Unconventional Cardiovascular Risk Factors and Systematic Coronary Risk Estimation (SCORE) in the Lebanese Rural Population: The Forgotten Factors.

Purpose: To evaluate the correlation between unconventional risk factors and the Systematic Coronary Risk Estimation (SCORE), and estimate the prevalence of conventional and unconventional cardiovascular (CV) risk factors in the rural Lebanese population in order to assess their CV risk. Methods: This is a retrospective descriptive study conducted between November 2017 and June 2019 among the Lebanese rural population. The risk factors were analyzed from the files of the patients who presented for the CV disease screening days organized by a non governmental organization. The CV risk estimation tool is the SCORE. The classification of socio-economic level ranges from zero (low level) to 3 (high level). Results: A total of 433 patients were included. The prevalence of hypertension, diabetes, dyslipidemia, smoking, and metabolic syndrome was 45.1%, 31.2%, 39.2%, 50% and 42.9% respectively. Only 13.6% of hypertensive patients and 6.7% of diabetics were controlled. A total of 0 or 1 point for the classification of socio-economic status was found in 62.6% of cases. A family history of CV diseases was present in 87.3% of participants. The SCORE was correlated with diabetes and metabolic syndrome (p = 0.000), without being correlated to socio-economic status (HR = -0.104; p = 0.059) or to family history (p = 0.834). Conclusion: The socio-economic status and the family history of CV disease must be evaluated in addition to the classical risk calculation of the SCORE to better pinpoint the actual risk of the targeted population. The risk factors are prevalent but poorly controlled, hence the need for a national effort to ensure better care for the rural Lebanese population.

Myocardial extraction of intracellular magnesium and atrial fibrillation after coronary surgery.

BACKGROUND: The effects of magnesium loading on the incidence of atrial fibrillation following coronary artery bypass graft surgery (CAGB) are equivocal. None of the previous studies assessed the influence of myocardial extraction of magnesium in these settings. The current trial aims to elucidate whether the incidence of atrial fibrillation following CABG is affected by the preoperative rate of myocardial extraction of magnesium. METHODS: The ethical committee approved the study protocol. 113 patients (94 male, mean age 63 ± 11 years) planned for elective CABG surgery under normothermic cardiopulmonary bypass were prospectively included. Preoperative independent variables included preoperative treatment, electrocardiographic abnormalities, left ventricular ejection fraction estimation, left atrial size, creatinine clearance and assays of plasma and intracellular magnesium, calcium, albumin, potassium and ionized calcium, drawn preoperatively from the coronary sinus and the aortic root. The covariates - including the rate of myocardial extraction of magnesium - were entered in a logistic regression model to predict the odds of atrial fibrillation. RESULTS: The incidence of post operative atrial fibrillation was 16%. A rate of myocardial extraction of intracellular magnesium ≥ 7% increases fivefold the multivariate risk of postoperative atrial fibrillation (p < .01). Advanced age was also significantly associated to postoperative atrial fibrillation. CONCLUSIONS: This study suggests that a preoperative rate of myocardial extraction of intracellular magnesium ≥ 7% could be a new and a potent predictive factor for postoperative atrial fibrillation.

Postoperative oral amiodarone versus oral bisoprolol as prophylaxis against atrial fibrillation after coronary artery bypass graft surgery: a prospective randomized trial.

BACKGROUND: Postoperative atrial fibrillation (AF) occurs in up to 50% of patients undergoing coronary artery bypass (CABG) surgery and is associated with complications. Amiodarone and beta blockers are effective as prophylaxis for AF after CABG. The purpose of this study was to compare oral amiodarone versus oral bisoprolol for prevention of AF after CABG. METHODS: In this randomized study, 200 patients admitted for elective CABG were given oral amiodarone (n=98 patients) or oral bisoprolol (n=102 patients) beginning 6 h after surgery. Amiodarone patients received 15 mg/Kg then 7 mg/Kg/day for one month. Bisoprolol patients received 2.5 mg then 2.5 mg bid indefinitely. RESULTS: Postoperative AF occurred in 15.3% of the patients in the amiodarone group and 12.7% of the patients in the bisoprolol group (p=0.60). Maximal ventricular rate tended to be lower in the bisoprolol group (125+/-6 beats/min) compared with the amiodarone group (144+/-7 beats/min, p=.06). Preoperative beta blockage did not affect AF incidence in either study group. There was no difference between the 2 groups for the onset time of AF episodes, total AF duration, AF recurrence and postoperative length of hospital stay. No serious postoperative complications occurred in the two study groups. Two reversible low cardiac output cases occurred with bisoprolol. CONCLUSIONS: Postoperative oral bisoprolol and amiodarone are equally effective for prophylaxis of AF after CABG. Treatment with bisoprolol resulted in a trend to lower ventricular response rate in AF cases. Both regimens were well tolerated.

Staged anesthesia for combined carotid and coronary artery revascularization: a different approach.

OBJECTIVE: Combined coronary artery bypass graft (CABG) surgery and carotid endarterectomy (CEA) are performed in an attempt to reduce the risk of postoperative stroke after CABG surgery in patients with significant or symptomatic carotid artery stenosis. The choice between regional and general anesthesia for CEA is still under debate. Regional anesthesia offers an excellent monitoring technique of the neurologic status of the awake patient during carotid clamping. In an attempt to improve monitoring of the neurologic status and avoid the use of temporary shunting in patients undergoing the combined procedure, a different approach is described combining regional anesthesia for CEA followed immediately by general anesthesia for CABG surgery. DESIGN: Prospective nonrandomized case series. SETTING: University hospital. PARTICIPANTS: Twenty patients scheduled for combined CEA and CABG surgery underwent a "staged" anesthetic approach from January to December 2004. INTERVENTIONS: Pulmonary, femoral artery, and urinary catheters were inserted under local anesthesia. A deep cervical plexus block was then performed and supplemented by a superficial cervical plexus block. The patient was draped for standard combined CEA and CABG surgery. CEA was then performed using standard techniques. Without altering the surgical field, general anesthesia was given and endotracheal intubation performed following the successful CEA. Coronary revascularization was then completed. MEASUREMENTS AND MAIN RESULTS: CEA and CABG surgery were completed successfully in all patients. There was no need for conversion from local to general anesthesia. Endotracheal intubation was easily performed in all patients. There was no hospital mortality in this series. No neurologic events were observed during the CEA. A reversible ischemic stroke, ipsilateral to the CEA, occurred postoperatively on awakening from CABG surgery in 1 patient. CONCLUSIONS: This staged anesthetic approach for combined CABG and CEA surgery is an alternative in this complex subset of patients.

[Balloon dilation of critical neonatal aortic stenosis: early and midterm results]. / Valvuloplastie percutanée des sténoses aortiques critiques néonatales--résultats à court et moyen terme.

OBJECTIVES: We evaluated our immediate and midterm results of balloon dilation of critical valvular aortic stenosis in 15 consecutive neonates. METHODS: Balloon dilatation was attempted in 15 neonates at a mean age of 14 days. Three patients (20%) had associated left heart hypoplasia. RESULTS: Balloon dilation could be performed in 14 out of the 15 neonates (93.3%). The average immediate maximal gradient reduction was 80 +/- 26%. The immediate mortality rate was nil, but 7 deaths (46%) occurred afterwards all not related to the dilation. Moderate to severe aortic regurgitation was noted in 7/14 (50%) of the dilated neonates but none has necessitated reintervention. At a mean follow-up of 11.5 months, survival and freedom of reintervention rates were respectively 40% and 50%. At last follow-up, 87.5% of the survivors were asymptomatic. CONCLUSION: This study confirms that dilation of aortic stenosis in neonates is effective, with encouraging immediate success but still disappointing short and midterm results.

[Percutaneous closure of atrial septal defects using the Amplatzer device]. / Fermeture percutanée des communications interauriculaires par la prothèse Amplatzer.

Percutaneous closure of an atrial septal defect (ASD) was undertaken in 10 patients aged from 3 to 33 years. The Amplatzer device was introduced intravenously and positioned under fluoroscopic and echographic control. The size of the ASD varied from 13 to 20 mm and that of the devices from 15 to 32 mm. One patient was operated for the removal of an improperly positioned device and closure of the ASD. All the other patients were discharged 24 hours after the procedure with successfull closure of the ASD. Complications were benign: spontaneously regressive arrhythmias (1 case) and migraines (2 cases). Our series reflects the experience of others, showing the faisability and efficiency of the procedure. Tridimensionnal or intracardiac echocardiography may improve this technique in the future.

Recurrence of left ventricular outflow tract obstruction after left anterior descending coronary artery revascularization in a patient with hypertrophic obstructive cardiomyopathy.

A patient with known hypertrophic obstructive cardiomyopathy presented with an anteroseptal myocardial infarction which resulted in the disappearance of his subaortic pressure gradient. Surgical revascularization of his left anterior descending coronary artery after the viability of his myocardium had been documented led to the recurrence of his left ventricular outflow tract obstruction and subaortic pressure gradient.

Aortic valve papillary fibroelastoma.

Cardiac papillary fibroelastomas are rare tumors of the heart and affect primarily the cardiac valves. These lesions are responsible for embolic accidents that clinically manifest as neurological and cardiovascular symptoms. We describe the case of a 40-yr-old woman who presented with a neurological deficit caused by a papillary tumor of the aortic valve. Diagnosis was made by transesophageal echocardiaphy and the tumor was surgically removed.

[Transcatheter closure of the patent ductus arteriosus in children. The first Lebanese series]. / Fermeture percutanée du canal artériel chez l'enfant. Une première série au Liban.

UNLABELLED: Percutaneous closure of the patent ductus arteriosus (PDA) has become an efficient and safe technique in children. We report the first Lebanese series of 8 children who had their PDA closed percutaneously with a coil or an Amplatzer Duct Occluder. METHODS: Patients median age was 3.2 years (range 1.2 to 12 years). The median minimal diameter of the PDA was 2.1 mm (1.2 to 4 mm). A coil was used in 4 children and an Amplatzer occluder in the 4 other patients. The device was chosen according to the diameter of the PDA. RESULTS: The results were excellent in all patients. A trivial shunt present in 3 cases, disappeared within 8 weeks. No complication were noted in this series. CONCLUSION: Percutaneous closure of the PDA in children, using interventional radiology, is a simple and reproducible technique. It is now the treatment of choice in most pediatric cardiac centers worldwide.