SummaryAimInsufficient oxygen supply to organs and tissues due to reduced arterial or venous blood flow results in ischaemia, during which, although ATP production stops, AMP and adenosine continue to be produced from ATP. The fate of irisin, which causes the production of heat instead of ATP during ischaemia, is unknown. Iloprost and sildenafil are two pharmaceutical agents that mediate the resumption of reperfusion (blood supply) via vasodilatation during ischaemic conditions. Our study aimed to explore the effects of iloprost and sildenafil on irisin levels in the heart, liver and kidney tissues and whether these pharmaceutical agents had any impact on serum irisin and nitric oxide levels in rats with induced experimental myocardial ischaemia.MethodsThe study included adult male Sprague-Dawley rats aged 10 months and weighing between 250 and 280 g. The animals were randomly allocated to eight groups, with five rats in each group. The groups were: sham (control), iloprost (ILO), sildenafil (SIL), ILO + SIL, myocardial ischaemia (MI), MI + ILO, MI + SIL and MI + ILO + SIL. The treatment protocols were implemented before inducing ischaemia, which was done by occluding the left coronary artery with a plastic ligature for 30 minutes. Following the reperfusion procedure, all rats were sacrificed after 24 hours, and their heart, liver and kidney tissues and blood samples were collected for analyses. An immunohistochemical method was used to measure the change in irisin levels, the ELISA method to quantify blood irisin levels, and Griess’ assay to determine nitric oxide (NO) levels in the serum and tissue. Myocardial ischaemia was confirmed based on the results of Masson’s trichrome staining, as well as levels of troponin and creatine kinase MB.ResultsIrisin levels in biological tissue and serum dropped statistically significantly in the ischaemic group (MI), but were restored with ILO and SIL administration. Individual SIL administration was more potently restorative than individual ILO administration or the combined administration of the two agents. NO level, on the other hand, showed the opposite tendency, reaching the highest level in the MI group, and falling with the use of pharmaceutical agents.ConclusionsIndividual or combined administration of ILO and SIL reduced myocardial ischaemia and NO levels, and increased irisin levels. Elevated levels of irisin obtained by drug administration could possibly contribute to accelerated wound recovery by local heat production. Sildenafil was more effective than iloprost in eliminating ischaemia and may be the first choice in offsetting the effects of ischaemia in the future.
No important adverse effect was detected during levosimendan infusion. Because levosimendan at a dose of 0.03-0.05 μg/kg/min increased myocardial performance significantly in the postoperative period, it can be used safely in end-stage renal disease patients undergoing isolated CABG. The requirement of vasopressors were lower in SG.
Using the off-pump technique is safe and improves postoperative early outcomes in high-risk patients with LMCA disease.
Objective: There is no common concencus the clinical results of coronary artery bypass grafting (CABG) surgery patients who underwent off-pump or conventional techniques. Our aim of this study was to compare the changes of myocardial functions, patients' clinical results, biochemical marker release during surgery and postoperatively in On-and Off-Pump CABG surgery. Method: A consecutive series of 50 coronary artery disease (CAD) patients who underwent elective CABG surgery included for this study. The patients were divided into two groups (Group 1, N = 25 and group 2, N = 25). Demographic data including the patients' age, gender, body mass index (BMI), diseased coronary artery numbers, LVEF were similar. Postoperative red package blood cell, fresh frozen plasma, and thrombocyte requirements were high in On-Pump group (p < 0.05). But there was not any significant difference when compared the number of unexpected surgery because of mediastinal bleeding after operations in both groups. Preoperative and postoperative N-Terminal Pro-Brain Natriuretic Peptide (NT-proBNP), cardiac Troponin-I (cTnI) levels during and after surgery, and left ventricular ejection fractions (LVEF) prior to discharge from hospital were compared. Results: There were no statistical significancy when compared postoperative mortality and morbidity. The operations time was low in off-pump group (p < 0.05). The NT-proBNP levels were similar in both groups (p > 0.05). However, cTnI levels were significantly higher in the on-pump group (p = 0.0001). Postoperative LVEF decreased significantly in both groups when compared to preoperative echocardiography examinations (p = 0.001). But the changes of postoperative LVEFs in both groups were not statistical significant (p > 0.05). Conclusion: Our study results indicated that cardiac enzyme release was high after On-Pump CABG surgery. However, LVEF decreased in both techniques. There were some advantages of OPCAB operations such as decrease of inflammatory responses and angina pectoris incidence due to extracorporeal circulation; however, these techniques did not affect postoperative mortality and morbidity. Therefore, in selected cases to provide longer operation time, Off-Pump CABG could be used but it has no superiority over On-Pump CABG surgery.
A 52-year-old patient was admitted in our hospital for postinfarction ventricular septal defect (VSD), left ventricular aneurysm and coronary artery disease. He was investigated by echocardiography and coronary angiography and proposed for operation. In the light of the patient's stable hemodynamic condition, surgical intervention was delayed. 3 weeks following the acute myocardial infarction open heart surgery was performed and had been managed just pre-operatively with an intra-aortic balloon pumping. The patient underwent successful VSD closure with a patch. The repair involves VSD closure and infarct exclusion technique. The patient discharged 10 days postoperatively. We consider that this modification is a simple and effective way to decrease the surgical risk of postinfarction VSD.
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