Mitral valve replacement in a patient with idiopathic hypereosinophilic syndrome and pulmonary arterial hypertension.

BACKGROUND AND AIMS: Idiopathic hypereosinophilic syndrome, a rarely seen systemic disease, may cause cardiac valvular lesions by eosinophilic infiltration. This report describes management of a 25-year-old woman with idiopathic hypereosinophilic syndrome, severe mitral stenosis, and pulmonary arterial hypertension. METHODS: The patient was presented with haemoptysia and dyspnea on exertion. Echocardiography showed severe mitral stenosis and pulmonary arterial hypertension. RESULTS: After hematological stabilization, she underwent mitral valve replacement using a No. 27 bovine pericardial valve. In the intensive care unit she had a pulmonary hypertensive crisis, which ameliorated gradually with sedation and nitroglycerin. She was extubated and discharged on the second and seventh days, respectively. CONCLUSION: Surgical experience for the patients with mitral dysfunction caused by idiopathic hypereosinophilic syndrome is limited. When mitral valve replacement is needed, the ideal type of prosthesis remains unclear and the presence of pulmonary arterial hypertension further complicates the management. We think that bioprosthetic valves would be the appropriate choice in eosinophilic mitral dysfunction requiring valve replacement.

Comparison of neopterin levels in patients with coronary artery ectasia versus patients with obstructive coronary artery disease.

OBJECTIVES: Inflammation has been reported as an important component of vascular aneurysm formation, as found in obstructive vascular disorder. Neopterin is produced by activated macrophages and is thought to represent a marker of immune activation and macrophage activity. The plasma neopterin levels were investigated in coronary artery ectasia (CAE) patients to investigate the role of inflammation. STUDY DESIGN: The study population consisted of three groups: the first consisted of 28 patients with isolated CAE without stenotic lesion; the second of 27 patients with obstructive coronary artery disease (O-CAD) without CAE; and the third group of 15 control subjects with normal coronary arteries (NCA). Plasma soluble neopterin levels were measured in all patients and control subjects using commercially available enzyme-linked immunosorbent assay kits. RESULTS: Plasma neopterin levels were found to be significantly higher in patients with isolated CAE compared with control subjects with angiographically NCA (18.5 +/- 8.8 versus 8.7 +/- 2.6 nmol/L, respectively, P = 0.006). Although neopterin levels were higher in patients with CAE than in patients with O-CAD, they did not reach the statistically significant levels (18.5 +/- 8.8 versus 16.8 +/- 8.2 nmol/L, respectively, P = 0.77). Patients with O-CAD had significantly higher levels of neopterin compared with subjects with angiographically NCA (16.8 +/- 8.2 versus 8.7 +/- 2.6 nmol/L, respectively, P = 0.03). The mean serum neopterin levels in patients with single-vessel, two-vessel, and diffuse ectasia were as follows: 17.4 +/- 9.9 nmol/L, 19.5 +/- 8.9 nmol/L, and 20 +/- 5.5 nmol/L, respectively (P = 0.4). CONCLUSION: Patients with isolated CAE have raised levels of neopterin compared with patients with NCA, showing the possible role of inflammatory processes (monocyte/macrophage activity) in the higher levels of neopterin in patients with O-CAD.

Elevated carbohydrate antigen 125 levels in hypertrophic cardiomyopathy patients with heart failure.

Carbohydrate antigen 125 (CA 125), known as a tumor marker for ovarian cancer, has been reported to increase and relate to severity in heart failure patients with systolic dysfunction. Hypertrophic cardiomyopathy (HCM) has a wide clinical spectrum that often includes heart failure symptoms. The aim of this study was to evaluate the role of CA 125 in HCM patients, its relation to severity of symptoms, and degree of diastolic dysfunction. CA 125 blood levels were determined in 32 HCM patients (21 male; age 51.3 +/- 18.4 years) and in 30 healthy volunteers (19 male; age 49.6 +/- 16.1 years). Echocardiographic examinations were performed in all patients. The results were grouped according to clinical status (New York Heart Association class) of the patients. The mean serum level of CA 125 was 14.6 +/- 23.8 U/ml in the study group and 7.6 +/- 4.8 U/ml in the control group. There was no significant difference between the groups (P = 0.12). CA 125 levels increased as the New York Heart Association functional class increased (class I/II: 6.2 +/- 2.4 U/ml; class III: 30.6 +/- 36.4 U/ml; P < 0.001). The mean CA 125 level in functional class III patients (30.6 +/- 36.4 U/ml) was significantly higher than that of the control group (7.6 +/- 4.8 U/ml) (P < 0.001) and the functional class I/II group (6.2 +/- 2.4 U/ml) (P < 0.001). There was a significant difference over all three diastolic dysfunction groups with respect to CA 125 levels (4.9 +/- 1.3 U/ml in impaired relaxation group, 11.8 +/- 6.9 U/ml in pseudonormal group, and 52.6 +/- 45.6 U/ml in restrictive filling group; P < 0.0001). Serum CA 125 is related to the clinical severity of HCM. Whether CA 125 has a specific biological role in HCM requires further investigation.

Statin use before by-pass surgery decreases the incidence and shortens the duration of postoperative atrial fibrillation.

BACKGROUND: The aim of the present observational study is to search the incidence of postoperative atrial fibrillation (AF) in patients with or without preoperative statin treatment. METHODS AND RESULTS: The population consisted of 362 consecutive patients (267 on and 95 not on statin). Diabetes mellitus was more frequent in statin group (p = 0.03). Other demographic and procedural variables were similar in the both groups (All p > 0.05). Postoperative AF was less frequent and its duration was shorter in statin group compared to non-statin group (p = 0.03 and 0.0001, respectively). The Kaplan-Meier analysis showed the protective effect of statins against the risk of developing AF (p = 0.01). CONCLUSION: Statin treatment before the by-pass surgery decreases the incidence and shortens the duration of postoperative AF.

Effect of atorvastatin on the recurrence rates of atrial fibrillation after electrical cardioversion.

To study the effect of atorvastatin on recurrence of atrial fibrillation (AF) after electrical cardioversion (EC), 48 patients with AF lasting 48 hours who were scheduled for EC were randomized to the atorvastatin (group I) and control (group II) groups. Six patients in group I (25%) and 2 patients in group II (8.3%) had spontaneous conversion before EC (p >0.05). The end point was the recurrence of AF during 3 months of follow-up. Eighteen patients in group I (12.5%) and 11 patients in group II (45.8%) had recurrence (p = 0.01, log-rank test). With the Cox proportional model, the predictors of recurrence included a body mass index of 25 to 30 kg/m2 (relative risk [RR] 0.07, 95% confidence interval [CI] 0.008 to 0.59), body mass index > or = 30 kg/m2 (RR 0.24, 95% CI 0.08 to 0.72), AF duration of > or = 3 months (RR 0.28, 95% CI 0.09 to 0.83), diabetes mellitus (RR 0.34, 95% CI 0.12 to 0.98), and left atrial diameter of > or = 45 mm (RR 0.23, 95% CI 0.07 to 0.74). Atorvastatin was associated with a significantly reduced risk of developing AF (unadjusted RR 0.23, 95% CI 0.064 to 0.82, p = 0.024). This association remained significant after adjustment for these predictors (adjusted RR 0.19, 95% CI 0.052 to 0.72, p = 0.01). High-sensitivity C-reactive protein levels at baseline were not different between the 2 groups (p = 0.92). Although the high-sensitivity C-reactive protein levels decreased significantly 48 hours after EC compared with the baseline levels in group I (2.82 +/- 1.46 vs 2.56 +/- 1.3 mg/dl, p = 0.02), no significant change occurred in group II (2.87 +/- 0.8 vs 2.84 +/- 0.8 mg/dl, p = 0.09). In conclusion, atorvastatin decreased the recurrence rate of AF after EC.

Membranous interventricular septal aneurysm and associated atrioventricular block causing symptoms in a 65-year-old man.

BACKGROUND: Membranous interventricular septal aneurysm has been reported to accompany atrioventricular (AV) conduction defects. If it is accompanied by AV block, patients generally become symptomatic before the age of 40. CASE REPORT: A 65-year-old male presented with presyncope and extreme fatigue for one week. Resting ECG showed a 2: 1 AV block. Transthoracic echocardiography revealed an interventricular septal aneurysm without any shunt. After making the diagnosis of type 2 second-degree AV block, a DDDR pacemaker was implanted. CONCLUSIONS: We presented a 65-year-old male with new-onset presyncope. A diagnosis of septal aneurysm and associated AV block was made and a pacemaker was implanted.

Effects of morning versus evening intake of atorvastatin on major cardiac event and restenosis rates in patients undergoing first elective percutaneous coronary intervention.

It is not known whether taking atorvastatin in the morning versus in the evening has a different effect on major cardiac event and restenosis rates in patients undergoing percutaneous coronary intervention. Therefore, the aim of the present study was to investigate the effects of morning versus evening intake of atorvastatin on major cardiac events and restenosis rates and also on serum lipid and high sensitivity C-reactive protein levels in patients with single-vessel disease who underwent first elective percutaneous coronary intervention.

The diameters of the aorta and its major branches in patients with isolated coronary artery ectasia.

We designed this study to evaluate the diameters of the aorta and its major branches in patients who had coronary ectasia. We assigned 80 patients (mean age, 57 +/- 11 yr) with isolated coronary artery ectasia to the study group and 25 patients (mean age, 54 +/- 10 yr) without structural or coronary arterial disease to the control group. All patients underwent coronary angiography and angiography of the aorta and its branches. We used computed quantitative angiography to measure the diameters of the coronary arteries, the aorta, and the major aortic branches. Within the study group, the diameter indices of the proximal portions of the right common iliac artery (P=0.041) and the left common iliac artery (P=0.035) were significantly larger than the diameter indices within the control group. The diameter indices of all other evaluated arteries were similar in both groups (all P >0.05).

Effect of clopidogrel plus aspirin on tissue perfusion and coronary flow in patients with ST-segment elevation myocardial infarction: a new reperfusion strategy.

BACKGROUND: Current reperfusion strategies may fail to achieve optimal tissue perfusion in ST-elevation myocardial infarction (STEMI). We investigated the effect of clopidogrel plus aspirin on tissue perfusion and coronary flow in infarct patients treated with fibrinolytic agents. METHODS: Consecutive 78 patients with STEMI were randomized to receive clopidogrel plus aspirin (clopidogrel group, n = 42) or placebo plus aspirin (placebo group, n = 36) before streptokinase. Maximum and total ST-segment resolutions (sumSTR) were calculated at 90 minutes after fibrinolysis. TIMI flow grade and corrected TIMI frame count in infarct-related artery were evaluated at predischarge. Inhospital ischemic and hemorrhagic events were also analyzed. RESULTS: Baseline characteristics were comparable in both groups. Both mean maximum ST-segment resolution (54.5 +/- 21.3% vs 44.6 +/- 22.0%, P = .047 ) and sumSTR (52.7 +/- 21.1% vs 42.8 +/- 20.7%, P = .041) were slightly higher in the clopidogrel group than placebo group. The rate of complete sumSTR 70% was significantly higher in the clopidogrel group compared with placebo group (31% vs 11%, P = .021). TIMI flows were similar in both groups, but corrected TIMI frame count was significantly lower in the clopidogrel group compared with placebo group (25.5 +/- 10.5 vs 33.5 +/- 11.8 frames, P = .027). Clinical events were comparable in 2 groups; however, there were 1 death caused by heart failure and moderate bleeding in the clopidogrel group. CONCLUSION: Our results suggest that clopidogrel plus aspirin compared with aspirin alone may improve myocardial tissue perfusion and coronary flow in STEMI patients receiving streptokinase.