Effect of oral anticoagulant therapy on coagulation activity and inflammatory markers in patients with atrial fibrillation undergoing ablation: a randomized comparison between dabigatran and warfarin

Atrial fibrillation [AF] is associated with inflammatory and hypercoagulability state. Previous studies evaluated the safety and efficacy of dabigatran and warfarin in prevention of thrombothic complications. This study was intended to assess the influence of these drugs on hemostatic and inflammatory markers among patient underwent pulmonary vein ablation. A total of 100 patients with AF who underwent catheter ablation were randomized to treatment with dabigatran [D] 110 mg twice daily or warfarin [W] adjusted to an * international normalized ratio [INR] of 2.0 to 3.0 for 3 months after ablation procedure. C - reactive protein [CRP], D-dimer, prothrombin fragment Fl + 2 [Fl +2], were measured at baseline before ablation procedures, after 30 days and after 90 days of treatment. After 3 months, the D-dimer was 164.9 +/- 48.9 in Dabigatran and 197.2 +/- 58.6 in warfarin group, Fl + 2 was 0.4 +/- 0.2 in dabigatran and 0.8 +/- 0.2 in warfarin group and CRP level was 1.8 +/- 1.6 in Dabigatran and 5.1 +/- 5 in warfarin group. [All p-values < 0.05] The results showed that treatment with dabigatran made greater changes in the serum level of CRP, D-dimer, Fl + 2. The pattern of changes in serum CRP levels D-dimer, Fl + 2 is much faster and with a greater slope in the dabigatran group

Intracoronary adenosine to prevent myonecrosis in patients with stable angina undergoing percutaneous interventions: a double-blinded randomized controlled trial

Significant elevation of cardiac biomarkers after percutaneous coronary intervention [PCI] is associated with increased mortality. However, clinical importance of lesser degrees of cardiac enzyme elevation has not been well understood. Multiple factors might have an etiologic role, and the incidence of myonecrosis has not changed dramatically despite pharmacological and technological advances in PCI. The aim of this study was to evaluate the role of intracoronary [1C] Adenosine in preventing the elevation of cardiac enzymes as a marker of myonecrosis after PCI in patients with chronic stable angina. Two hundred sixty patients with chronic stable angina who were candidates for PCI were randomly assigned to double-blinded pretreatment with 1C Adenosine or placebo before crossing of the guide wire. The patients were observed during the hospital course, and blood samples were obtained in standard intervals after the intervention for cardiac biomarkers. The primary end point of this study was post-PCI myonecrosis, and secondary end point was safety of 1C Adenosine administration in the setting of PCI in patients with chronic stable angina. Of the 260 patients, who were initially randomized, finally 83 patients were analyzed in the placebo and 96 in the Adenosine arms. The study patients were comparable in clinical and angio graphic characteristics. The mean of the patients age was 57.3 years [range = 35 to 79 years], and 77.5% were male. There were no differences in the mean serum cardiac biomarkers between the study groups [mean creatine kinase-MB [CK.MB] level of 29.5 +/- 14.5 IU/L in the placebo group and 31.5 +/- 18.5 IU/L in the control group; p value = 0.41; mean cardiac troponin I [cTnI] level of 0. 097 _0.178 microg/L in the placebo group and 0.167 +/- 0.5 microg/L in the control group; p value = 0.24]. Despite promising results in primary PCI, our study showed that a strategy of 1C Adenosine pretreatment is not beneficial in reducing post-PCI myonecrosis in patients with chronic stable angina and should not be routinely used

Risk factors of reperfusion failure following primary angioplasty for ST-segment elevation myocardial infarction [STEMI]

Although percutaneous coronary intervention [PCI] improves outcomes compared to thrombolysis, a substantial number of ST-elevation myocardial infarction [STEMI] patients do not achieve optimal myocardial reperfusion. This study was designed to evaluate factors related to suboptimal myocardial reperfusion after primary PCI in patients with STEMI. Totally, 155 patients [124 men; mean age = 56.6 +/- 11.03 years, range = 31- 85 years] with STEMI undergoing primary PCI were retrospectively studied. Additionally, the relationships between the occurrence of reperfusion failure and variables such as age, sex, cardiac risk factors, family history, Body Mass Index, time of symptom onset, ejection fraction, previous PCI, coronary artery bypass graft surgery or previous myocardial infarction, and angiographic data were analyzed. Procedural success was 97.1% and complete ST resolution occurred in 43.2%. Age; cardiac risk factors; family history; body mass index; previous MI, coronary artery bypass graft surgery, or PCI; and use of thrombectomy device and GP2b/3a inhibitor were not the determining factors [p value > 0.05]. According to our multivariate analysis, time of symptom onset [OR [95% CI]: 045 [0.2 to 0.98]; p value = 0.044] and ejection fraction [OR [95% CI]:0.37 [0.26 to .091]; p value = 0.050] had reverse and male gender had direct significant associations with failed reperfusion [OR [95% CI]: 0.34 [0.11 to 1.08]; p value = 0.068]. More degrees of ST resolution occurred when the right coronary artery was the culprit vessel [p value = 0.001]. The presence of more than three cardiac risk factors was associated with failed reperfusion [p value = 0.050]. Considering the initial risk profile of patients with acute STEMI, including time of symptom onset and ejection fraction, as well as the accumulation of cardiac risk factors in a given patient, we could predict failed myocardial reperfusion to design a more aggressive therapeutic strategy

Noninvasive localization of accessory pathways in patients with Wolff-Parkinson-White syndrome: a strain imaging study

Noninvasive techniques for the localization of the accessory pathways [APs] might help guide mapping procedures and ablation techniques. We sought to examine the diagnostic accuracy of strain imaging for the localization of the APs in Wolff-Parkinson-White syndrome. We prospectively studied 25 patients [mean age = 32 +/- 17 years, 58.3% men] with evidence of pre-excitation on electrocardiography [ECG]. Electromechanical interval was defined as the time difference between the onset of delta wave and the onset of regional myocardial contraction. Time differences between the onset of delta wave [delta] and the onset of regional myocardial contraction [delta-So], peak systolic motion [delta-Sm], regional strain [delta-epsilon], peak strain [delta-epsilonp], and peak strain rate [delta-SRp] were measured. There was a significant difference between time to onset of delta wave to onset of peak systolic motion [mean +/- SD] in the AP location [A] and normal segments [B] versus that in the normal volunteers [C] [A: [57.08 +/- 23.88 msec] vs. B: [75.20 +/- 14.75] vs. C: [72.9 0 +/- 11.16]; p value [A vs. B] = 0.004 and p value [A vs. C] = 0.18] and [A: [49.17 +/- 35.79] vs. B: [67.60 +/- 14.51] vs. C: [67.40 +/- 6.06 msec]; p value [A vs. B] < 0.001 and p value [A vs. C] = 0.12, respectively]. Our study showed that strain imaging parameters [[delta-So] and [delta-Strain]] are superior to the ECG in the localization of the APs [84% vs. 76%]

[Incidence rate of pressure sores after cardiac surgery during hospitalization and its relevant factors]

This study was conducted to assess incidence rate sores after cardiac surgery during hospitalization and its relevant factors, also discussed differences between sore and burn as a result of unstandard connections of electrocautery system in operating room. Surgical patients because of risk factors that exist in operating room, have more potential to develop pressure sore than general acut patients. Pressure sores and burn may both occur in the intraoperative environments and are often difficult for personnel to differentiate upon postoperative inspection. This descriptive cross-sectional study was conducted on 333 patients in 6 month, who were operated in Shaheed Rajaei Cardiovascular Medical and Research Center. Samples were selected Unrandomly. Demographic information, pre-intra-post operation [ICU and surgical ward] were collected by questionnaire.Data were analyzed using software SPSS 15 and descriptive statistical tests. Incidence rate of pressure sores after cardiac surgery was 21.3%.71 patients were involved with pressure sores, 67 cases in ICU and 4 cases after admission in ward.68[95.7%]were first degree and 3[4.2%]were second degree. This Shows meaning relationship with, sex, hypertension, myocardial infarction, intraoperative Hypoxemia ,Using mattress postoperatively, inotropic drugs, blood pressure<80mmhg,reoperation,decreased hematocrit and albumin, hospitalization and duration of staying in ward. More skin damage were seen after operation in ICU immediately or in the first 24 hours. It is worthful to control comorbidities before, during and after operation. Incidence of pressure sores can be minimized by providing enough perfusion during operation, using silicon mattress on bed of operating room, using mattress and changing position especially during stay in ICU, also paying attention to nutritional states and other known factors in study. Electrocautery system of operating rooms must always and periodically be checked, also taking care of probably bums to prevent from converting into pressure sores is very important

Development and validation of the first Iranian questionnaire to assess quality of life in patients with heart failure: IHF-QoL

In its Constitution of 1948, WHO defined health as "a state of complete physical, mental, and social well-being, and not merely the absence of disease and infirmity". In 1994, the Agency for Health Care Policy and Research published clinical practice guidelines recommending providers to routinely evaluate patients' HRQoL [Health Related Quality of Life] and use their assessment to modify and guide patient care. To create a valid, sensitive, disease-specific Persian health status quality of life questionnaire for patients with chronic heart failure in Iran. Considering the existing relevant inventories and scientific literature, the authors designed the first draft of questionnaire which was modified and validated, using expert opinions and finalized in a session of expert panel. The questionnaire was processed among 130 patients with heart failure. Construct validity evaluated by principle component factor analysis, and promax method was used for factor rotation. MacNew quality of life questionnaire was selected to assess convergence validity, and the agreements were measured in 60 patients. Discriminant validity was also assessed. Thirty patients were followed for 3 months and responsiveness of questionnaire was measured. Cronbach's alpha, item analysis, and Intra-class correlation coefficients [ICCs] were used to investigate reliability of questionnaire. SPSS 15 for Windows was applied for statistical analysis. Principle component factor analysis revealed 4 main components. Sub-group analysis suggested that IHF-QoL questionnaire demonstrated an acceptable discriminant validity. High conformity between this inventory and MacNew questionnaire revealed an appropriate convergence validity. Cronbach's alpha [alpha] for the overall questionnaire was equal to 0.922. Intra-class correlation coeffcients [ICCs] for all components were significant [from. 708 to. 883; all P values < 0.001]. Patients fallow-up revealed an acceptable responsiveness of our questionnaire. IHF-QoL questionnaire is a valid and reliable inventory. It can be applied in daily clinical practice and in the clinical research context

Intraoperative magnesium sulfate can reduce narcotic requirement after coronary bypass surgery

Narcotics are the most common drugs used after cardiac surgery and their side effects, including respiratory depression, hemodynamic instability, nausea and vomiting, and itching are dose dependent. Magnesium is both an N Methyl D Aspartate [NMDA]-receptor and a calcium-receptor antagonist and can modify the important mechanisms of nociception. The purpose of this study was to investigate the effect of magnesium sulfate on the pain score and reducing narcotic requirement in coronary artery bypass grafting surgery [CABG] patients. This randomized, double blinded, placebo-controlled trial recruited 185 patients [105 male and 80 female] undergoing elective CABG. Mean age was 58 +/- 11 years [range 24 to 79 years]. The patients were divided into two groups randomly: Group I received magnesium sulfate as an IV infusion [80 mg/kg] during a one-hour period post induction and Group 2 received the same volume of normal saline as a placebo. During the postoperative period, the patients' morphine requirement and pain score [visual analogue seale scaled as 0 to 10, 0=no pain and 10= worst possible pain] at 6[th], 12[th], 18[th], and 24[th] hours were recorded and documented. There were no significant differences between the two groups with respect to the baseline data. In the magnesium sulfate group, only 30 [32%] patients needed morphine sulfate, whereas 75 [83%] patients in the placebo group required some doses of morphine sulfate [p value < 0.001]. The odds ratio showed that magnesium sulfate could strongly prevent the need for opioid analgesics for pain control. The intraoperative use of magnesium sulfate can reduce the need for opioids post CABG

Incidence and predictors of cardiac markers elevation after coronary intervention

This study evaluated the incidence and predictors of CK-MB and troponin elevation after successful coronary intervention. CK-MB and troponin elevation after coronary intervention correlate with late cardiac events and survival. [1, 2, 19, 24] We investigated the incidence and predictors of CK-MB and troponin elevation in patients who underwent percutaneous coronary intervention in Rajaie Cardiovascular, Medical and Research Center. CK-MB and troponin elevation was detectable in 203 [70%] patients. Predictors of cardiac enzyme elevation were hyperlipidemia, functional class, and smoking. There were no in-hospital adverse events in the CK-MB and troponin elevation group. Cardiac enzyme elevation after coronary intervention was detected in 70% of all our patients and was more common in diffuse atherosclerosis hyperlipidemia, smoking, and high functional class. Enzyme elevation was observed even in the absence of discernible procedural complications, and early discharge of patients with CK-MB and troponin elevation is safe. Midterm survival of patients with CK-MB and or troponin elevation was similar to those with normal enzymes

Balloon angioplasty versus surgical repair of coarctation of aorta in infants

Coarctation of the aorta is a discrete stenosis of the proximal thoracic aorta. The common clinical pattern is congestive heart failure in infancy. Treatment methods include balloon angioplasty and surgical repair in this age group. Percutaneous balloon angioplasty is a less invasive method for the repair of discrete coarctation but remains controversial as a primary treatment strategy for a native coarctation. This study aimed to compare the effectiveness and outcome of balloon angioplasty and surgical repair in coarctation infants younger than 1 year old. This retrospective study evaluated the results of the two methods in 167 patients younger than one year old admitted into a tertiary heart center pediatric ward with the diagnosis of coarctation of the aorta: Balloon angioplasty was done for 55 and surgical repair for 112 infants. Patients with previous interventions were not included in this study. Primary results revealed no significant difference in the effectiveness of the two methods [p value = 0.0601]. While the rate of recurrent coarctation was significantly lower in the surgery group [19 [17%] vs. 11 [20%], p value = 0.0470], the mortality rate was lower in the balloon angioplasty method [5 [5.5%] vs. 13 [11.6%], p value = 0.039]. Our multivariate logistic regression model, however, showed no statistically significant difference [p value = 0.120]. Because of the incidence of re-coarctation, balloon angioplasty compared with surgical repair did not confer an improved outcome for our infants' coarctation

Percutaneous mitral balloon valvotomy; single center experience: a review of outcome

Percutaneous balloon mitral valvotomy [BMV] has been accepted as an alternative to surgical mitral commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Despite the worldwide use of the BMV technique, no studies have been hitherto designed to assess the outcome of the patients undergoing BMV in Iran. The present study reports the outcome of 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center during a 15-year time period. A total of 2531 patients underwent 3138 BMV procedures at Shaheed Rajaei Cardiovascular, Medical and Research Center between 1992 and 2006. Seventy-three percent [2278] of the cases were followed for 48 +/- 41 months. Recurrent stenosis in 802 [25.8%], mitral valve replacement [MVR] in 213 [6.9%], immediate good result in 3110 [99.1%], and successful outcome in 2000 [72.9%] cases were the outcome of the BMV procedures in the current study. Concordant to the similar studies, we concluded that BMV produces a good clinical outcome in a high percentage of patients. The recent study demonstrated that the successful outcome of BMV was multi factorial and the selection of patients with rheumatic mitral stenosis is recommended to be based on both anatomic and clinical characteristics of the individuals. The procedure-related variables must also be considered in order to predict the outcome

Echocardiographic assessment of adults with repaired tetralogy of fallot: a cardiovascular magnetic resonance comparison study

Surgical management of the tetralogy of Fallot [TOP] results in anatomic and functional abnormalities in the majority of patients. Right ventricular [RV] dilation from pulmonary regurgitation [PR], residual atrial and/or ventricular septal defect, tricuspid regurgitation, right ventricular outflow tract [RVOT] aneurysm, and pulmonary artery peripheral stenosis are some of the abnormalities frequently encountered in patients with repaired TOP. Cardiovascular magnetic resonance [CMR] can provide assessments of anatomical connections, biventricular function, flow measurement, and more, without ionizing radiation. Echocardiography is the most frequently used modality for the initial assessment and follow-up of most patients with CHD. We sought to evaluate adult patients with repaired TOP by transthoracic echocardiography and compare them with CMR. 156 patients [52 women, mean age= 23 +/- 5.5 years] late after TOP repair with severe PR were evaluated. Ventricular size and function and TOP -associated anomalies such as patent ductus arteriosus [PDA], peripheral pulmonary stenosis [PPS], and persistent left superior vena cava [LSVC] were evaluated by transthoracic echocardiography and CMR separately. Mean of LV ejection fraction by CMR was 52 +/- 9% and by echocardiography was 47 +/- 5.1%. We found a significant correlation between LVEF assessed by CMR and 2D visual assessment in multiple views. Mean of RVEF by CMR was 37 +/- 8% and RV end diastolic volume index was 161 +/- 57.3 mm[3]. Linear correlation between CMR-RVEF and RVEF measured by echocardiography was weak. There was almost perfect agreement between CMR and echocardiography for the diagnosis of LSVC [99.2%]. Agreement was 88.3% in the diagnosis of PDA, 66.4% in the diagnosis of PPS, and 93% in the diagnosis of the right aortic arch was. Adults late after repaired TOF have significantly reduced biventricular systolic function. Despite abnormal LV geometry, visual assessment of LV systolic function by an expert echocardiologist has an acceptable agreement compared to the quantitative measurement of LV systolic function by CMR. However, the correlation between CMR-RVEF and RVEF measured by echocardiography is weak. We found incremental diagnostic value of CMR in PPS and PDA. Atrial septal defect and ventricular septal defect are found more frequently by echocardiography

Physician-related factors affecting cardiac rehabilitation referral

Despite the positive impact of cardiac rehabilitation [CR] on quality of life and mortality, the majority of people who could benefit from this program fail to participate in it. The lack of referral from the physician is a common reason that patients give for not seeking CR. The objective of this study was to compare factors affecting CR referral by cardiologists. A cross-sectional survey of 122 cardiologists, including 89 general cardiac specialists and 33 fellows in cardiology from 11 major cardiology training centers in Iran, was done in 2010. They responded to the 14- item investigatorgenerated survey, examining the physician's attitudinal and knowledge factors affecting CR referral. 47.9% of the subjects reported having available CR centers but only 6.6% reported continuous medical education on the topic. 90.7% of the physicians reported that less than 15% of patients are referred to CR centers. The main factor affecting the low referral rate was limited general knowledge about CR programs [79.5%] such as program attributes and benefits, methods of reimbursement. Lack of insurance coverage, unavailability of CR centers in the community and low physicians' fee were other factors reported by the physicians. Cardiologists' inadequate general knowledge of and attitude toward CR programs seem to be a potential threat for cardiac prevention and rehabilitation in some societies

Growth status of Iranian children with hemodynamically important congenital heart disease

The relationship between congenital heart disease [CHD] and growth retardation is well documented. We investigated the growth condition of Iranian children with several types of congenital heart disease [CHD] and compared it with worldwide researches. Growth condition was investigated in 469 patients with important CHD aged from 1 month to 18 years. The patients were divided into two groups; infants [aged 12 months or less], and children [1-18 yrs of age]. Children with hemodynamically unimportant small VSDs or small ASDs were not studied. Other exclusion criteria were prematurity, known genetic disorders and neurologic disease affecting growth. All patients' cardiac diagnoses were made on the basis of clinical and laboratory examinations; including electrocardiography, echocardiography, cardiac catheterization, and angiography. Body weight and height of all patients were measured using conventional methods and compared with standard growth charts. In all patients body weights and heights were significantly lower than normal population. This difference was greater in the weight of female children. Other risk factors for growth failure were large left-to-right intracardiac shunts, pulmonary hypertension and cyanosis. Iranian children with CHD have growth failure somewhat different from other countries. Lower body weights of cyanotic patients and female children indicated that these patients need more nutritional and psychosocial attention

Comparison of the clinical efficacy of Bovine thrombin and compression method in femoral pseudoneurysm of parients undergoing percutaneous coronary intervention

Pseudoaneurysm has been an increasingly common complication of catheterization procedures during the past two decades, with the greatest incidence being in the femoral artery. Treatment of iatrogenic femoral artery pseudoaneurysm with the injection of thrombin is reported to be an efficacious and safe procedure. In this study, we evaluated the efficacy and success rate of percutaneous ultrasonographically-guided thrombin injection and compression method for the treatment of pseudoaneurysm and for studying of the effect of thrombin injection on systemic coagulation parameters. This cohort clinical trial was conducted on patients with femoral pseudoaneurysm after percutaneous intervention [PCI] in Shaheed Rajaie Cardiovascular Medical and Research Center. The patients were divided into two randomized groups and treated with either the compression method or the percutaneous ultrasonographically-guided thrombin injection method. Pseudoaneurysm size, pseudoaneurysm neck size, thrombin dose, thrombosis time, outcome of therapy, and complications were documented prospectively. Duplex sonographic follow-up examinations were performed at 0 and 24 hours afterwards. Partial thrombin time as well as the Quick test [prothrombin time] was monitored before and after the intervention. Thirty patients between 15 and 85 years of age with femoral pseudoaneurysm following catheterization were enrolled in this study. The average length and width of the pseudoaneurysms were respectively 2.45 +/- 1.15 cm and 2.06 +/- 1.07 cm. In total, 13 thrombin injections were administered. The mean thrombin dose was 500-2000 IU. The success rate of thrombin injection was %92.30 [12 of 13 patients], which was significantly higher than that of compression 82.35% [13 of 17 patients] [p value<0.05]. No thromboembolic, infectious, or allergic complications occurred. In this study, the percutaneous ultrasonographically-guided thrombin injection method was successful and safe in the management of femoral pseudoaneurysms. Changes in coagulating factors indicated the possibility of thrombin passage into the arterial circulation.

Is the peak-to-mean pressure gradient ratio useful for assessment of aortic valve prosthesis obstruction?

The evaluation of prosthetic valves is very difficult with two-dimensional transthoracic echocardiography alone. Doppler and color flow imaging as well as transesophageal echocardiography are more reliable to detect prosthetic valve dysfunction. However, Doppler study sometimes tends to be misleading due to the load-depending characteristics of peak and mean pressure gradients. The peak-to-mean pressure decrease ratio is a load-independent measure, which was previously used for the detecting and grading of aortic valve stenosis. We assessed the usefulness of this method for the evaluation of aortic valve prosthesis obstruction. One hundred fifty-four patients with aortic valve prostheses were included in this study. Transthoracic and transesophageal echocardiographic examinations were performed in all the patients. Peak velocity and velocity time integral of the aortic valve and left ventricular outflow tract, peak and mean aortic valve pressure gradients, peak-to-mean pressure gradient ratio, and time velocity integral [TVI] index were measured. There was a significant relation between the TVI index [p value<0.001] and aortic prosthesis obstruction. A TVI index<0.2 had a sensitivity of 71% and specificity of 100% for the detection of aortic valve prosthesis obstruction. However, no significant relation was found between the peak-to-mean pressure ratio and aortic valve prosthesis obstruction [p value=0.09]. Although the peak-to-mean pressure gradient [PG/MG] ratio is a simple, quick, and load-independent method which may be useful for the grading of aortic valve stenosis, it is poorly associated with aortic valve prosthesis obstruction. The TVI index is a useful measure for the detection of aortic prosthesis obstruction

Thromboelastography analysis after autologous transfusion in patients undergoing coronary artery bypass surgery

Acute normovolemic hemodilution [ANH] includes the removal of blood from a patient either immediately before or shortly after the induction of anesthesia and the simultaneous replacement with an appropriate volume of plasma substitute to maintain normovolemia. Thromboelastography [TEG] is a non-invasive diagnostic approach designed to monitor and analyze the coagulability state of a blood sample in order to assist clinical assessment of the haemostatic condition of the patient. The aim of this study was to use the ANH technique in patients requiring coronary artery bypass graft [CABG] surgery and to confirm the advantages of the ANH technique along with TEG. A controlled randomized clinical trial was conducted in 130 patients [32 females mean age 57 +/- 9.0 years, range 38 to 79 years] who were scheduled for CABG surgery with cardiopulmonary bypass [CPB]. They were equally divided into two equal-sized ANH and control groups [n=65]. Patients in group A underwent ANH with an average of 500 ml whole blood removal after the inducting of anesthesia and their removed blood was replaced with crystalloid solution; blood was not removed in the subjects of the control group. Serum levels of hemoglobin and platelets, TEG parameters analysis, homodynamic changes before and after the operation, and the amount of blood transfused during surgery and in the ICU were checked in both groups. Statistical analysis was performed using repeated measures ANOVA models. After the surgery, there were significant decreases in hemoglobin and platelets levels [p < 0.005], but the decrease was less in the ANH group. However, no difference was found in the amount of platelets decrease between the two groups. Changes in TEG parameters - K, ANGLE, EPL and CI- in the ANH group were statistically significant before and after the surgery [all p-values < 0.05]. Also, there were significant differences in Ma, EPL, and CI parameters between the ANH and control groups [all p-values < 0.05]. Use of ANH in patient undergoing CABG surgery results in greater preservation of coagulation factors and platelets that may reduce the amount of bleeding

Evaluation of the relation between anterior mitral valve leaflet motion based on height-to-length ratio and the immediate outcome of percutaneous balloon mitral valvuloplasty

The purpose of this study was to investigate whether there is any relation between mitral leaflet motion based on height-to-length ratio of the anterior mitral valve leaflet doming in diastole and the immediate outcome of balloon mitral valvuloplasty,. The study population consisted of 49 patients [47 women, mean age: 43.7 +/- 13.35 years] with symptomatic rheumatic mitral stenosis who underwent balloon valvuloplasty. Complete transthoracic and transesophageal studies were performed in all the patients before valvuloplasty, and transthoracic study was repeated 24-48 hours after valvuloplasty. The severity of the restriction of the mitral valve leaflet motion was classified based on the heightto- length ratio of the anterior mitral valve leaflet doming. Mitral valve thickness, calcification, subvalvular thickening, and mobility were scored according to the Wilkins system. Optimal immediate outcome of balloon mitral valvuloplasty was defined as a valve area improvement of 50% or more or a final mitral valve area of >/= 1.5 cm[2] and mitral regurgitation Sellers' grade >/= 2. There was a significant relation between the total mitral valve score and its thickness with the optimal immediate post-balloon mitral valvuloplasty results [p value=0.03 and 0.04, respectively], but no relation was found between the Wilkins score and its components with the anterior mitral valve leaflet height-to-length ratio. There was no significant relationship between the amount of increase in the mitral valve area, decrease in trans-mitral pressure gradients, decrease in pulmonary artery pressure, and anterior mitral leaflet height-to-length ratio [all p values>0.05; all the correlation coefficients<0.2]. Our study showed that post-balloon mitral valvuloplasty results are mainly affected by valve thickness and the total Wilkins score. In addition, the severity of mitral leaflet motion restriction in terms of the height-to-length ratio of the anterior mitral valve leaflet has no significant relation with the immediate result of balloon mitral valvuloplasty

Prognostic value of serum B-Type natriuretic peptide in early mortality and morbidity of children with congenital heart disease after open heart surgery

Brain type natriuretic peptide [BNP] is a cardiac hormone that is secreted mainly by the ventricles in response to volume expansion and pressure load. It can predict post-operative complications after heart surgery in adults. We sought to investigate the prognostic value of BNP in children after heart surgery. We measured the BNP serum levels in 96 children with congenital heart diseases before, immediately after, and 12 hours after open heart surgery. We studied the ability of the post-operative BNP serum level variations to predict mortality and morbidity in children. In total, 96 patients, comprising 40 [41.7%] females and 56 [58.3%] males with a mean age of 4.1 years [range: 1 month to 17 years], with various congenital heart diseases were studied. The rise in the serum BNP level 12 hours post surgery was directly related to mortality before discharge from hospital [P value=0.004], congestive heart failure after surgery [P value<0.001], patients' cyanosis [P value=0.045], duration of ICU stay [r=0.342, P value=0.004], and post-operative need for inotropic drugs [P value<0.001]. The rise in the BNP serum level 12 hours after heart surgery is a good marker for predicting mortality, morbidity, and early diagnosis of heart failure in children