Effect of maintenance hemodialysis on diastolic left ventricular function in end-stage renal disease

PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed. RESULTS: Mean age was 58 ± 13 years and 21 ( percent50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment. DISCUSSION: The acute and long-term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end-stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end-stage renal disease. CONCLUSION: It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end-stage renal disease. However, in patients with endstage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term.

Association between the left atrial diameter and radiofrequency ablation procedure at restoring sinus rhythm [mid term and long term results]

Atrial fibrillation [AF] is the most common arhythmia type among other arythmias. In this study, we aimed to search the effect of left atrium diameter in AF treatment with radiofrequency ablation procedure. Preoperative left atrium diameter and postoperative sinus rhythm restoration was prospectively studied in 84 patients who had undergone valve surgery and radiofrequency [RF] ablation procedure in Department of Cardiovascular Surgery from January 2004 to March 2009. The patients were classified in two groups. Group-I consisted of the patients with left atrial diameter less than 5 cm, and Group II consisted of the ones whose left atrial size was more than 5cm. Normal sinus rhytm restoration was followed by electrocardiography [ECG]. ECG monitoring was done in early postoperative period, 12[th], 24[th] and 36[th] monthes following the operation. In early post-operative period normal sinus rhythm [NSR] was recorded in 34 patients [Group I: 20, Group II: 14] in which unipolar RFA was performed. Supraventricular tachycardia [SVT] was observed in 20 patients [Group I: 10, Group II: 10] and NSR was restored with medical treatment in these patients. AF was permanent in 26 patients [Group I: 8, Group II: 18] and nodal rhythm was observed in 4 patients [Group I: 2, Group II: 2]. The ECG monitoring was done in the patients in early postoperative period at 12[th], 24[th] and 36[th] monthes. Datas were evaluated with statistical studies, too. Radiofrequency [RF] ablation is a feasible, efficient and safe method for the treatment for Atrial fibrillation [AF]. In our study we found that left atrial diameter is an important factor in restoring sinus rhythm. However, AF treatment with extended left atrium is more difficult

Brachial plexus injury due to median sternotomy and lima harvesting

Brachial plexus injury is an unusual and under-recognised complication of coronary artery bypass grafting especially when internal mammary artery harvesting takes place. It is believed to be due to sternal retraction resulting in compression of the brachial plexus. Although the majority of cases are transient, there are cases where the injury is permanent and may have severe implications as illustrated in the accompanying case history. We investigated that injury to the brachial plexus was retrospectively assessed in the results of eight patients who underwent median sternotomy for open heart surgery. Between March 2006 and October 2008, 455 patients underwent cardiac surgery with median sternotomy. In post operative period peripheric neuropathy symptoms were observed in eight [1.7%] patients. All patients were placed in the hands up position after right internal jugular vein cannulation, and internal mammary artery was prepared for all those patients. The symptoms were classified as pain, sensory impairment and motor impairment. Brachial plexus injury was detected postoperatively in these eight patients. The patients with injured nerves were older and had undergone longer operation times. There were no differences between the patients with injured nerves and the others with respect to mammary artery harvesting or other operative variables. Full recovery occured in seven of eight [87%] patients after six monthes, one [13%] patient suffered from disesthesia. It is known that heart surgery sometimes causes partial brachial plexus injury, especially in the lower trunk. However, these peripheral nerve problems are usually not considered clinically important and are not investigated. Patients undergoing open heart surgery must be closely followed up for peripheral nerve injury during the postoperative period