ABSTRACT
BACKGROUND: Atrial fibrillation (AF) is a common complication of coronary artery bypass grafting (CABG), and may have an inflammatory and/or thrombotic etiology. We sought to determine the expression of inflammatory (interleukin [IL]-6), thrombotic (tissue factor and von Willebrand factor [VWF]) and remodeling (matrix metalloproteinase [MMP]-9 and tissue inhibitor of metalloproteinase [TIMP]-1) markers by left atrial appendage (LAA) and right atrial appendage (RAA) tissue in the prediction of postoperative AF. We determined whether the tissue expression of markers of certain different pathophysiologic mechanisms predicted the development of AF after CABG. METHODS: LAA and RAA tissue was excised during CABG in 100 patients free of AF and inflammation. Tissue marker expression was quantified by immunohistochemistry and was related to 30-day postoperative AF. RESULTS: Overall, there were no significant differences in staining intensity of any marker between LAA tissue and RAA tissue. However, more intense expression of VWF by LAA tissue predicted the 30 patients with postoperative AF as compared with those free of AF (P = 0.006). IL-6, MMP-9 and TIMP-1 expression by RAA and LAA epicardial tissue was stronger than expression by endocardium or cardiomyocytes (all P < 0.025) but failed to predict AF. CONCLUSION: In this study, one of the largest to investigate tissue expression of pathophysiologic markers in relation to postoperative AF, we show that more intense expression of VWF by LAA tissue is a significant predictor of postoperative AF. This points towards a possible role of endothelial damage/dysfunction (as reflected by VWF changes) in the pathogenesis of postoperative AF.
Subject(s)
Atrial Fibrillation/metabolism , Biomarkers/metabolism , Endothelium/metabolism , Inflammation/metabolism , Myocardium/metabolism , Thrombosis/metabolism , Aged , Atrial Fibrillation/etiology , Coronary Artery Bypass/adverse effects , Female , Humans , Immunohistochemistry , Male , Middle Aged , Postoperative ComplicationsABSTRACT
It seems that mitral valve (MV) replacement technique is already standardized but still under discussion is the surgical approach. At Heart Surgery Clinic of Vilnius University MV replacement was started in 1970 (our total experience in valve surgery is 4396 operations). The most popular surgical approach was through left atrium (LA) from the right side. In cases with small atrium we used right atrial and transseptal and transverse transeptal biatrial (TTBA) approach. Left atrium approach is quite useful in many cases except those with small LA, LV hypertrophy and heart rotation when it can result a greater trauma for the heart, extended time of operation and, possibly, reduced performance after it. From September 1992 till May 1993 we used extended vertical transseptal (EVT) approach in 18 patients for MV replacement or repair, mitral and aortic valve replacement was performed for 5 patients, mitral valve replacement and tricuspid valvuloplasty for 13 patients, 5 patients had mitral valve reoperations and for 3 patients aortocoronary by-pass performed additionally. The technique used was exactly as proposed by O. Alfieri et al, and incorporated bicaval cannulation and vertical transseptal incision extended into the roof of LA. From the first operation it became clear that this approach was superior to all others we had used during 20 years, since it gives perfect visibility of mitral valve, does not require retractors (only traction sutures are applied) and allows even to very easily use the continuous suture for valve fixation. Size of LA is no longer important.(ABSTRACT TRUNCATED AT 250 WORDS)
Subject(s)
Mitral Valve/surgery , Adult , Aged , Coronary Artery Bypass , Heart Valve Prosthesis , Humans , Middle Aged , Postoperative Complications , Reoperation , SuturesABSTRACT
A comparison of the clinical data and those of ECG under physical exercises with the results of coronary angiography is presented for 130 patients with the ischaemic heart disease, aged 28 to 68 years; 63 of them had survived myocardial infarction, 63 had angina of effort, 65--angina at rest and angina of effort, 2 presented no complaints. The comparison of the clinical and coronarographic data demonstrated a high correlation in cases of angina; in 85.3% of the patients with typical angina pectoris coronary angiography revealed anatomic changes in the coronaries. Having compared the data to the positive exercise test with the results of coronary angiography, the authors found that 87.9% of the examined patients have--with a positive exercise test--coronary lesions and the S--T segment depression during physicial exercises 1 mm below the iso-electric line, which permits to diagnose anatomic changes in the coronaries. According to the authors, an acute onset of the disease, a brief history (up to 1 year) and a prompt restoration of the ECG following physical exercises are typical rather for local lesions of one coronary branch.
