Effect of milrinone on short-term outcome of patients with myocardial dysfunction undergoing coronary artery bypass graft: A randomized controlled trial.

BACKGROUND: Myocardial dysfunction needing inotropic support is a typical complication after on-pump cardiac surgery. In this study, we evaluate the effect of milrinone on patients with ventricular dysfunction undergoing coronary artery bypass graft (CABG). METHODS: Seventy patients with impaired left ventricular function [left ventricular ejection fraction (LVEF) < 35%] undergoing on-pump CABG were enrolled. Patients were randomized to receive either an intraoperative bolus of milrinone (50 microg/kg) or saline as placebo followed by a 24-hour infusion of each agent (0.5 microg/kg/min). Hemodynamic parameters and transthoracic echocardiographic measurement of systolic and diastolic functions were the variables evaluated. RESULTS: Serum levels of creatine phosphokinase (CPK), the MB isoenzyme of creatine kinase (CK-MB), occurrence of myocardial ischemia or infarction, and mean duration of using inotropic agents were significantly lower in the milrinone group (p < 0.05). There were no significant differences between the two groups regarding the development of ventricular arrhythmia, duration of cardiopulmonary bypass, intra-aortic balloon pump and inotropic support requirement, duration of mechanical ventilation, duration of intensive care unit stay and mortality rate. Although mean pre-operative LVEF was significantly lower in the milrinone group, there was no significant difference between post-operative LVEFs. CONCLUSIONS: We suggest that perioperative administration of milrinone in patients undergoing on-pump CABG, especially those with low LVEF, is beneficial.

Ability of amiodarone and propranolol alone or in combination to prevent post-coronary bypass atrial fibrillation.

Atrial fibrillation (AF) is the most common arrhythmia in coronary artery bypass grafting (CABG) patients. The purpose of this study was to determine the best prophylaxis for AF prior to CABG. In this double-blind randomized study, 240 consecutive patients underwent elective CABG. They were then divided randomly into three groups to receive propranolol (n = 80), amiodarone (n = 80), or both drugs (n = 80). All groups received their medications from preoperative day 7 to post-CABG day 5. The patients were well matched for age, sex, risk factors, comorbidities, ejection fraction, and cardioplegic technique. Post-CABG AF developed in 22 patients (9.2%) of whom 13 (16.3%) had received propranolol, 5 (6.3%) had received amiodarone, and 4 (5%) had received both drugs. The difference between the propranolol group and the other two groups was statistically significant (P= 0.02), but that between the amiodarone and amiodarone + propranolol group was not significant. Age was a significant predictor of post-CABG AF (P= 0.034). Other factors such as diabetes, sex, hyperlipidemia, smoking, hypertension, family history, cerebrovascular accidents, left atrial size, and ejection fraction were not significant predictors of post-CABG AF. Preoperative amiodarone or amiodarone with propranolol were more effective than propranolol in reducing the frequency of AF. There was a strong relationship between age and the development of AF. (Clinicaltrial.gov registration NCT00654290.).

Pericardial PEComa: echocardiographic features.

The patient was a 19 year old man referred to our center due to progressive effort dyspnea and left sided pleuritic chest pain for 1 month. Echocardiographic examination showed a posteriorly located, giant, well demarcated mass, that compresses the left atrium. It was encased by moderate pericardial effusion. Histhopathological analysis disclosed neoplastic cells arranged around blood vessels with immunoreactivity for HMB-45 indicative of PEComa (Perivascular Epitheloid Cell differentiation). Six month follow up was uneventful. Up to the best of our knowledge, this is the first case of pericardial PEComa reported in the literature.

Perivascular epithelioid cell tumor of the pericardium: a case report.

A large pericardial mass, which was found to be a perivascular epithelioid cell tumor, was excised from a 20-year-old man. To our knowledge, this is the first report of this distinctive neoplasm as a pericardial mass.