Effect of sequential coronary artery bypass venous grafting on right ventricular functions assessed by tissue Doppler echocardiography

Background

Coronary artery bypass graft surgery is a well-known and proven method of treatment for coronary artery disease. A modification of this method is complete revascularisation of the right ventricle by sequential bypass grafting of the right coronary artery, the effects of which on ventricular function need to be clarified. We sought to determine the effect of the sequential bypass graft method on right ventricular (RV) function utilising tissue Doppler echocardiography.

Methods

A total of 35 coronary artery disease patients (group A: 20 sequential grafts; group B: 15 individual grafts) were enrolled. Patients were examined pre-operatively with tissue Doppler echocardiography for RV function, and again postoperatively after the first month.

Results

Pre-operatively, there were no significant differences with regard to demographics or basal echocardiographic findings. On the other hand, postoperative right ventricular diastolic function was found to have improved significantly as the right ventricular E wave and E/A increased (9.5 ± 1.6 vs 7.6 ± 2.7 cm/s, p = 0.009 and 1.4 ± 0.2 vs 0.9 ± 0.2, p ≤ 0.01, respectively), while the A wave and isovolumic relaxation times (6.8 ± 2.1 vs 8.3 ± 3.4 cm/s, p < 0.03 and 55.2 ± 11.9 vs 87.2 ± 16.2 ms, p < 0.001, respectively) decreased. Although the S-wave peak amplitude decreased in group A patients, it did not reach statistical significance.

Conclusions

Sequential, but not single, complete revascularisation of the right coronary artery appeared to improve the diastolic function of the right ventricle.     

The antiangiogenic effects of levosimendan in a CAM assay

BackgroundThere is a physiological balance between the stimulatory and inhibitory signals for blood vessel growth. In many symptomatic patients with peripheral artery disease, coronary artery disease, and ischemic chronic wounds, there is a pathological insufficiency of angiogenesis. Therefore, determining the angiogenic or antiangiogenic effects of molecules currently used in cardiovascular treatment is crucial. Although levosimendan is the most well studied calcium sensitizer in preclinical and clinical practice, to the best of our knowledge, there are no previous studies investigating its angiogenic or antiangiogenic effects. In the present study, we aimed to investigate the effects of levosimendan on angiogenesis.MethodsThe antiangiogenic efficacy of levosimendan was examined in vivo in the chick chorioallantoic membrane (CAM) model by using 20 fertilized eggs and drug solutions of 1 and 10 μmol/L concentrations. Decreases in the density of the capillaries were assessed and scored.ResultsSignificant antiangiogenic effects were observed at 1 and 10 μmol/L concentrations of levosimendan. The antiangiogenic scores of levosimendan at 1 and 10 μmol/L concentrations were 0.6 and 1.10, respectively. The antiangiogenic score of bevacizumab, used as a positive control, was 0.95 at 1.0 μmol/L concentration. No significant difference was found between the antiangiogenic scores of levosimendan and bevacizumab (p = 0.54).ConclusionsOur results indicate that levosimendan has antiangiogenic effects on the chorioallantoic membrane. However, these findings must be confirmed in future studies on humans.     

Diagnosis and follow up of patients with primary cardiac tumours: a single-centre experience of myxomas

Objective

In this study, 12 patients who were diagnosed as having cardiac tumours and were operated on in the Department of Cardiovascular Surgery following referral from the Department of Cardiology were enrolled between January 1995 and October 2007.

Methods

The symptoms, clinical findings, diagnostic methods, localisation of masses and surgical applications were recorded retrospectively.

Results

There were 10 female (83%) and two (17%) male patients; their ages ranged from 35 to 70 years (mean 68.7 years). Twelve patients were diagnosed with myxomas, nine of which were located within the left atrium and three in the right atrium. The most common symptoms at clinical presentation were those associated with heart failure or embolisation. Diagnosis of the tumours was made by echocardiography in all patients. The masses were completely resected in eight patients and the interatrial septae were partially excised with mass resection in two patients. The defect was reconstructed with a pericardial patch in one of the patients, and primarily reconstructed in the other. We carried out debridement with mass resection in another case. Femoro–popliteal aorto–iliac thrombo-endarterectomy was performed with mass resection in a further case.

Conclusion

Atrial myxomas are the most common primary cardiac tumours. They can cause valvular or inflow–outflow tract obstruction, thrombo-embolism, arrhythmias, or pericardial disorders. Most atrial myxomas are benign but due to non-specific symptoms, early diagnosis may be a challenge and they must be removed by surgical resection. Diagnosis and follow up with the collaboration of cardiology and cardiovascular surgery departments is important for meticulous care of these patients.     

Vascular graft infection by Staphylococcus aureus: efficacy of linezolid,teicoplanin and vancomycin systemic prophylaxis protocols in a rat model

Objective

We investigated experimentally the in vivo prophylactic efficacies of linezolid, teicoplanin and vancomycin in subcutaneously implanted dacron graft infection caused by methicillin-resistant Staphylococcus aureus (MRSA).

Materials and methods

Dacron grafts (1 cm²) were aseptically implanted into subcutaneous pockets that were surgically prepared in the backs of 50 rats. Ten of these rats were used as the control group (group I). Grafts in the remaining 40 rats were infected by inoculation of MRSA at the concentration of 2 × 10⁷ colony-forming units (CFU)/ml. Ten of these rats constituted the contaminated, untreated group II. The other three study groups comprising 10 rats each were contaminated and then treated with linezolid (group III), teicoplanin (group IV) and vancomycin (group V), respectively. All rats were sacrificed and the grafts were removed after seven days and evaluated.

Results

The bacterial count decreased in the rats from the groups treated with linezolid, teicoplanin and vancomycin. The linezolid and teicoplanin groups, however, showed a significantly lower bacterial number than the vancomycin group (p = 0.009 and p = 0.01). The intensity of inflammation was highest in the contaminated, untreated group, as expected.

Conclusions

Single-dose linezolid, teicoplanin and vancomycin for peri-operative prophylaxis may prevent bacterial growth in vascular graft infections. The effect of linezolid and teicoplanin seemed similar and their effect was greater than that of vancomycin.     

Early thrombosis in bovine mesenteric vein grafts after infrainguinal reconstruction

INTRODUCTION:

Autologous vein grafts are still the gold standard in infrainguinal arterial bypass grafting procedures. However, due to the unavailability of suitable autologous vein grafts, heterogeneous grafts are usually preferred. In the present study, surgical outcomes with bovine mesenteric vein grafts (ProCol, Hancock Jaffe Laboratories, USA) in the infrainguinal location in patients with ischemic leg infection or necrosis are presented.

METHODS:

Seven patients who underwent infrainguinal arterial reconstructions with ProCol grafts were evaluated retrospectively.

RESULTS:

Graft thrombosis was seen in two patients on postoperative day 1 (28.5%). The shortest and the longest patency durations were six and 18 months, respectively. Aneurysmal dilation developed postoperatively in two grafts (28.5%) after 12 and 18 months, respectively.

CONCLUSION:

In cases where infection accompanies ischemia, and autologous veins are not available as graft materials, ProCol grafts can be used as temporary grafts in infrainguinal arterial reconstructions. The use of the graft is believed to be unacceptable for any indication other than infection due to its low short- and long-term patency rates and high risk of aneurysm formation in this location.     

Frequency of the mdr-1 C>T gene polymorphism in patients with COPD

BACKGROUND AND AIM:

The multi‐drug resistant‐1 (MDR‐1) gene is located on human chromosome 7 and encodes a glycosylated membrane protein that is a member of the ATP‐binding cassette transporters superfamily. The aim of the study was to reveal the role of the C3435T MDR‐1 gene polymorphism in chronic obstructive pulmonary disease.

METHOD:

DNA samples from 41 patients with chronic obstructive pulmonary disease and 50 healthy control participants were used to compare MDR‐1 gene profiles. Genotyping assays were performed using the StripAssay technique that is based on reverse‐hybridization.

RESULTS:

The T allele polymorphism in the MDR‐1 gene located at position 3435 in exon 26 was shown to correlate with chronic obstructive pulmonary disease.

CONCLUSION:

These preliminary results suggest that the T allele polymorphism of the MDR‐1 gene is associated with chronic obstructive pulmonary disease.     

Pulmonary lymphangitic sarcomatosis and a review of the literature

Intrapulmonary spread of a sarcoma via lymphatics is a rare cause of death in a young adult. A 31-year old man was admitted to our hospital complaining of dyspnea and malaise of 2 months’ duration. A chest radiography revealed bilateral hilar enlargement, and reticulonodular infiltrations. Thoracic CT-scans demonstrated mediastinal lymphadenopathy, thickening of interlobular septa, polygonal lines, and thickening of bronchovascular bundles. The diagnosis was made by open-lung biopsy. The patient died within 3 months after diagnosis. Pulmonary lymphangitic sarcomatosis is a rare but important manifestation of an angiosarcoma. Optimal treatment of these patients is not well defined, but a trial of chemotherapy may be warranted.