Background:Although it is accepted that inducing cardioplegia is the gold standard in myocardial protection, there is still no consensus on the exact type of the cardioplegia. There are fewer studies on the type of the cardioplegia in hearts of the children than adults and they are contradictory. The effects of esmolol have been reviewed (a type of ultrashort-acting beta-adrenergic antagonist, i.e., ß-blockers) in conjunction with the cardioplegia due to the effect of the β-blockers in reducing the myocardial ischemia and reperfusion.Materials and Methods:The left ventricle ejection fraction (LVEF), systolic blood pressure, central venous pressure (CVP), heart rate, etc., were recorded separately in patients who received the cardioplegia without esmolol (n = 35) and with esmolol (n = 30) and matched for the age and sex.Results:The amount of inotrope used in the group without esmolol (100%) was considerably higher than in the group with esmolol (86.7%). Postoperative arrhythmias did not differ significantly between the two groups. There was no significant difference in the duration of cardiopulmonary bypass (CPB), time of the extubation, length of the ICU stay, the first day EF after surgery, and the first week EF after surgery as well. Creatinine kinase-MB (CKMB) was significantly higher in the group without esmolol during operation than in the group with esmolol.Conclusions:The patients who received cardioplegia along with esmolol had less inotropic requirement after operation, and increase in EF and cardiac output (CO) 1 week after surgery. In addition, it reduced damage to the heart during surgery, and patients may have greater stability in the cardiac conduction system.
Coronary artery anomalies are reported to have a higher incidence in young victims of sudden cardiac arrest (4-15%), as compared to adults (1%). Among coronary anomalies, anomalous coronary artery arising from the opposite sinus of Valsalva (ACAOS) remains a major clinical problem which poses daunting challenges. The current paper reports on the first case with main left coronary anomalies with aortic failure due to the web sub-aortic. A 29-year-old woman with orthopnea referred to a doctor. Echocardiography and electrocardiogram (ECG) confirmed sub aortic web with severe aortic insufficiency. Subsequently, the patient was subjected to aortic valve replacement surgery and the subvalvular resection was performed. During the surgery, the aorta was initially opened and the left coronary hole was not found in the coronary sinus. Therefore, only a cardioplegia from the right coronary (artery) hole was administered to the patient. The cusps of the valve and subvalvular web were removed. During the release, the left main artery which apparently originated from the right coronary artery(RCA) was found to be damaged. Therefore, the damaged part of the left main coronary artery was repaired, the valve was placed, and the aorta was repaired. Following deaeration, cross-clamp was removed, and the right heart started to work; nonetheless, the left heart was not engaged in any activity. Therefore, the cross-clump was attached again to the aorta, and a vein graft on the left anterior descending (LAD) artery was placed on the aorta. After the removal of the cross-clamp, the heart recovered its normal function, and the patient was removed from the pump with low inotropic. Thereafter, she was transferred to the Intensive Care Unit (ICU) of open-heart surgery. The present report aimed to express the incidence of multiple complications, such as recurrence of illness, the optimal time for surgery, the best way of surgery, getting cardiologists' attention (colleagues) during angiography, and knowing the characteristics of these abnormalities.
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