ABSTRACT
We are describing two-dimensional and live/real time three-dimensional transthoracic as well as two-dimensional transesophageal echocardiographic findings in an elderly patient with epithelioid hemangioma involving the anterior leaflet of the mitral valve.
Subject(s)
Echocardiography, Three-Dimensional/methods , Echocardiography, Transesophageal/methods , Heart Neoplasms/diagnostic imaging , Hemangioendothelioma, Epithelioid/diagnostic imaging , Aged, 80 and over , Diagnosis, Differential , Female , Humans , Mitral ValveABSTRACT
BACKGROUND: High-energy phosphate metabolism is altered in the ischemic myocardium. We investigated the effects of in vivo administration of phosphocreatine (PCr) in a transient ischemic rat model to emulate off-pump myocardial revascularization. STUDY DESIGN: Rats received either PCr (100 mg/kg) or saline intravenously 1 hour before surgery. Regional ischemia was maintained for 12 minutes by ligation of the left anterior descending artery and compared with sham-operated animals. Cardiac tissue was studied for ATP, PCr, and inorganic phosphate (Pi) using (31)P-cryo-NMR. Results were compared by ANOVA. RESULTS: Levels of ATP were significantly (p < 0.01) lower in the ischemic hearts compared with controls; Pi and PCr remained unchanged. The PCr/Pi ratio was altered in ischemic hearts, reflecting an increased energy demand. PCr administration significantly (p < 0.01) elevated the content of PCr and ATP in both normal and ischemic hearts. CONCLUSIONS: PCr restores high-energy phosphates and attenuates metabolic stress during periods of myocardial ischemia in the rat. Preconditioning with PCr may serve as a useful adjunct to off-pump coronary revascularization.
Subject(s)
Adenosine Triphosphate/metabolism , Disease Models, Animal , Myocardial Ischemia/drug therapy , Myocardial Ischemia/metabolism , Phosphates/metabolism , Phosphocreatine/therapeutic use , Adenosine Triphosphate/analysis , Analysis of Variance , Animals , Coronary Vessels/surgery , Drug Evaluation, Preclinical , Energy Metabolism , Glycolysis/drug effects , Injections, Intravenous , Ischemic Preconditioning, Myocardial/methods , Ligation , Magnetic Resonance Imaging , Male , Myocardial Ischemia/diagnosis , Myocardial Reperfusion/methods , Myocardium/chemistry , Myocardium/metabolism , Phosphates/analysis , Phosphocreatine/pharmacology , Phosphorus Isotopes , Phosphorylation/drug effects , Rats , Rats, Sprague-Dawley , Time FactorsABSTRACT
BACKGROUND: Obesity is epidemic in the United States and afflicts 97 million adults. Prior single center studies have been contradictory as to obese patients having higher risks with coronary artery bypass operations. Our objective was to assess the independent effect of both moderate (body mass index [BMI], 35 to 39.9) and extreme (BMI > or = 40) obesity on bypass operation outcomes using the Society of Thoracic Surgeons National Cardiac Database. METHODS: The study population consisted of 559,004 patients from the Society of Thoracic Surgeons database who underwent first-time, isolated coronary artery bypass grafting between January 1997 and December 2000. We compared 42,060 moderately obese patients (BMI, 35 to 39.9) and 18,735 extremely obese patients (BMI > or = 40) with 498,209 normal or mildly obese patients (BMI, 18.5 to 34.9). Multivariable logistic regression was used to determine whether BMI subgroups were independent predictors of operative risk after adjusting for other preoperative factors. RESULTS: Compared with normal or mildly obese patients (BMI, 18.5 to 34.9), moderate and severely obese patients were younger and more likely to be diabetic and hypertensive. After adjusting for these and other known preoperative risk factors, moderate obesity slightly elevated patients' operative risk (adjusted odds ratio, 1.21; confidence interval, 1.13 to 1.29). In contrast, extremely obese patients had marked higher risk for operative mortality (adjusted odds ratio, 1.58; confidence interval, 1.45 to 1.73). Major perioperative complications, particularly deep sternal wound infection, renal failure, and prolonged postoperative hospital stay also increased for extremely obese patients. CONCLUSIONS: Extreme obesity (body mass index > or = 40) is a significant independent predictor for adverse outcomes and prolonged hospitalization after coronary artery bypass operation.
