Combined coronary surgery and aortic valve replacement after previous right pneumonectomy

Cardiac surgery in patients with previous pneumonectomy is infrequently reported. We report a case of combined coronary artery bypass grafting and aortic valve replacement in a patient with left ventricular ejection fraction less then 35% and a previous right pneumonectomy. All steps in operative management of this rare condition are discussed

[Control of blood pressure morning surge in a lebanese hypertensive population]

The primary endpoint of this prospective clinical study is to ascertain the degree of blood pressure control in the early-morning hours after 8 weeks of treatment with telmisartan in hypertensive patients using home blood pressure measurements. Two hundred forty Lebanese patients with uncontrolled hypertension are enrolled in the study. The blood pressure is measured at the initial visit, then at week 4 of follow-up [optional visit] and after the 8 weeks period, by the physician at his office [with pulse rate] and by the patient at home in the morning. The blood pressure measured by the patient at home in the morning has a mean value of 129.7/79.1 mmhg, significantly less than 135/85 mmhg [P< 10[-5]], and it is reduced by 31.9/13.5 mmhg [P< 10[-5]]. At the physician's office, the reduction is 34.8/16 mmhg [P< 10[-5]. Heart rate is decreased by 4.7 +/- 0.5 bpm [P< 10[-5]. The drug was well tolerated. This study has demonstrated that Telmisartan, by his long half-life, protects the patients against the early-morning hours blood pressure surge, period during which coronary and cerebral events are the most frequent