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Background: Cardiac troponin I (cTnI) is reported to be very specific formyocardial cell damage without cross reactivity with skeletal muscle isoform.Evaluation of cTnI after CABG will be useful as an early marker of excessivepost operative myocardial damage when a specific therapeutic intervention canstill be efficient and improve outcome.Methodology: The study comprised of 50 patients who undergo Coronary arterybypass surgery at V.S group of Hospital. Blood sample were taken after 12 hour (T12) and 24 hour ( T24 ) of post CABG. The sample were analysed for cTnI.Results: Our results show that Troponin I levels after 2 hours, 12 hours and 24hours in patients who had better outcome after CABG was 9.2 ng/ml, 13.9 ng/mland 10.9 ng/ml respectively. Whereas, Troponin I levels after 2 hours, 12 hoursand 24 hours in patients who had adverse outcome like death of patients afterCABG was 10.6 ng/ml, 38.7 ng/ml and 28.9 ng/ml respectively.Conclusion: Routine measurement of cardiac troponin levels after cardiactroponin can identify group of patients at increased risk of complications ordeath.
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Objective To summarize the incidence of cardiac allograft vasculopathy (CAV) after heart transplantation and the effect on the long-term survival of recipients. Methods Clinical data of 1 006 heart transplant recipients were retrospectively analyzed. Of 48 CAV patients, 4 cases were not included in this analysis due to lack of imaging evidence. A total of 1 002 recipients were divided into the CAV group (n=44) and non-CAV group (n=958) according to the incidence of CAV. The incidence of CAV was summarized. Clinical data of all patients were statistically compared between two groups. Imaging diagnosis, coronary artery disease, drug treatment and complications, postoperative survival and causes of death of CAV patients were analyzed. Results Among 1 006 heart transplant recipients, 48 cases (4.77%) developed CAV. Compared with the non-CAV group, the proportion of preoperative smoking history, preoperative hypertension history, coronary artery disease and perioperative infection was significantly higher in the CAV group (all P < 0.05). Among 44 patients diagnosed with CAV by imaging examination, 24 cases were diagnosed with CAV by coronary CT angiography (CTA), 4 cases by coronary angiography (CAG), and 16 cases by coronary CTA combined with CAG. Among 44 patients, the proportion of grade Ⅰ CAV was 45% (20/44), 30% (13/44) for grade Ⅱ CAV and 25% (11/44) for grade Ⅲ CAV, respectively. All patients received long-term use of statins after operation, and 20 patients were given with antiplatelet drugs. Among 44 CAV patients, 11 patients underwent percutaneous coronary intervention, 6 cases received repeated heart transplantation, and 8 patients died. Kaplan-Meier survival analysis demonstrated that there was no significant difference in the long-term survival rate between the CAV and non-CAV groups (P > 0.05), whereas the survival rate of patients tended to decline after the diagnosis of CAV (at postoperative 6-7 years). The long-term survival rates of patients with grade Ⅰ, grade Ⅱ and grade Ⅲ CAV showed no significant difference (P > 0.05). Even for patients with grade Ⅰ CAV, the long-term survival rate tended to decline. Conclusions CAV is a common and intractable complication following heart transplantation, and the long-term survival rate of patients after the diagnosis of CAV tended to decline. Deepening understanding of CAV, prompt prevention, diagnosis and treatment should be delivered to improve the long-term survival rate of patients after heart transplantation.
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We present herein the case of a 45-year-old man with a coronary artery aneurysm (diameter 19 mm) in the proximal part of the left anterior descending branch associated with eosinophilic granulomatosis with polyangiitis (EGPA). As coronary angiography showed #6 : 100% and #12-2 : 90%, and Tc-99 m myocardial scintigraphy showed exertional ischemia in the anterior septum, revascularization was considered to be indicated. Prednisolone and mepolizumab were administered preoperatively to suppress the activity of vasculitis due to eosinophilia, and surgery was performed when the eosinophil count normalized. The patient underwent off-pump coronary artery bypass grafting (LITA-LAD, SVG-OM2). The patient was discharged, and the postoperative course was uneventful. In coronary artery bypass grafting for EGPA, eosinophils may infiltrate the internal thoracic artery and result in vasculitis, which may affect the patency rate. Perioperative management of vasculitis may thus be important.
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A 75-year-old man with situs inversus totalis, presented to our hospital complaining of chest pain. ECG showed ST depression in the leads of Ⅰ, aVL, V5, and V6. Blood tests showed cardiac enzyme (Troponin I) elevation. Coronary angiography revealed severe calcification and stenosis of the anatomical left anterior descending artery (LAD) , and the anatomical right coronary artery (RCA). The Patient underwent coronary artery bypass grafting (CABG) using the right internal thoracic artery and saphenous vein graft. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.
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@#Objective To explore the predictive value of myocardial vitality in the improvement of cardiac function after coronary artery bypass grafting (CABG) in patients with ischemic heart failure. Methods From December 8, 2015 to November 12, 2018, 46 patients with ischemic heart failure who underwent CABG operation alone were collected retrospectively. There were 41 males and 5 females with an average age of 60.4±8.0 years. The myocardial vitality and number of different types of myocardium were measured. The clinical data of patients in the left ventricular ejection fraction (LVEF) improvement group (≥5%) and non-improvement group (<5%) were compared and analyzed. The correlation between each index and LVEF improvement was analyzed by logistic multivariate regression analysis, and the boundary value of hibernating myocardium between LVEF improvement and non-improvement was obtained by receiver operating characteristic (ROC) curve. Results There were significant differences in the number of hibernating myocardium (15.0%±12.3% vs. 4.3%±4.5%, P=0.000), the number of normal myocardium (74.7%±13.7% vs. 82.4%±8.6%, P=0.027), and cardiac function classification (NYHA) development (−0.7±0.7 vs. −0.3±0.5, P=0.047) between the two groups, but there was no significant difference in other indexes between the two groups (P>0.05). Logistic regression analysis showed that the number of hibernating myocardium was an independent factor affecting the improvement of LVEF after CABG in patients with ischemic heart failure (OR=1.366, 95%CI 1.033-1.807, P=0.029). The ROC curve showed that the threshold value, sensitivity and specificity of hibernating myocardium were 15.0%, 43.8% and 100.0%, respectively. Conclusion The percentage of hibernating myocardium to left ventricular wall area ≥15.0% can accurately predict the improvement of LVEF in patients with ischemic heart failure after CABG. Preoperative myocardial vitality assessment has important diagnostic value in predicting the improvement of cardiac function in patients with ischemic heart failure after simple CABG.
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The aim of this study was to analyze if off-pump coronary artery bypass surgery (CABG) is associated with better treatment outcomes in elderly patients (>70 years of age) than on-pump CABG, using meta-analysis. Medline, PubMed, Cochrane and Google Scholar databases were searched until September 13, 2016. Sensitivity and quality assessment were performed. Twenty-two studies, three randomized control trials (RCTs) and 20 non-RCTs were included with 24,127 patients. The risk of death associated with on-pump or off-pump CABG in the RCTs were similar (pooled OR=0.945, 95%CI=0.652 to 1.371, P=0.766). However, in the non-RCTs, mortality risk was lower in patients treated with off-pump CABG than on-pump CABG (pooled OR=0.631, 95%CI=0.587 to 0.944, P=0.003). No differences were observed between the two treatment groups in terms of the occurrence of 30-day post-operative stroke or myocardial infarction (P≥0.147). In the non-RCTs, off-pump CABG treatment was associated with a shorter length of hospital stay (pooled standardized difference in means=-0.401, 95%CI=-0.621 to -0.181, P≤0.001). The meta-analysis with pooled data from non-RCTs, but not RCTs, found that mortality was lower with off-pump compared with on-pump CABG, and suggested that there may be some benefit of off-pump CABG compared with on-pump CABG in the risk of mortality and length of hospital stay.
Subject(s)
Humans , Aged , Coronary Artery Bypass/methods , Stroke/etiology , Clinical Trials as Topic , Coronary Artery Bypass, Off-Pump/adverse effects , Coronary Artery Bypass, Off-Pump/methods , Coronary Artery Bypass/adverse effects , Risk Factors , Treatment OutcomeABSTRACT
Spontaneous coronary artery dissection is a rare condition that usually causes a coronary syndrome, but may also cause sudden death. It is more common in women and is associated with factors such as the peripartum period and oral contraceptive use. We report two cases. A 45-year-old woman with hepatitis C, presenting in the emergency room with angina. An intravascular ultrasound showed a dissecting hematoma involving the left, anterior descending and circumflex coronary arteries. She was initially managed with nitroglycerin, anticoagulation and anti-platelet drugs but due to persistence of symptoms, she required surgical revascularization. A 32-year-old woman presenting in the emergency room with angina. A coronary angiogram revealed a dissection of the anterior descending coronary artery. Eight days later an intravenous ultrasound showed a retrograde progression of the dissection and she was subjected to a surgical revascularization.
Subject(s)
Humans , Female , Adult , Middle Aged , Vascular Diseases/congenital , Coronary Vessel Anomalies/diagnostic imaging , Vascular Diseases/surgery , Vascular Diseases/diagnostic imaging , Coronary Angiography , Coronary Vessel Anomalies/surgeryABSTRACT
A 70-year-old man with dextrocardia with situs inversus, presented to our hospital complaining of chest pain. ECG showed ST elevations in leads II, III and <sub>a</sub>V<sub>f</sub> , and ST depressions in leads V3 through V6. Blood tests showed creatinine kinase elevation. He underwent coronary angiography, which revealed obstruction of the anatomical right coronary artery and we diagnosed acute inferior myocardial infarction. However, the anatomical left coronary artery was not clearly identifiable because of its anomalous origin. He was transferred to our intensive care unit and intra-aortic balloon pumping was initiated. Coronary 3D-CT was then performed to obtain an anatomical overview of the coronary artery system. This enabled a second coronary angiography which showed obstruction of the left anterior descending artery and stenosis of the left main trunk in the first diagonal branch and the ramus intermedius branch. Coronary artery bypass grafting surgery (CABG) was indicated. He underwent conventional quintuple CABG using the right internal thoracic artery and saphenous vein grafts. Preoperatively we made digital mirror images of the original coronary angiographic images to clarify his coronary artery anatomy. During surgery, the main surgeon continuously stood on the patient's left side except when opening and closing the chest, which enabled us to perform CABG. The postoperative course was uneventful. CABG in a patient with situs inversus totalis is very rare. We present this case with a review of the relevant literature.
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Spontaneous coronary artery dissection is a rare but often fatal cause of acute myocardial ischemia that occurs in young or middle-aged and otherwise healthy patients. We report a case of spontaneous left main coronary artery dissection in a young woman who was treated with emergency coronary artery bypass grafting. She improved after surgery but required a long recuperative period because of her cardiac failure and multiple organ failure, developed expiring on the 78th postoperative day. Spontaneous coronary artery dissection is unpredictable, and sudden death is the usual mode of clinical presentation. Prompt diagnosis and coronary artery revascularization are essential in order to achieve a favorable outcome in such cases.
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A 51-year-old man admitted to our hospital because of an ECG abnormality pointed out by his local doctor. He had been hospitalized for scarlet fever at age 10. A coronary artery CT scan showed coronary artery aneurysm of the left main trunk (LMT), and coronary angiography showed 3-vessel disease including a chronic total occlusion of the right coronary artery (RCA). We performed conventional coronary artery bypass grafting (CABG) using an arterial graft and aneurysmectomy. The patency of the graft was confirmed by coronary angiography postoperatively. The pathological diagnosis of the coronary aneurysm was Kawasaki disease. CABG is a standard procedure for coronary artery aneurysms with Kawasaki disease. However, there are no established treatment guidelines on whether to perform aneurysmectomy. We chose CABG with aneurysmectomy because of the possibility of intra-aneurysmal thrombosis leading to peripheral occlusion, and the cause of the coronary artery aneurysm could not be determined. However, even if additional treatment by percutaneous coronary intervention (PCI) is not possible, it is important to avoid occlusion of the graft.
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Introdução: Complicações pulmonares no pós-operatório imediato de cirurgia de revascularização do miocárdio (CRM) aumentam o risco de morbi-mortalidade; a fisioterapia respiratória com suas técnicas e recursos, como a aplicação de pressão positiva tem sido testadas com o objetivo de diminuir as complicações. Objetivo: Comparar os efeitos da fisioterapia respiratória convencional (FRC) com a associação da FRC e EPAP (pressão positiva expiratória final) na função pulmonar e nos achados radiológicos no pósoperatório de CRM. Método: Ensaio clínico randomizado, composto por cinqüenta e quatro pacientes submetidos à CRM eletiva no Instituto de Cardiologia do Rio Grande do Sul (IC-FUC/RS), entre julho e outubro de 2006, divididos em dois grupos: um que recebeu FRC (GA) e outro que além desta fez uso de EPAP (GB) e avaliados por meio de espirometria, manovacuometria e radiografia torácica no pré-operatório, 2o e 6o dia pós-operatório. Resultados: Valores espirométricos e de manovacuometria apresentaram variações significativas entre os três momentos avaliados independente da técnica, não havendo diferença significativa entre os grupos. O percentual de queda do VEF1 e da CVF relacionando 2o PO e 6o PO com o pré-operatório foi maior para o grupo EPAP com significância estatística (p ≤ 0,05), exceto para o VEF1 do 6o PO em relação ao pré-operatório (p=0,058). Nos achados radiológicos de tórax, não h ouve diferença estatisticamente significativa entre os grupos no que diz respeito a atelectasia. Conclusão: A terapia EPAP associada à FRC não demonstrou superioridade no pós-operatório imediato de CRM no que diz respeito à função pulmonar e aos achados radiológicos comparada à FRC (AU)
Introduction: Pulmonary complications in the immediate postoperative period of coronary artery bypass grafting (CABG) increase the morbidity and mortality risk. Respiratory physical therapy with its techniques and resources, such as application of positive pressure, have been tested with the aim of diminishing the complications. Objective: To compare the effects of conventional chest physical therapy (PT) with the EPAP+PT combination (expiratory positive airway pressure) on the pulmonary function and radiological findings in postoperative CABG. Method: Randomized clinical trial with 54 patients submitted to elective CABG at the Instituto de Cardiologia of Rio Grande do Sul (ICFUC/ RS) from Jul to Oct 2006, divided in two groups: one receiving PT (GA) and the other receiving both CT and EPAP (GB) and evaluated through spirometry, manovacuometry, and pre-operative and postoperative (day 2 and 6) thoracic X-rays. Results: Spirometric and manovacuometry values presented significant variations between the three time points regardless of the technique, with no significant difference between the groups. The percentage of VEF1 and CVF decrease at days 2PO and 6PO as compared to preoperative values was greater in the EPAP group, with statistical significance (pd"0.05), except for VEF1 at day 6PO as compared to the preoperative value (p=0.058). In the chest X-rays analysis, there was no statistically significant difference between the groups concerning atelectasis. Conclusion: EPAP+PT was not superior in the immediate postoperative CABG concerning pulmonary function and radiological findings as compared to PT (AU)