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Impact of oxIdatIve stress on coronary
collateral flow
Yıldız A, Gür M, Yılmaz R, Demirbağ R, Erel Ö
Coronary collateral flow is
an important clinical entity with significant impact on the cardiovascular
morbidity and mortality. Oxidative stress leads to increased cardiovascular
risk via oxidation of vital molecules. This study sought to determine the
relationship between the degree of angiographically visible coronary
collateral circulation and serum markers of oxidative stress such as lipid
hydroperoxide (LOOH) and free sulfhydryl groups (-SH).
The study population included 87 patients (mean age=57.9±10.4 years, 58 men)
with angiographically documented total coronary occlusion in one of the
major coronary arteries. Development of collaterals was classified by
Rentrop's method. Patients were defined as having poorly developed
collaterals for Rentrop grades 0 and 1 or well-developed collaterals for
Rentrop grades 2 and 3. LOOH levels were measured by ferrous oxidation with
xylenol orange assay whereas -SH levels were spectrophotometrically measured
by the assay of reduced glutathione production rate.
There were statistically significant differences between well and poorly
developed collateral groups with respect to serum urea (p=0.021), total
cholesterol (p=0.043), LDL cholesterol (p=0.037), LOOH (p=0.014) and -SH
(p=0.001) levels. Serum LOOH (X2=4.614, ß=-0.801, p=0.035), -SH (X2=14.544,
ß=28.412, p=0.001) and urea (X2=5.464, ß=-0.059, p=0.017) levels were
independent predictors of well-developed coronary collateral flow. Serum
LOOH level was inversely correlated with the degree (poorly or well-developed)
of coronary collateral flow (r=-0.228, p=0.0316). Serum -SH level was
correlated with the degree of coronary collateral flow (r=0.392, p=0.0001)
and was inversely correlated with age (r=-0.316, p=0.003) and heart
rate(r=-0.254, p=0.019).
Findings of the present study suggest that serum levels of both -SH and LOOH
are independently associated with the coronary collateral flow development
and reduced serum -SH level and/or increased serum LOOH level might
represent biochemical marker(s) of impaired coronary collateral flow.
ComparatIve estImatIon of anesthesIa varIants and
correctIon therapy In patIents wIth low ejectIon fractIon underwent coronary
surgery
Agzam Z, Arystan S,
Vladimir M, Avşar Ö, Batyraliev T, Vural A.
To compare of
anesthesia techniques in coronary artery grafting patients
with low cardiac output.
High
perioperative lethality after coronary surgery is relevant
in ischemic heart disease patients with low ejection
fraction. To reduce pulmonary arteriospasm and vascular
resistance as the cause of low cardiac output syndrome
during cardiac surgery inhalations of nitric oxide and high
thoracic epidural anesthesia are applied
We
prospectively studied 130 ischemic heart disease patients
underwent myocardium revascularization procedure with
cardiopulmonary bypass. In 60 patients we used general
anesthesia with traditional fluid therapy. In 20 patients we
used combination of general anesthesia and with applying of
L-arginine. In 50 patients we used combination of general
anesthesia and high thoracic epidural anesthesia with
applying of L-arginine. During anesthesia and operation we
studied haemodynamic indices changes.
Applying of
combined high thoracic epidural anesthesia with L-arginine
reduces pulmonary artery resistance up to 32%, peripheral
vascular resistance up to 32,8%. Left ventricle stroke index
increases up to 26,7% before, and up to 32,3% after
cardiopulmonary bypass that decrease rate of low cardiac
output syndrome development up to 3 times and inotropic
agent requirement up to 1,5 times.
Application
of L-arginine and combined high thoracic epidural anesthesia
improves heart function and increases cardiac index and
cardiac output and prevents development of low cardiac
output syndrome during and after coronary surgery with
cardiopulmonary bypass.
Key Words: L-arginine,
Coronary artery grafting, High thoracic epidural anesthesia
The relatIon wIth plasma myeloperoxsIdase enzym
levels between severty of coronary artery dIsease and early prognosIs In
acute myocardIal InfarctIon wIth ST segment elevatIon
Kaya G.M, Yalçın R, Okyay
K, Poyraz F, Bayraktar N, Timurkaynak T, Özdemir M, Cemri M,
Abacı A, Boyacı B, Demirkan D, Çengel A.
In this research, relation of plasma
myeloperoxydase enzyme (MPO) in early stage acute myocardial infarct
patients who have increasing ST to coronary arterial involvement
penetration and in-hospital early stage complications was studied.21
patients with AMI diagnosis and increasing ST (16 male between ages of
36-76, age average 56.6±12.1 years) and 21 healthy
subjects who were similar in terms of risk factors of coronary arterial
illnesses (11) male between ages of 21-72, age average 47.2±11.8) were
accepted to this research. Blood was taken for plasma MPO level from the
patients during the first six hours after the chest pains started.
Patients were divided into two groups according to the MPO level: Normal (Group
1 with 10 patients) and High (Group 2 with 11 patients). Transthoracic
echocardiography was done to all patients during the first 48 hours. 16
out of 21 patients (76.1%) had coronary angiography. Patients were also
observed for early stage complications during in-hospital stage.When
compared to healthy subjects, plasma MPO levels of patients with acute
myocardium infarct were significantly higher (226.5 ng/ml as opposed to
87.2 ng/ml, p=0.015). There was no significant difference from the angles
of age, sex, high blood pressure, diabetes mellitus, hyperlipidemia, smoking
and family history. Furthermore, there was no significant difference in
terms of mortality and morbidity between the two groups.
However, 5 patients, 2
mortality, 3 morbidity, were in group 2 which had high level of plasma MPO
enzyme. There was a significant difference between the two groups in terms
of coronary arterial involvement penetration (p=0.038). Half of the
patients in Group 2 with high level of plasma MPO enzyme values were multi-artery
patients whereas all patients in Group 1 with normal values were single-artery
patients. Penetration in coronary arterial involvement may be more and
atherosclerotic plaque may be more instable in patients with high level of
plasma MPO values. More intensive antiagregant and anti- thrombotic
treatment and early stage coronary angiography may be beneficial in these
patients.
The comparIson of effect and safety of
levosImendan wIth dobutamIne In decompan-sated heart faIlure
Kayançiçek H, Karaca I, Dağlı N,
Yavuzkır M, Özbay Y.
Levosimendan is a
strong calcium sensitiser with inotropic and vasodilatory
effects and have positive effects on symthoms, haemodynamic
parameters and mortality in decompansated heart failure.
Dobutamine is a beta adrenergic agent which shows its
inotropic effect by increasing the intracellular calcium
concentration and this causes arrhytmia and long term
mortality increase. In this study, we aimed to compare the
effectiveness and safety of levosimendan with dobutamine in
decompansated heart failure.
A total of
60 decompansated heart failure patients (30 of them treated
by levosimendan, mean age 67,2±9,8 years, n=19 male, 30 of
them treated by dobutamine, mean age 68,1±9,0 years, n=20
male ) were included to study. Levosimendan was given 6 mcg/kg
loading dose for 10 minutes then 0.1 mcg/kg/min maintanence
infusion for 24 hours. Dobutamine was infused 6 mcg/kg/min
for 48 hours without any loading dose. "New York Heart
Association (NYHA)" functional capacity, echocardiogrphic
assesment of systolic and diastolic parameters, bichemical
markers and adverse events were evaluated in both groups at
the end of the treatment.
Functional
capacity was significantly improved in favour of
levosimendan (p<0,05) [ NYHA class was changed from 3,5±0,5
to 2,3±0,5 in levosimendan group (p<0,05), from 3,4±0,5 to
2,6±0,6 in dobutamine group (p<0,05)]. It was found that
levosimendan had higher effect on systolic parameters than
dobutamine [a 30 % increase in EF in levosimendan group, 17
% in dobutamine group (p<0,05), 38 % and 15 % increase in
cardiac index respectively (p<0,05)]. Both drugs were not
any significant effect on diastolic functions. Adverse
events were lower in levosimendan group. The most commonly
observed adverse events were headache (6.6 %) and
hypotension (13.3 %) in levosimendan group whereas VPS (13.3
%) and tachycardia (13.3 %) in dobutamine group.
We think
that levosimendan is more effective and safer than dobutamin
in decompansated heart failure. And if these findings would
supported by ungoing large scale study, levosimendan will
take large place in decompansated heart failure treatment.
The technIcs of retaIned IntracardIac aIr removal
of early In open cardIac surgery
Demirtürk S.O, Uçar İ.H, Özışık K.
Retained intracardiac
air has hazardous effects for cardiopulmonary bypass.
Removal of intracardiac air during cardiac surgery should be
accomplished in the most effective manner. Transesophageal
echocardiography of the left atrium, left ventricle, and
aorta is a highly sensitive method for detecting retained
intracardiac air bubbles. Routine air
clearing
methods are needle aspiration of the ascending aorta and
left atrial, left ventricular, and aortic aspiration after
careful passive chamber filling. Sensitive techniques for
intracardiac air detection reveals retained air surprisingly
often after cardiopulmonary bypass. There are possible
adverse consequences of this air. Mobilization of the air,
positive chamber filling, stretching of the atrial wall and
ballottement are critical for air removal. Mobilized air
removal, nonsuction venting of the left atrium are very
important and elimination of air must be shown before
cardiopulmonary bypass is terminated.
Key Words: İntracardiac early, Open cardiac surgery
The Importance of glycoproteIn IIb/IIIa
receptor blockers In the treatment of acute coronary syndrome
Tuncer M, Batyraliev T,
Güntekin Ü, Gümrülçüoğlu A.H.
In the pathogenesis of unstable
coronary artery diseases, platelets respond to vascular
injury by adhesion, activation and aggregation, finally
leading to thrombus formation. Many new drugs have been
developed to prevent thrombus formation at different levels
mentioned above with the better understanding physio-pathology
of unstable angina and non- ST-segment elevation acute
myocardial infarction known as acute coranary syndrome, and
ST-segment elevation acute myocardial infarction.
It will be discussed newly developed Glycoprotein IIb/IIIa (GP
IIb/IIIa) receptor blockers that block thrombus formation at
the level of platelets adhesion to collagen.
Coronary veIn arterIalIzatIon: a new gate for
coronary surgery
Grbolar A, Qaradaghi L,
Taşoğlu İ, Yener A.
A 52 years-old male
patient admitted to our clinic with history of dyspnea and
chest pain. On echocardiography ejection fraction was 45%
with global hypokinetic movement. Coronary angiography
revealed 80% stenosis in left anterior descending and
circumflex artery and 95% in the right coronary artery. The
right coronary artery was delicate and not suitable for
bypass. Postoperative follow up complicated demanding
revision operation.
Operation
revealed an akinetic right side of the heart causing failure
weaning from cardiopulmonary bypass machine. We decided to
perform an aorto-right coronary vein bypass with ligation of
vein proximal to anastomosis site which gave the chance of
retrograde feeding of the right system and we succeded.
Key Word:
Coronary artery bypass grafting, Coronary vein
arterialization, Open heart surgery
ThrombocytopenIa
and thrombosIs after the tIrofIban treatment
Güntekin Ü, Batyraliev T,
Tuncer M, Karben Z, Demirbaş Ö, Preobrazhensky D.
Tirofiban, an
glycoprotein (GP) IIb/IIIa inhibitor, is an antiplatelet
agent used in the acute coronary syndromes and
interventional cardiology. Although thrombocytopenia has
been observed with its usage but thrombus formation has not
been reported. Here, we present a case of acute profound
thrombocytopenia and trombus formation secondary to
tirofiban infusion.
