Malondialdehyde-modified LDL IgG antibody levels and indices of cardiac function in valvular heart and coronary artery disease patients

To compare the changes in anti-malondialde-hyde-modified low-density lipoprotein [MDA-LDL] IgG levels among patients undergoing off-pump and on-pump coronary artery bypass grafting [CABG] or valvuloplasty. A total of 38, 39 and 34 patients who underwent off-pump CABG, on-pump CABG and valvuloplasty, respectively, were enrolled in this study. Serum anti-MDA-LDL IgG values were measured 24 h before and after the operative procedures and at discharge. Echocardiogra-phy was also done before surgery and before discharge. The results were compared with values from 50 healthy controls. In all patients, a reduction in antibody titers was observed post-operatively. However, the decrease was significant only in the off-pump CABG - before surgery: 42.33 [25.83-58.51], after surgery: 30.86 [16.36-51.33] and at discharge: 10.96 [6.82-23.57; p = 0.027]. There was a significant positive association between anti-MDA-LDL IgG levels and ejection fraction [r = 0.248, p = 0.036] and a negative association with E/E', a marker of pulmonary capillary wedge pressure, in the coronary patients [r = -0.345, p = 0.012], but no significant associations were found in patients with valvular heart disease. Serum anti-MDA-LDL IgG levels were associated with cardiac function indices in coronary patients undergoing CABG

Problems of cold agglutinins in cardiac surgery: how to manage cardiopulmonary bypass and myocardial protection

Cold agglutinins are of unique relevance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass [CPB]. Cold autoimmune diseases are defined by the presence of abnormal circulating proteins [usually IgM or IgA antibodies] that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease. Immunoglobulin M autoantibodies to red blood cells, which activate at varying levels of hypothermia, can cause catastrophic hemagglutination, microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB and myocardial protection requires individualized planning. We describe a case of MV repair and CABG in a patient with high titer cold agglutinins and high thermal amplitude for antibody activation. Normothermic CPB and continuous warm blood cardioplegia were successfully used

evaluation of survival in patients who need intra aortic balloon pump [IABP] after cardiac surgery

Introduction: In some cases, assist devices are required to ensure an adequate cardiac output after cardiac surgery. Intra-aortic balloon pump [IABP] is the most commonly used cardiac assist device, which provides first-line support for patients with heart failure. The aim of this study was to determine factors affecting the mortality rate of patients receiving IABP

Materials and Methods: In this retrospective cohort study, 235 patients requiring IABP support were analyzed over 14 years period [between January 1999 and December 2013] from which 137 patients survived the 30 days follow-up. Perioperative and demographic factors such as age, weight, underlying disease, ejection fraction, ventricular aneurysm and cardiopulmonary bypass [CPB] and cross clamp time were recorded and analyzed

Results: The overall operative mortality was reported to be 41.7%. Male-to-female ratio was 131:104 and the mean age of the subjects was 57.58 +/- 11.07 years. Early mortality rate was higher among young subjects and those with prolonged CPB [162.71 +/- 35.25, P<0.001] and ACC [129.94 +/- 54.39, P<0.001]. In addition, mortality rate was higher among females [P=0.04]. Patients' weight, comorbidity, preoperative ejection fraction, ventricular aneurysm and stenosis of the left main coronary did not affect the mortality rate [P>0.05]

Conclusion: IABP is a simple, effective method for temporary cardiac support, especially for aged patients. In addition, lower duration of surgery is associated with better surgical outcomes

Emergency conversion from off pump to cardiopulmonary bypass in patients with coronary artery bypass graft surgery

As off pump Coronary artery bypass grafting surgery [CABG] is a developing method in coronary cardiac surgery, most surgeons are anxious about the danger of emergency crash conversion. In this observational study we tried to show the rate and outcome of conversion In this descriptive study about 477 coronary offpump CABG patients were operated in Ghaem hospital in Mashhad, Iran, from Jan 2012 to Jan 2013. In this group 20 patients needed to convert to Cardiopulmonary Bypass [CPB] immediately. We analyzed these 20 patients and produced the results. There was no cerebrovascular accident [CVA] and no neurologic problems. There was one death among these 20 patients. There was one case of renal failure who was the same patient that expired.75% of these 20 patients had hypertension and 45% had diabetes.20 patients [4.19%] had an emergency switch to On-pump CABG and only one death occurred among 20 patients

successful resection of cardiac metastasis of round cell liposarcoma

Myxoid is a common type of liposarcoma. Cardiac metastasis of sarcoma is a rare diagnosis. Transthoracic echocardiography is a useful tool for beginning the diagnosis. Curative resection of metastasis and then combination systemic chemotherapy for advanced disease is recommended. We report a 50 year old woman who presented with a cardiac metastasis of high grade round cell liposarcoma to right atrium and right ventricle. The tumor was diagnosed with computed tomography and transthoracic echocardiography. The tumor size was 10*10 cm. This is the second report of successful resection of a large intracardiac metastasis of liposarcoma