kinase-MB (CKMB). The ST-segment shift wasmuchlower in patients treated with ACE-I as well as the ST-segment peak elevation. The remote ischemic preconditioning (RIPC) stimulus decreased expression of B1 and B2 kinin receptors and this suggested the role of kinins in cardioprotection. ST-segment shift could be reduced by administration of ACE-I before coronary interventions. In patients who were unresponsive to initial preconditioning ischemia, the infusion of intracoronary enalaprilat during the angioplasty could elicit adequate myocardial protection. The effect of bradykinin is dose dependent. Low doses of bradykinin prevent the increased leukocyte adhesion induced by ischemia reperfusion. High doses activate the bradykinin B2 receptors and lead to increase in leukocyte adhesion. The stimulation of kinin receptor pathway causes a reduction in infarct size, troponin T, peak CKMB levels, and edema of the myocardium. Considering the importance of bradykinin and ACE-I in cardiovascular interventions, further RCTs are required to determine the dosage and precise details of functional pathways of these agents.

Mitral stenosis is a common and important type of valvular heart disease. This study was performed to determine and compare the hemodynamic, echocardiographic and clinical data before and after percutaneous transvenous mitral commissurotomy (PTMC). In this prospective cohort, the data for 171 consecutive patients with PTMC at a university referral heart hospital have been collected and analyzed from March 2015 till September 2016. Due to the missing data reported on the medical charts, 20 cases were further dismissed. Therefore, clinical studyonhemodynamicmonitoring and echocardiography have been observed and compared on the remaining 151 consecutive cases. In this study, demographic data, clinical symptoms and medication before the procedure and systolic pulmonary arterial pressure (SPAP), pulmonary capillary wedge pressure (PCWP), trans mitral valve gradient and mitral valve area (MVA) before and after PTMC have been measured. The results showed that according to Wilcoxon test there was a significant increase in PCWP, significant decrease in mean gradient of mitral valve and significant reduction in SPAP after PTMC (P = 0.0001). In this study, post-procedure mitral regurgitation (MR) values after echocardiography and angiography have been compared and it was stated that about 90.4% (138 cases) are diagnosed with mild MR (no MR and mild MR) in angiography while 10.6% (16 cases) have trivial and mild MR in echocardiography (P < 0.0001). Totally it may be concluded that there is significant difference between the hemodynamic and echocardiographic data after PTMC. Echocardiography estimates the MR complications after PTMC to be higher than angiography.

A higher mean platelet volume (MPV) can lead to an increase in platelet activation and thrombosis in coronary artery bypass graft (CABG) patients. Therefore, the goal of this study was to demonstrate the relationship between postoperative hemorrhagic plural effusion (PE) and the MPV in the early postoperative period, after a CABG. This study was conducted between January 2012 and January 2013. The study population was composed of 85 non-PE patients and 71 PE patients based on thecontrol chest X-rays obtained two weeks after the operation. The PE group was compared with the non-PE group statistically in terms of the clinical, laboratory, and postoperative parameters. The number of males (P = 0.033) and MPV (P A higher preoperative MPV was independently associated with a lower hemorrhagic PE incidence in patients with CABG during the early postoperative period. As a simple and widely available blood test value, the MPV can help to predict the development of PE in CABG patients postoperatively

The best way to reduce the occurrence of arrhythmias that generally occur after an open heart surgery is to improve the quality of myocardial protection against reperfusion damage during the cross-clamp time. In this regard, different cardioplegic solutions play a key role. Differences in the types and contents of cardioplegic solutions may lead to different results of effective protection of the myocardium. The purpose of this study was to compare the effects of the newly introduced procaine hydrochloride (PHC) containing cardioplegic solution (Shahid Ghazi Pharmaceutical Co. Tabriz, Iran) and lidocaine (L) in cardioplegic solution on post aortic clamp arrhythmia in coronary artery bypass graft surgery. This study is a randomized clinical trial that was performed in Rajaie cardiovascular, Medical and research center after obtaining permission from the ethics committee. A total of 100 patient candidates for coronary intervention from October 2016 to March 2017 were divided into two groups and randomly assigned one of the two cardioplegic solutions that were only different in the antiarrhythmic solution contents of procaine hydrochloride and lidocaine. After aortic de-clamp during post ischemic time, spontaneous sinus rhythm return, post-operative arrhythmia, and the dosage of lidocaine, magnesium and inotropic drugs, or the use of defibrillator and pacemaker in the operating room or the intensive care unit have been investigated. After aortic de-clamp, in the PHC group, the spontaneous return of heart rate was higher (P value = 0.02, 64% for PHC and 42% for L group). Furthermore, the required dosage for lidocaine and magnesium (P = 0.02) and inotrope (P = 0.04) were also relatively lower, but in general, the percentage of arrhythmia occurred requiring defibrillator and pacemaker after operation between the two groups did not show any significant differences. Clinically, the required cardioplegic solution volumes were slightly higher in PHC group. Although the cardioplegic solution containing procaine hydrochloride is effective in protecting myocardium during non-complex surgeries to spontaneously reverse the heart rhythm, it does not have any significant effects on decreasing arrhythmia after aortic de-clamp and is not preferable to the cardioplegic solution containing lidocaine. Obviously, the definitive result depends on the repetition of the results based on similar clinical studies, with more patients

Although giant cell myocarditis (GCM) is a rare, potentially fatal disease but its true prevalence is likely to be underestimated. GCM can lead to progressive heart failure, fatal ventricular arrhythmia and atrio-ventricular block. The present report describes three cases of biopsy-proven GCM with clinical presentation including arrhythmia and heart failure. All patients were treated with immunosuppressant drugs. Arrhythmia and symptoms of heart failure with immunosuppression had a relative improvement in three patients.

The reported annals incidence of pericardial cysts (PC) in medical literature varies from 1/100000 to 1/120000. They are usually incidentally found during a thoracic or cardiac surgery or by an imaging modality by chance or remain clinically asymptomatic until the 3rd or 4th decades of life. However, in rare cases, compression or rupture of cysts into the surrounding structures, lead to the appearance of symptoms that may further be diagnosed by imaging modalities. We report the case of a 35-year-old man, with presentation of palpitation and chest pain and dyspnea. A transthoracic echocardiography (TTE) and computed tomography (CT scan) confirmed the presence of a cystic lesion the in right lower cardiac border. With the impression of a hydatid cyst, he has undergone open cardiac surgery and during mediastinal exploration a well-defined cyst filled with pasty and thrombotic materials was found intrapericardialy that was attached to the right atrial wall. The cyst with the inflammatory thick wall was enblockly resected. In the histological examination, diagnosis of pericardial cyst was confirmed. The postoperative phase was uneventful and during 6 months of follow-up he was good with no pericardial effusion on TEE

The left atrial appendage (LAA) lies within the confines of the pericardium in close relation to the free wall of the left ventricle. The LAA is long and thin with a narrow base. The LAA is best evaluated by transesophageal echocardiography. Surgeons may ligate the LAA during mitral valve (MV) replacement to remove a potential source of embolism. Unfortunately, a high rate of unsuccessful LAA occlusion has been reported, regardless of the technique employed. A 57 years old woman underwent cardiac surgery (mitral valve, aortic valve and tricuspid valve replacement and LAA closure). In post pump intra-operational transesophagial echocardiography (TEE) we detected a hypoechogenic mass in left atrium. It has no interference with mechanical MV prosthesis and pulmonary veins. Because of its new presentation after cardiac surgery, we suggested that it might be invaginated LAA. After confirmation, this complication was treated by pulling it out. The inversion of LAA is a rare complication. This diagnosis should be considered when a pedunculated mass is encountered in these setting. To prevent this complication, we suggest the use of intraoperative TEE to avoid unnecessary work up and fatal complications.