Warfarin Resistance, a case report

In tolerance to oral anticoagulant drugs may arise as an inborn genetic defect resulting in insensitive hepatic receptor sites to oral anticoagulants or it may be due to one of several acquired causes such as noningestion or malabsorption of the drugs, simultaneous ingestion of barbiturates or the inadvertent consumption of foods with a high vitamin K content. It is an uncommon phenomenon and the genetic defect is usually not recognized until the need for oral anticoagulation arises. We report here a case of resistance to Warfarin in the hope that an awareness of this phenomenon may turn up similar case of study

Single stage aortic valve replacement and splenectomy in a patient with severe aortic stenosis

Splenomegaly-induced thrombocytopenia is fully described in hematological and surgical literature, but its association with severe aortic stenosis is rare. We present a case of severe aortic valve stenosis with severe splenomegaly-induced thrombocytopenia in which aortic valve replacement was done with a number 23 homograft and splenectomy was performed after the end of cardiopulmonary bypass. Platelet count turned to normal value post-operatively, and the patient spent an ordinary convalescence period and was discharged from the hospital without any complications

role of transesophagesl echocardiography in diagnosis and treatment in a series of patients with chronic thromboembolic pulmonary hypertension

We describe 6 cases of chronic thromboembolic pulmonary hypertension, who underwent pulmonary thromboendarterectomy in our center. Transthoracic and transesophageal echocardiography provided valuable data on surgical accessibility of thrombus, its extension, chronicity and hemodunamic conse1uances on right ventricular transesophageal echocardiography as a rapid, bedside and easily available method has been a useful guide for diagnosis and guiding the treatment for these patients

One years clinical out come after coronary artery bypass graft with and without cardiopulmonary bypass

It is estimated that cardiopulmonary disorders eslkjpecially coronary artery disease are the leading causes of mortality in world and Iran. The arteriosclerotic process in the coronary arteries, as in other blood vessels, consists of focal intimal accumulation of lipids, complex carbohydrates, blood and blood products, fibrous tissue, and calcium deposits associated with changes in the media, that causes unstable angina and myocardial infarction. Treatment of these patients is medical therapy and coronary artery bypass grafts surgery [CABGs] with or without cardiopulmonary bypass [CPB]. The aim of this research is stu4ing One Years Clinical Out come after Coronary Artery Bypass. This research is cross sectional and case control trial study. It was performed in Shahid Madani hospital in Tabriz - Iran during the year 2006-2007. The patients who had CABGs with or without CPB were studied. The information was collected by filling a questionnaire and was analyzed by the t-test and chi-square program. In this study 196patients had CABG without CPB [group I] and 133 with CPB [group 11]. Number of grafts in group I 2.49 +/- 0.04 and 2.73 +/- 0.04 in group II. The rate of complications in 2 groups was not significant, EF is improved in group I, and use of Introps and IABP was less than in group II. In group I hospitalization [lCU, hospital] was less than in comparison with group II. According to results CABG without CPB is a safe method According to results out comes of this stu4 is comparable with other studies in world

Hepatitis a virus and coronary artery diseases

Many studies have reported on the association between human coronary artery disease [CAD] and certain persistent bacterial and viral infections. The aim of the present analysis was to investigate the possible association between HAV infection and angiography proven CAD. Blood from 200 patients undergoing coronary angiography was tested for antibodies to HAV by enzyme immunosorbent assay at Madani Heart Hospital, Tabriz University of Medical Sciences, Iran. CAD prevalence was 90% in HAV seropositive and 84.4% in HAV seronegative patients [Pv = 0.2]. This analysis demonstrated that HAV seropositive is not a risk factor for CAD

Survey of operative outcome for aortic dissection

To survey the results of operative outcome for aortic dissection. A retrospective study on 46 patients, admitted for operation in Shahid Madani Heart Hospital in Tabriz, Iran from 1994-2003. A questionnaire was used for collecting data. Statistical analysis was performed and was carried out through a descriptive statistical methods. We included 30 males [65%] and 16 females [35%]. Seven [15.2%] died in the operating room before surgery, while 39 patients [59% male and 41% female] underwent surgery. The mean age of patients was 48.9 +/- 2.3 years old. Pre-operative diagnosis was carried out by transesophageal echocardiography and angiography. All patients were operated in an emergency situation. In 42% of patients aortic valve replacement [AVR] with ascending aorta was replaced. In 24% only the ascending aorta was replaced, and in 10% the aortic valve was repaired with acute aortic dissection. In 10% of patients, the ascending aorta with aortic arch was replaced. Four patients [14%] had distal aortic dissection and replacement. Major complications were hemorrhage [31%] and respiratory failure [13.8%]. A total of 20.7% died in hospital, and only 21 patients [45.5%] could be followed for 10 years. Acute aortic dissection is a fatal disease. With early diagnosis and surgical intervention, we can save approximately 75% of patients with very good functional class and survival in the mid term

Oxidative stress and homocysteine metabolism following coronary artery bypass grafting by on -pump and off- pump techniques

It is well documented that coronary artery bypass grafting [CABG] with cardiopulmonary bypass [CPB] causes ischemia and oxidative stress of the whole body. To compare the effect of on - pump and off -pump CABG on the induction of the oxidative stress and the metabolism of homocysteine which is involved in the synthesis of glutathione was investigated in the CABG patients during the early postoperative period. Plasma homocysteine, folate total antioxidant capacity [TAC] and malonedialdehyde [MDA] were determined by standard methods on blood samples obtained from 40 patients undergoing CABG, preoperatively and at 0, 12, 48, 120 hours and 6 months after surgery, The patients were divided into two matched groups. One of the groups underwent off - pump and the other on - pump CABG. A marked reduction of homocysteine, folate and significant elevation of MDA were noticed at 0, 12, 48 hours after operation in the both groups [P<0.05]. A negative and marked correlation between homocysteine and TAC but a positive and significant correlation between homocysteine and MDA were observed [P<0.05 in the both groups]. In CABG operation because of oxidative stress and consumption of GSH [Reduced Glutathione] immediate reduction in the plasma levels of homocyteine occurs in the both techniques. However using off pump CABG induction of oxidative stress and changes in plasma levels of homocysteine are not as high as on- pump CABG. The on-pump technique was correlated with a faster decrease in the homocysteine level during the first 12 hours and with a faster and higher elevation of the homocysteine concentration 12-48 hours postoperatively

Preoperative transcranial and carotid Doppler study in coronary artery bypass graft patients

To assess the correlation of postoperative neurologic complications with preoperative transcranial and carotid Doppler study findings of coronary artery bypass graft [CABG] patients. In a descriptive, analytic, follow up study we prospectively studied 201 patients undergoing elective and isolated CABG surgery during a 12 month period from October 2003 to September 2004 at Madani Hospital of Tabriz Medical Sciences University, Iran. Neurologic examination, intracranial cerebral arterial study using transcranial Doppler [TCD] and carotid duplex were performed preoperatively. Intraoperative and postoperative complications were followed up for one month. Two hundred and one patients [158 male, 43 female] with a mean age of 57.29 +/- 9.67 were studied. Out of these, 131 patients had 3 coronary vessels disease, 64 had 2 vessels, 5 had one vessel, and one patient had diffuse coronary disease. A TCD was performed in 183 patients and disclosed abnormalities in 22 patients and was normal in 161 cases. The total number of involved arteries was 34. Among 154 carotid duplex studied patients, 102 had plaque, inducing <50% stenosis in 99, 50-74% stenosis in one, and 75-90% stenosis in 2 cases. Postoperative neurologic complication occurred as follows: 4 stroke, 7 delirium, and 3 amnesia. One of the operated patients died. Nine of 161 patients with normal TCD [5.6%] and 5 of 22 [22.7%] with intracranial cerebral arterial disease [ICAD] showed central nervous system [CNS] complications [p=0.015]. There were significant correlations between number of involved cerebral arteries and post CABG CNS complications [p=0.0001], including stroke [p=0.007], and between diabetes mellitus history with these complications [p=0.012]. Our results suggest that lCAD is an independent risk factor for CNS complications after CABG surgery. Hence, we recommend pre-CABG evaluation of the cerebral arteries by TCD, for the risk assessment of CABG surgery

Ultra-low dose aprotinin effects on reducing the need for blood transfusion in cardiac surgery

To assess the effects of ultra-low dose one million kallikrein inhibitor units [KIU] of aprotinin on bleeding and the need for transfusion after cardiac surgery. We carried out this randomized clinical trial on 162 cardiac surgery patients in Shahid Madani Hospital, Tabriz, Iran from April 2004 to December 2005. The patients were randomly divided into 2 groups of 81 individuals. In the aprotinin group, 0.5 million KIU infused before and 0.5 million KIU during cardiopulmonary bypass. In the placebo group, 100 ml normal saline was infused as above. The need to use fresh frozen plasma [FFP], packed red blood cells [PRBCs] transfusion during, after operation, the rate of chest tubes drainage at 6, 12 and 24 hours after surgery were measured in 2 groups. Chest tubes drainage at 6 hours after surgery was 190 +/- 24 ml in the aprotinin group and 266 +/- 33 ml in the placebo group [p=0.066]. The amount of bleeding at 12 and 24 hours was significantly different between 2 groups [p=0.048, p=0.009]. The frequency of blood products transfusion in the aprotinin group was 68% and in the placebo group was 75% [p=0.02]. The number of PRBCs and FFP units transfused were significantly lower in the aprotinin group [p=0.000, p=0.005]. Total amount of blood and products transfusion in the aprotinin group was 2.56 +/- 0.27 units and in placebo group it was 4.37 +/- 0.27 units [p=0.0001]. Results indicate that the use of one million KIU of aprotinin in cardiac surgery is effective in reducing postoperative bleeding and transfusion requirements

Surgical Radiofrequency MAZE III Ablation for Treatment of Atrial Fibrillation During Open Heart Surgery

Atrial fibrillation is a common arrhythmia in patients with rheumatic mitral and other valve diseases who are c and idates for valve repair surgeries. Conversion of rhythm to sinus has positive effects on quality of life and lower use of medications. The aim of this clinical study was to evaluate the effectiveness of the radiofrequency ablation Maze III procedure in the treatment of atrial fibrillation associated with rheumatic heart valve disease We applied a modified Cox III Maze procedure using radiofrequency ablation in the treatment of atrial fibrillation associated with rheumatic heart valve disease and evaluated the outcome of 20 patients of atrial fibrillation associated rheumatic valve disease who underwent radiofrequency ablation Maze III procedure plus heart valve surgery. Demographic, echocardiographic, Electrocardiographic and Doppler study data were calculated before surgery, six month and one year after surgery.No perioperative deaths occurred in the study group. Duration of additional time for doing radiofrequency ablation was about 22 minutes. Freedom from atrial fibrillation was 85% and 75% at six months and one year follow-up respectively.The addition of the radiofrequency ablation Maze procedure to heart valve surgery is safe and effective in the treatment of atrial fibrillation associated with rheumatic heart valve disease