Correlation between total plasma homocysteine level and grading of coronary artery disease

Elevated total plasma homocysteine [tHcy] levels constitute a risk factor for coronary artery disease [CAD]. A possible relationship was investigated between admission plasma homocysteine level and the angiographic severity and extension of coronary artery disease in patients with CAD. This study looks at the relationship between total plasma homocysteine and severity of coronary artery disease. From April 2006 to December 2006, 100 consecutive patients [65 male and 35 female] that referred to our institute for coronary artery bypass graft surgery enrolled. Fasting blood samples for homocysteine were obtained on admission. Plasma homocysteine concentration was measured with high-performance liquid chromatography [HPLC]. Our patients presented in Group 1, total plasma homocysteine >12 micromoles per liter and Group 2, total plasma homocysteine 60 years was correlated with high tHcy, but gender, hypertension, history of smoking, hypercholesterolemia, family history, and diabetes mellitus were not statistically difference between two groups. A positive correlation was found between abnormal plasma homocysteine level and vessel score [r = 0.35; p=0.002]. Moreover, a positive correlation was also found with extent score [r = 0.46; p =0.002]. As results of these scoring, there was a better correlation between the tHcy level and the extent of CAD when compared with the vessel score [r = 0.68, p < 0.001]. Abnormal elevated homocysteine levels in patients with coronary artery disease correlated with the extent of atherosclerotic disease

Therapeutic effect of transmyocardial laser revascularization [TMLR] in patients with chest pain and normal coronary angiography [cardiac syndrome X]

Patients with syndrome X coronary disease represent a heterogeneous group of patients. Medical treatment with dilators and calcium channel blockers are not very effective. We evaluated the use of transmyocardial laser revascularization [TMLR] in treating 5 patients with this syndrome. Between May 2002 to December 2005, 5 patients with cardiac syndrome X [mean age of 49.7 years] underwent TMLR. All our cases were postmenopausal women. Mean class of Canadian class of angina was 3.4. Patients were none responding to maximum medical treatment. Angiograms showed small coronary arties with a large gap between branches which corresponded with severe ischemic on Thallium scan. We used Co2 laser between 35 to 45 joules of energy and we made 20 to 30 channels on the beating heart controlled by trans-esophagus echocardiography. Our patients were followed for 2.8 years. During follow up our patients remained asymptomatic and without any need medical treatment. Mean of Canadian class of angina after intervention was 1.8. Our patients returned to full activities. TMLR is an effective treatment in patients with syndrome X and coronary insufficiency

[Extra cardiac conduit Fontan procedure in 41 patients]

The Fontan operation is the definitive operation for palliation of complex congenital heart disease with single -ventricle physiology. The use of the extra cardiac conduit has recently been gaining popularity. The purpose of this study was to compare the outcomes of extra cardiac conduit Fontan procedure [off-pump technique] and that of traditional technique [lateral tunnel technique] in which cardiopulmonary bypass is routinely used. Forty one patients in different age groups underwent extra cardiac conduit Fontan procedure between April 2001 and December 2004. Data were collected from ICU sheets, files and during follow up visits. Under general anesthesia and through median sternotomy, using two temporary decompressing shunts, superior vena cava implanted on right pulmonary artery and a conduit interposed between transected inferior vena cava and main pulmonary artery. Fenestration was done in almost all patients and previous shunts were closed if there were any. Of our patients, 13 were female and 28 were male. Mean age of the patients was 11.1 years [SD=7.8].In 24.4% of cases Fontan procedure was done as the first palliative surgery and in 75.6% of them there was previous history of palliative procedures. In 6 patients [14.6%] we were constrained to use cardiopulmonary bypass which was predictable or necessary in 50% of cases. There was no reoperation due to post operative bleeding. Two cases suffered from prolonged plural effusion. Our in-hospital mortality was 9.8%. During 2-24 months follow up, we found two cases who were in NYHA functional class II and one case in functional class I. Extra cardiac conduit Fontan procedure could be used in a safe way. The results of this study were comparable and even in some cases better than that of the traditional technique

[Mediastinitis following coronary artery bypass graft surgery]

Mediastinitis is one of the ominous complications following cardiac surgery and has a higher degree of mortality. The aim of this study is to determine pre, intra and postoperative variables that predispose patients to mediastimitis. In this study, 27 pre, intra and postoperative variables were assessed. 1100 patients underwent coronary artery bypass surgery between June 1998 to 2000 and 35 [3.18%] patients developed mediastinitis [Group 1] who were compared with those who did not develop this complication [Group 2]. Mean age of Group 1 and 2 were 64.6 + 12 and 58.3 +14 years respectively. Group 1 comprised of 26 men and 9 women whereas Group 2 comprised of 788 men and 277 women. There was no meaningful difference as far as smoking, hypercholestremia or hypertension were concerned, however diabetes mellitus, obesity and chronic obstructive pulmonary diseases were much more common in Group 1 [p<0.05]. Majority of the patients in Group 1 compared to Group 2 were in class 3 and 4 based on New York Heart Associations severity of heart failure [p<0.05]. Both left and right internal mammary artery grafts were used in 14.2% of Group 1 and 8.9% of Group 2 patients [p<0.01]. 342% of Group 1 and 7.1% of Group 2 patients underwent re-operation because of hemorrhage. The need for mechanical ventilator for more than 24 hours was observed in 7[20%] and 91[81.5%] of Group 1 and 2 respectively. Multivariate analysis demonstrated that 4 out of the 27 variables had a crucial effect in the development of mediastimitis and these veriables included obesity, severity of heart failure, length of operation time, and re-operation. Postopertive one-month mortality was 14% and 4.6% respectively in Groups 1 and 2.The study documents that obesity, prolonged operative time, severity of heart failure, and reoperation are the most important predisposing factors in mediastinitis following coronary artery bypass graft surgery