Background: The slow coronary flow (SCF) phenomenon is a coronary microvascular disorder characterized by the delayed passage of contrast in the absence of obstructive epicardial coronary disease. Recent studies showed the possible role of endothelial dysfunction, diffuse atherosclerosis and inflammation in the pathogenesis of this phenomenon. We aimed to investigate the effect of statin on myocardial perfusion in patients with SCF. Methods and Results: The study population consisted of 97 patients with SCF. Coronary flow patterns of the cases are determined by thrombolysis in myocardial infarction (TIMI) frame count method. Single-photon emission computed tomographic myocardial perfusion imaging studies and lipid parameters of the patients were obtained before and after 6 months of simvastatin treatment period. During the study, daily single dose of 40 mg simvastatin has been given to each subject. We found a significant positive correlation between mean TIMI frame count and basal reversibility score (r = 0.84, p = 0.0001). In addition, analysis of the reversibility scores demonstrates that simvastatin treatment has significantly improved the myocardial perfusion abnormality at the end of the follow-up period. Conclusion: Present findings allow us to conclude that simvastatin improved myocardial perfusion in patients with SCF.
The use of coronary artery bypass grafting (CABG) in primary treatment of acute myocardial infarction is still debated. We evaluated the predictors of mortality in patients undergoing primary CABG for ST-elevated myocardial infarction (STEMI). Between January 2003 and January 2008, all patients referred to our institution with STEMI who did not qualify for primary angioplasty and required CABG were included in this study. Survivors and nonsurvivors were compared retrospectively in terms of demo-graphics, preoperative, intraoperative, and postoperative characteristics. Preoperatively confirmed cases of STEMI (n = 150) were included in the analysis. There were 114 survivors and 36 nonsurvivors. In-hospital mortality rate was 22%. In Cox regression analysis age, cardiogenic shock (Killip ≥3), preoperative cardiac troponin levels, preoperative use of intra-aortic balloon counterpulsation (IABP), previous myocardial infarction, and percutaneous coronary intervention were independent predictors of in-hospital mortality. After multivariate analysis, factors predicting in-hospital mortality were age, preoperative cardiac troponin levels, and preoperative IABP. Age, preoperative cardiac troponin levels, and preoperative IABP use were predictive factors of in-hospital mortality in patients undergoing primary CABG for STEMI.
Routine use of intravascular shunting for a stenotic carotid artery with contralateral occlusion may not be necessary. The choice of using a shunt is safe when made intraoperatively by assessing the neurological status of the patient continuously. This requires expertise and strong cooperation between the anaesthesiologist and the surgical teams.
Objective: Atrial fibrillation (AF) is a common complication of cardiovascular surgery and its mechanisms are not well understood. The aim of our study was a prospective investigation of the relationship between AF development and tissue or blood magnesium levels. Methods: This prospective observational study evaluated 20 patients undergoing elective initial coronary artery bypass graft (CABG) surgery. Right atrial appendage and skeletal muscle samples were obtained for tissue magnesium level analysis before, during (at 60 th minute) and 30 minutes after cardiopulmonary bypass (CPB) with simultaneous blood samples. Daily measurements of blood Mg levels and continuous monitoring for AF were performed for 7 postoperative days. Statistical analyses were performed using ANOVA, independent samples t and Chi-square tests. Results: AF developed in 5 out of 20 patients during postoperative period (25%). Patients with or without AF did not differ in terms of tissue and blood magnesium levels during and early after CPB and during 7 days after the operation. Blood magnesium levels were significantly higher in the whole study population on postoperative days 3 through 7 (day 3 -1.13±0.11 mmol/L; day 4-, 1.18±0.07 mmol/L; day 5-1.15±0.10 mmol/L; day 6-1.17±0.08 mmol/L; and day 7, 1.22±0.08 mmol/L) compared to day 1 and day 2 (day 1-0.96±0.13 mmol/L and day 2-1.02±0.12 mmol/L; p<0.002 for all comparisons). Conclusion: Although patients with and without AF did not significantly differ with regard to blood and tissue magnesium levels, the coincidence of an early postoperative reduction in magnesium levels in all patients and occurrence of all AF incidences at this time period suggests a potential association deserving further investigation. (Anadolu Kardiyol Derg 2010; 10: 446-51) Key words: Coronary artery bypass grafting, atrial fibrillation, tissue magnesium level, blood magnesium level ÖZET Amaç: Atriyal fibrilasyon (AF), mekanizması halen tam olarak anlaşılmamakla birlikte kardiyovasküler cerrahi sonrası en sık karşılaşılan komplikasyonlardan biridir. Çalışmamızda, prospektif olarak doku ve kan magnezyum seviyelerine ile AF arasındaki ilişkinin araştırılması planlanmıştır. Yöntemler: Bu prospektif gözlemsel çalışmada, elektif koroner arter baypas greft cerrahisi uygulanacak 20 hastanın kardiyopulmoner baypas öncesi, pompanın 60. dakikası, pompadan sonraki 30. dakikada eş zamanlı olarak atriyum dokusu, rektus abdominis kas dokusu ve kan örnekleri, ayrıca postoperatif 7 gün boyunca günlük kan örnekleri alındı ve magnezyum seviyelerine bakıldı. AF postoperatif 7.güne kadar sürekli monitorize edildi. İstatistiksel analizlerde ANOVA, bağımsız örneklem t ve Ki-kare testleri kullanıldı. Bulgular: Postoperatif dönemde 20 hastadan 5'inde AF gelişti (%25). AF gelişen ve gelişmeyen hastalar arasında kardiyopulmoner baypas öncesi, sırası ve sonrasındaki kan ve doku magnezyum düzeyleri ve postoperatif 7 gün boyunca kan magnezyum düzeyleri açısından fark yoktu. Tüm hastalarda ise kan magnezyum düzeyleri 3 ile 7. günler arasında (3. gün ...
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