Postischemic infusion of sivelestat sodium hydrate, a selective neutrophil elastase inhibitor, protects against myocardial stunning in swine

Purpose  

It seems controversial whether or not neutrophil elastase inhibitors are effective in attenuating myocardial ischemia/reperfusion injury. We thus investigated possible protective effects of sivelestat, a neutrophil elastase inhibitor, against myocardial stunning i.e., prolonged myocardial dysfunction following a brief episode of ischemia.     

Location of flow axis line in the left ventricle and its interaction with local myocardial motion

Background  

The interaction between local myocardial motion and blood flow dynamics should be assessed to evaluate left ventricular pump function.     

Use of continuous retrograde gaseous oxygen persufflation for myocardial protection during open heart surgery

Purpose  

The infusion of a cardioplegic solution is the standard method of myocardial protection during open heart surgery. However, this method interrupts the surgical procedure and it is difficult to ensure a bloodless surgical field. To address these problems, the effect of continuous retrograde gaseous oxygen persufflation (ROP) on myocardial protection was assessed in comparison to St. Thomas’ solution (STS).     

Atorvastatin pretreatment diminishes the levels of myocardial ischemia markers early after CABG operation: an observational study

Background  

Statin pretreatment has been associated with a decrease in myocardial ischemia markers after various procedures and cardiovascular events. This study examined the potential beneficial effects of preoperative atorvastatin treatment among patients undergoing on-pump CABG operation.     

17β-estradiol effects on human coronaries and grafts employed in myocardial revascularization: a preliminary study

Background  

This study was undertaken to compare the in vitro effects of 17β-estradiol on human epicardial coronary arteries, resistance coronary arteries and on arterial vessels usually employed as grafts in surgical myocardial revascularization.     

Impact of chronic cyanosis and reoxygenation on the microheterogeneity of the myocardial blood flow: digital radiographic study in neonatal rats

Purpose  

This study sought to show the heterogeneity of myocardial blood flow in the chronically hypoxic infantile myocardium and its response to reoxygenation using a novel type of digital radiography.     

Cardiac troponin T: an important predictor of late death and myocardial infarction following hip fracture: an eight-year prospective observational cohort study

Background  

Cardiac troponin is an accurate marker of minimal myocardial injury and has been shown to predict adverse outcomes in various non-acute coronary disease settings. Patients with hip fracture (HF), an osteoporotic, mostly octogenarian population, are prone to sustain myocardial injury through both peri-fracture stress and subsequent surgery (osteosynthesis or hemiarthroplasty).     

Left ventricular remodeling after myocardial infarction impairs early diastolic,but not systolic,function in the radial direction in the remote normal region

Background  

It is acknowledged that expansion of the remote normal region of the left ventricle causes remodeling after myocardial infarction (MI). However, the characteristics of that region have not been fully elucidated.     

Low bone mineral density is associated with increased risk for myocardial infarction in men and women

Summary  

The association between bone mineral density (BMD) and myocardial infarction (MI) was investigated in 6,872 men and women. For both men and women, lower BMD in the femoral neck and hip was associated with increased risk of MI largely independent of smoking, hypertension, hypertriglyceridemia, and diabetes.     

Concurrent subarachnoid haemorrhage and myocardial injury

Purpose

Subarachnoid haemorrhage is frequently associated with myocardial injury and dysfunction. This report describes such a case, reviews the understanding of this phenomenon, and discusses the implications for timing of surgical clipping of intracranial aneurysm in patients with concurrent myocardial damage.

Clinical Features

A 64-yr-old woman presented with syncope and congestive heart failure. A diagnosis of subarachnoid haemorrhage was made three days following the initial diagnosis of myocardial infarction. The patient presented for clipping of an intracranial aneurysm on day 36, after her cardiac status had stabilized. No new myocardial ischaemic events occurred, either intra-operatively or post-operatively. Ultimate neurological recovery was poor.

Conclusions

This case report demonstrates four important aspects of the clinical course of patients with concurrent subarachnoid haemorrhage and myocardial damage: 1) On presentation, cardiac features may predominate, and delay diagnosis and treatment of the underlying subarachnoid haemorrhage. 2) Left ventncular dysfunction, although dramatic, is usually transient. 3) There is confusion regarding the appropriate cardiac risk assessment and management in such patients when presenting for surgery. 4) Long-term morbidity is most often related to neurological, not medical, complications.     

Perioperative myocardial infarction in patients undergoing myocardial revascularization surgery

Introduction

Perioperative myocardial infarction adversely affects the prognosis of patients undergoing coronary artery bypass graft and its diagnosis was hampered by numerous difficulties, because the pathophysiology is different from the traditional instability atherosclerotic and the clinical difficulty to be characterized.

Objective

To identify the frequency of perioperative myocardial infarction and its outcome in patients undergoing coronary artery bypass graft.

Methods

Retrospective cohort study performed in a tertiary hospital specialized in cardiology, from May 01, 2011 to April 30, 2012, which included all records containing coronary artery bypass graft records. To confirm the diagnosis of perioperative myocardial infarction criteria, the Third Universal Definition of Myocardial Infarction was used.

Results

We analyzed 116 cases. Perioperative myocardial infarction was diagnosed in 28 patients (24.1%). Number of grafts and use and cardiopulmonary bypass time were associated with this diagnosis and the mean age was significantly higher in this group. The diagnostic criteria elevated troponin I, which was positive in 99.1% of cases regardless of diagnosis of perioperative myocardial infarction. No significant difference was found between length of hospital stay and intensive care unit in patients with and without this complication, however patients with perioperative myocardial infarction progressed with worse left ventricular function and more death cases.

Conclusion

The frequency of perioperative myocardial infarction found in this study was considered high and as a consequence the same observed average higher troponin I, more cases of worsening left ventricular function and death.     

Ventricular Function in Surgery for Congenital Heart Disease

Background  

The history of measuring myocardial edema by two-dimensional echocardiography and the pathophysiology of myocardial edema are reviewed.     

No hypoperfusion is produced in the epicardium during application of myocardial topical negative pressure in a porcine model

Background  

Topical negative pressure (TNP), commonly used in wound therapy, has been shown to increase blood flow and stimulate angiogenesis in skeletal muscle. We have previously shown that a myocardial TNP of -50 mmHg significantly increases microvascular blood flow in the myocardium. When TPN is used in wound therapy (on skeletal and subcutaneous tissue) a zone of relative hypoperfusion is seen close to the wound edge. Hypoperfusion induced by TNP is thought to depend on tissue density, distance from the negative pressure source, and the amount negative pressure applied. When applying TNP to the myocardium, a significant, long-standing zone of hypoperfusion could theoretically cause ischemia, and negative effects on the myocardium. The current study was designed to elucidate whether hypoperfusion was produced during myocardial TNP.     

Serum levels of matrix metalloproteinases -1,-2,-3 and -9 in thoracic aortic diseases and acute myocardial ischemia

Background  

Matrix metalloproteinases (MMPs) constitute a family of zinc-dependent proteases (endopeptidases) whose catalytic action is the degradation of the extracellular matrix components. In addition, they play the major role in the degradation of collagen and in the process of tissue remodeling. The present clinical study investigated blood serum levels of metalloproteinases- 1, -2, -3 and -9 in patients with acute and chronic aortic dissection, thoracic aortic aneurysm and acute myocardial ischemia compared to healthy individuals.     

Postoperative real-time electrocardiography monitoring detects myocardial ischemia: a case report

Purpose

This case report outlines the utility and challenges of remote continuous postoperative electrocardiography ECG) monitoring, which is routed through a secure smartphone to provide real-time detection and management of myocardial ischemia.

Clinical features

A 42-yr-old male with previous myocardial infarction and angioplasty underwent a radical prostatectomy. At three hours and 45 min postoperatively, remote real-time ECG monitoring was initiated upon the patient’s arrival on a regular surgical ward. Monitor alerts were routed to a study clinician’s smartphone. About six hours postoperatively, alarms were received and horizontal ST segment depressions were observed. A 12-lead ECG validated the ST segment changes, prompting initiation of a metoprolol iv and a red blood cell transfusion. Approximately seven hours and 30 min postoperatively, the ST segments normalized. The patient was discharged on postoperative day 3 and followed for four years without any sequelae.

Conclusion

This case report illustrates the use of remote ECG monitoring and clinician response in real time with the use of a smartphone. With each alert, a small ECG strip is transmitted to the smartphone for viewing. In our view, this technology and management system provides a possible means to interrupt myocardial ischemic cascades in real time and prevent postoperative myocardial infarction.

     

Mortality following hip fracture surgery in patients with recent myocardial infarction

INTRODUCTION

In an elective setting, surgery is best avoided for at least 6 months following myocardial infarction. However, in the presence of a femoral neck fracture, this would most probably lead to significant complications in relation to prolonged immobilisation. There is no published mortality data for patients undergoing surgery for hip fracture following a recent myocardial infarction. The aim of this retrospective study was to assess the mortality of hip fracture patients with a recent myocardial infarction that have undergone surgery at our institution.

PATIENTS AND METHODS

Between January 2003 and October 2005, 2270 patients were admitted to our unit with a proximal femoral fracture. Of these, 11 patients were found to have a recent myocardial infarction.

RESULTS

Of these 11 patients, 8 were female. The average age was 78.2 years (range, 59–90 years). Average delay from the time of infarction to operation was 11.2 days (range, 3–23 days). Mortality at 1 and 6 months was 45.4% and 63.5%, respectively.

DISCUSSION

This is much higher than the overall reported mortality following proximal femur fracture. This information may be useful when planning future peri-operative care and discussing overall prognosis with patients and their relatives.     

Hybrid myocardial revascularization

Background

In patients with advanced coronary artery disease (CAD), coronary artery bypass grafting (CABG) is associated with improved long-term outcomes while percutaneous coronary intervention (PCI) is associated with lower periprocedural complications. A new approach has emerged in the last decade that attempts to reap the benefits of bypass surgery and stenting while minimizing the shortcomings of each approach, hybrid myocardial revascularization (HMR).Three strategies for timing of the hybrid revascularization exists, each with their own inherent advantages and shortcomings: (1) CABG followed by PCI, (2) PCI followed by CABG, or (3) simultaneous CABG + PCI in a hybrid suite.

Studies

The results of the first randomized control trial comparing HMR (CABG first) and standard CABG, POL-MIDES (Prospective Randomized PilOt Study EvaLuating the Safety and Efficacy of Hybrid Revascularization in MultIvessel Coronary Artery DisEaSe), show HMR was feasible for 93.9% of patients whereas conversion to standard CABG was required for 6.1%. At 1 year, both groups had similar all-cause mortality (CABG 2.9% vs. HMR 2%) and major adverse clinical event (MACE)-free survival rates (CABG 92.2% vs. HMR 89.8%). Results of observational and comparative studies show that minimally invasive HMR procedures in patients with multivessel CAD carry minimal perioperative mortality risk and low morbidity and do not increase the risk of postoperative bleeding. The advantage they offer in comparison to classical surgical revascularization is indeed faster rehabilitation and patient’s return to normal life.

Conclusion

Hybrid myocardial revascularization has been developed as a promising technique for the treatment of high-risk patients with CAD. Hybrid revascularization using minimally invasive surgical techniques combined with PCI offers to a part of patients an advantage of optimal revascularization of the most important artery of the heart, together with adequate myocardial revascularization in a relatively delicate way. Indeed, to patients with high operative risk of standard surgery, it offers an alternative which should be considered carefully.

     

Ulcerated calcification of the interventricular septum causing Transient Ischemic Attacks: Case Report

Background  

Calcific deposits are frequently observed at sites of healed myocardial infarcts. Grossly visible calcification of myocardial infarcts and calcified intracavitary cardiac thrombi are less common but recently are becoming more frequent findings during surgical ventricular restoration procedures.     

Metabolic monitoring during continuous warm- and cold-blood cardioplegia by means of myocardial tissue pH and Po2

Objectives

To study the changes in myocardial tissue pH and Po₂ during cold- and warm-blood cardioplegic arrests.

Design

An experimental study in dogs.

Methods

Nine dogs underwent the following procedures: 30 minutes with an empty heart beating under cardiopulmonary bypass (control period); 30 minutes of warm (33 °C) cardioplegic arrest with a 1:4 mix of crystalloid in blood solution administered continuously at 150 mL/min; 30 minutes of cold (15 °C) cardioplegic arrest; and 30 minutes of myocardial reperfusion. The cardioplegic blood solution was administered antegradely through the ascending aorta.

Main outcome measures

Tissue pH and Po₂. Arterial and coronary sinus oxygen content and myocardial consumption calculated.

Results

There was a modest but significant increase in the left anterior descending (LAD) and circumflex (Cx) tissue pH throughout the experiment. Pmo₂ in the LAD territory averaged 44 (7) mm Hg (mean and standard error of the mean) during the bypass period, 123 (23) mm Hg at the termination of warm cardioplegic arrest, 146 (28) mm Hg at the end of cold arrest and 66 (17) mm Hg after reperfusion. Oxygen consumption averaged 0.65 (0.15) mL/min during the bypass period, 0.3 (0.18) mL/min at the end of warm arrest, 0.25 (0.16) mL/min at the end of cold arrest and 0.45 (0.08) mL/min after reperfusion (p < 0.05). Oxygen delivery to the LAD territory was greater than myocardial oxygen consumption by an average of 2.02 (0.4) mL/min during bypass, 2.02 (0.62) mL/min after warm arrest, 2.12 (0.5) mL/min after cold arrest and 1.55 (0.25) mL/min after reperfusion (p > 0.05).

Conclusions

During cardioplegic arrest, tissue Po₂ increased and oxygen consumption decreased significantly, whereas tissue pH remained normal, suggesting that continuous warm- and cold-blood cardioplegia maintained aerobic glycolysis during myocardial arrest. Thus, the increase in myocardial tissue Pmo₂ during cardioplegic arrest reflects the decrease in myocardial oxygen consumption while maintaining oxygen supply.     

Short-term and long-term outcomes of postinfarction ventricular septal perforation

Purpose  

Ventricular septal perforation represents a serious complication after acute myocardial infarction. This study aimed to evaluate the short-term and longterm outcomes of postinfarction ventricular septal perforation (VSP).