Does cardiopulmonary bypass change serum neuron-specific enolase levels?

OBJECTIVE: The effects of cardiopulmonary bypass (CPB) on serum neuron-specific enolase (NSE) levels in patients without cognitive dysfunction and neurological deficit are not yet clarified. This study was designed to see the sole effect of extracorporeal circulation on serum NSE levels in patients without any clinically observed neurological deficit. METHODS: Thirty-two consecutive patients undergoing first elective open-heart surgery were included in this prospective study. Neurological status was assessed by clinical examination before surgery, and on the postoperative first and second days. Blood samples were obtained after anesthesia induction before the administration of heparin, within the first hour post CPB, 24 and 48 hours after the end of operation. Each blood sample was assayed for hemoglobin (Hb), hematocrit and NSE levels. The Friedman's Test to compare the serial measurements of NSE and hemoglobin samples and the post-hoc Tukey test for paired comparisons between pre and postoperative values were applied Pearson correlation test was used to examine the correlation between NSE concentration and aortic cross-clamping time and CPB time, age, postoperative hematocrit and hemoglobin levels and the amount of blood products transfusion. RESULTS: There were no significant differences between NSE values at any sampling time: 11.6+/-8.0 mg/dL, 8.7+/-4.7 mg/dL, 9.3+/-5.4 mg/dL and 8.9+/-5.8 mg/dL, measured preoperatively, at the end of operation, on the first and second post-operative days, respectively. There was no significant correlation between NSE values with any of the compared variables including CPB time. CONCLUSION: This study demonstrated that the possible damage of CPB on central nervous system and on blood cells did not reach to the extent of causing any significant increase in serum NSE levels in non-complicated patients undergoing open-heart surgery.

Is remote preconditioning as effective as direct ischemic preconditioning in preventing spinal cord ischemic injury?

BACKGROUND: Spinal cord injury remains a devastating complication of thoracic and thoracoabdominal aortic operations. The aim of this study was to assess the affectivity of direct ischemic preconditioning (PC) and remote PC in preventing spinal cord ischemic injury in an experimental model. MATERIALS AND METHODS: Thirty-eight New Zealand white rabbits were divided into five groups: One group served as Sham group (n = 7). Rabbits in other groups had their abdominal aorta cross-clamped for 40 min. Before aortic occlusion, aorta was clamped twice at the same site of aortic occlusion for 5 min followed by 15 min of reperfusion after each ischemic episode in one group (Direct PC, n = 8), left renal artery was clamped twice for 5 min followed by 15 min of reperfusion after each renal ischemic episode in one group (Remote PC, n = 8), left renal artery was first clamped for 5 min followed by 15 min of reperfusion and then aorta was clamped for 5 min followed by 15 min of reperfusion in one group (Remote + Direct PC, n = 8), and no PC method was used in Control group (n = 7). RESULTS: In all PC groups, neurological status of rabbits (Tarlov score) at post-ischemia 24th and 48th hours was better than the control group (P < 0.05), but worse than Sham group (P < 0.05). Mean viability index values in PC groups were higher than control group (P < 0.01). Post-ischemia serum NSE and MDA levels obtained in all three PC groups were significantly lower than control group (P < 0.05 and P < 0.01). CONCLUSIONS: The use of direct ischemic PC and/or remote PC is an effective way of reducing spinal cord ischemic injury because of aortic occlusion, while direct PC is more effective. The combined use of direct PC and remote PC did not provide better protection.

Left atrial free-floating ball thrombus in a case of hyperthrophic cardiomyopathy.

Left atrial free-floating ball thrombus is a rarely seen pathology in the absence or presence of mitral valve disease. This pathologic condition carries high risks of embolic complications and deterioration of hemodynamics. The case reported here is a 34-year-old woman who had been followed-up by another center with the diagnosis of hypertrophic cardiomyopathy (HCM) was admitted to our emergency department in cardiogenic shock due to left atrial free-floating ball thrombus partially obstructed the left ventricular inflow. Emergency surgery was undertaken to remove the ball mass, additionally septal myectomy and mitral valve replacement were performed. Pathologic examination of the mass confirmed the thrombus formation. This rare case of left atrial free floating ball thrombus associated with HCM is presented and current literature is reviewed.

Transpulmonary surgical closure of patent ductus arteriosus with hypothermic circulatory arrest in an adult patient.

Untreated patent ductus arteriosus carries a higher risk in adults than in children, especially when the defect is large (>4.0 mm in diameter), short, or friable. Therefore, various technical precautions have been suggested for application during surgical closure of a patent ductus arteriosus in an adult. We report the case of a 47-year-old woman with a patent ductus arteriosus who underwent transpulmonary surgical closure of the ductus under hypothermic total circulatory arrest. We discuss the technique in light of the current English-language medical literature.

Replacement of a Björk-Shiley Delrin aortic valve still functioning after 25 years.

We report the case of a patient who had undergone implantation of a Björk-Shiley Delrin valve in the aortic position 25 years earlier and who now presented with severe mitral stenosis. The patient underwent mitral valve replacement and aortic valve re-replacement. We review the justification for prophylactic replacement of Björk-Shiley Delrin heart valves.