89 research outputs found
Rhabdomyolysis due to the additive effect of statin therapy and hypothyroidism: a case report
We describe a patient with previously undiagnosed hypothyroidism who developed rhabdomyolysis while taking a statin. He had no other precipitating factors. The statin was stopped, intravenous fluids were started immediately and L-thyroxin was given after confirming the diagnosis of hypothyroidism. His symptoms improved over a few days. Because rhabdomyolysis is a rare but potentially life threatening disorder when complicated by acute tubular necrosis and renal failure, physicians must pay special attention when starting statins in patients with hyperlipidemia
Impact of transcatheter aortic valve implantation on the left ventricular mass
Background: Aortic stenosis (AS) induces pressure overload of the left ventricle (LV) and results in left ventricular hypertrophy. The remodeling of the LV in patients with AS is a complex process including structural and functional disturbances. After aortic valve replacement, reverse remodeling of LV begins. The aim of this study was to evaluate the impact of transcatheter aortic valve ımplantation (TAVI) on LV mass (LVM) in early and mid-term follow-ups after the procedure.
Methods and Results: We enrolled consecutive 75 patients who underwent successful TAVI. Transthoracic echocardiography was performed prior to TAVI and at hospital discharge, in the 1st month and 6th month of the follow-ups. The mean LV ejection fraction improved significantly after TAVI (54.2 ± 15.0% to 57.3 ± 11.7%, p < 0.001). There were no significant changes between the baseline and discharge mean LVM and LVM index values (LVMI; p = 0.1). However, LVMI decreased significantly in the 1st month of follow-up compared to baseline (123.3 ± 20.3 to 127.9 ± 21.3 g/m2, respectively, p < 0.001). Also, significant regression of LVM was observed at the 1st month of follow-up compared to baseline (228.3 ± 33.5 g vs. 236.5 ± 34.2 g, respectively, p < 0.001). Furthermore, the significant regression in both of LVM and LVMI continued at 1st and 6th months of the follow-ups (p < 0.001).
Conclusions: A significant regression of LVM was observed after TAVI. These changes may have prognostic value in patients with severe AS
Immediate recovery of the left atrial and left ventricular diastolic function after transcatheter aortic valve implantation: A transesophageal echocardiography study
Background: Chronic increased afterload due to severe aortic stenosis (AS) results in compensatory concentric left ventricular (LV) hypertrophy and LV dysfunction. These in turn cause remodeling of the left heart. The aim of this study was to investigate the acute effect of transcatheter aortic valve implantation (TAVI) on left atrial (LA) mechanics and LV diastolic function.
Methods: The study consisted of a total of 35 consecutive patients (mean age was 77.7 ± 5.0 years, 25 female) undergoing TAVI. All TAVI procedures have been performed under the transesophageal echocardiography (TEE) guidance. Before and 24 h after TAVI, all patients underwent transthoracic echocardiography (TTE) and mitral inflow velocities with pulsed-wave (PW) Doppler including early filling wave (E), late diastolic filling wave (A), and E/A ratio were obtained. LV diastolic function was also explored by pulsed tissue Doppler imaging (TDI). Early (E’) and late (A’) diastolic annular velocities, E’/A’ ratio and E/E’ ratio were obtained. In addition, during the procedure before and minutes after the valve implantation, the left atrial appendage-peak antegrade flow velocity (LAA-PAFV) was measured and recorded with TEE.
Results: Compared with baseline, the mean mitral E, septal E’ and E’/A’ ratio increased significantly after TAVI. In addition, the LAA-PAFV increased significantly within minutes of TAVI (32.45 ± 10.7 cm/s vs. 47.6 ± 12.6 cm/s, p < 0.001).
Conclusions: TAVI improves LV diastolic function and LA performance immediately
Impact of transcatheter aortic valve implantation in patients with reduced ejection fraction
Background: Aortic stenosis increases with age. According to guidelines, left ventricular systolic dysfunction is an indication for aortic valve replacement, even in asymptomatic patients. There is no clear data on the application of transcatheter aortic valve implantation (TAVI), which is a method showing continuous improvement in recent years, in patients with reduced ejection fraction (REF) having a poor prognosis for surgical aortic valve replacement. We therefore aimed to investigate the effect of TAVI on left ventricular ejection fraction (LVEF) and also its efficacy and safety in patients with REF. Methods and results: The study included 104 patients who underwent transfemoral TAVI in our clinic. The patients were divided into two groups: LVEF ≤ 45% (REF group, n = 28) and LVEF > 45% (preserved ejection fraction [PEF] group, n = 76). Follow-up measurements were performed at baseline, discharge, 1st, 6th and 12th months. No statistical difference was found between the groups with respect to complications and mortality rates. A statistically significant difference was detected in LVEF after TAVI, either in all patients (53.9 ± 14.6, 57.0 ± 11.4, 59.4 ± 8.4, 60.4 ± 6.8, 63.2 ± 3.9, respectively, at baseline, discharge, 1st, 6th and 12th months, p < 0.001) or in the groups separately. A statistically significant increase in LVEF (p < 0.001) was determined at discharge, 1st, 6th and 12th months, whereas LVEF increased in all follow-ups of the PEF group, however this elevation reached a statistical significance only at the 1st month (p = 0.04). Conclusions: Our study has shown the positive effect of TAVI on LVEF and its effective and safe applicability in patients with REF.
Effects of blood cardioplegia with deferroxamine on myocardial nitric oxide production and myocardial performance
Amaç: Bu çalişmada rutin kullanilan kan kardiyoplejisi ile deferoksaminli kan kardiyoplejisinin sol ventrikül
fonksiyonlari üzerine etkileri, myokardiyal Nitrik Oksit (NO) düzeyleri ve hemodinamik parametreler
karşilaştirilarak değerlendirildi.
Yöntem: Aortakoroner bypass operasyonu olan 20 elektif hasta üzerinde çalişma yapildi. Hastalar kontrol ve
çalişma grubu olarak 10 ar kişilik 2 gruba ayrildi. Kontrol grubunda yaş ortalamasi (61.30+2.12), çalişma grubunda
ise (53.20±3.21) idi. Her iki grupta distal anastomoz , X- klemp, Kardiyopulmoner bypass (CPB) süreleri
benzer değerlerdeydi (p>0.05). Kardiyopleji iki gruba da antegrad yoldan verildi. Kan örnekleri koroner sinüsten
alinarak ölçümler yapildi. Hemodinamik parametreler CPB öncesi ve sonrasinda ayri ayri değerlendirildi.
Bulgular: Çalişma grubunda NO düzeyleri tüm örneklemelerde yüksek bulundu ancak yalnizca CPB sonrasinda
istatistiksel olarak anlamli idi. Myokard hasarinin bir göstergesi olan kreatin kinaz MB izoenzim (CK-MB)
değerleri çalişma grubunda daha düşük düzeyde bulundu (p< 0.05). Her iki grup arasinda hemodinamik olarak bir
farklilik gözlenmedi.
Sonuç: Bu bulgular, deferroksaminli kan kardiyoplejisi kullanilan vakalarda endotel fonksiyonlarinin daha iyi
korunduğunu ve myokard hasarinin daha az olduğunu göstermektedir. Deferroksaminli kan kardiyoplejisi açik
kalp cerrahisinde aortik kross klemp esnasindaki myokard korunmasinda iyi bir seçenektirObjective: The effects of deferroxamine addition to routine blood cardioplegia on left ventricular function,
myocardial nitric oxide (NO) production and hemodynamics were assessed.
Methods: Twenty patients who underwent coronary artery bypass grafting (CABG) electively were studied in
two groups, 10 in each. Ten patients in whom routine blood cardioplegia was used served as controls. In the other
10 patients (study group), blood cardioplegia with deferroxamine was used. Mean age was 61.30+2.12 in the
control group, and 53.20±3.21 in the study group. The number of distal anastomoses, X-clamp and cardiopulmonary
bypass (CPB) times were similar in two groups. Cardioplegia was delivered antegradely in both groups.
Blood samples were taken from the coronary sinus. Hemodynamic measurements were done before and following
CPB.
Results: In the study group, myocardial NO levels were found to be higher at all sampling times, however, the
difference was statistically significant only following CPB. Creatine kinase MB isoenzyme levels reflecting the
degree of myocardial injury were measured lower in the study group postoperatively(p<0.05). There was no
difference in hemodynamics between the two groups.
Conclusions: These findings demonstrate that the addition of deferroxamine to blood cardioplegic solution
maintains higher myocardial NO levels indicating better endothelial function and causes less myocardial injury.
Blood cardioplegia with deferroxamine is a valuable alternative method of myocardial protection during aortic
cross clamping in cardiac surgery
Rhabdomyolysis due to the additive effect of statin therapy and hypothyroidism: a case report
Abstract We describe a patient with previously undiagnosed hypothyroidism who developed rhabdomyolysis while taking a statin. He had no other precipitating factors. The statin was stopped, intravenous fluids were started immediately and L-thyroxin was given after confirming the diagnosis of hypothyroidism. His symptoms improved over a few days. Because rhabdomyolysis is a rare but potentially life threatening disorder when complicated by acute tubular necrosis and renal failure, physicians must pay special attention when starting statins in patients with hyperlipidemia.</p
Coronary artery disease incidence between type II diabetic and non-diabetic patients with Leriche syndrome
Background: Coronary artery disease (CAD) is the major determinant of
preoperative morbidity and mortality for patients requiring major
vascular surgery. The management of CAD in these patients is
controversial. Aims: The incidence and severity of CAD in diabetic and
non-diabetic patients with Leriche syndrome was explored. Settings and
design: 107 patients with Leriche syndrome were selected as major
vascular occlusion and grouped according to their diabetic Status. Sex,
age, dyslipidemia, obesity, hypertension, clinic cardiac status,
coronary angiographic lesions and coronary revascularisation procedures
were noted. Material & Methods: Patients' demographics,
intra-operative and per-operative data were recorded and compared. In
every patient with Leriche syndrome scheduled for elective vascular
reconstruction coronary angiography was performed. Lesions were
evaluated for the percentages of stenosis. Preliminary coronary bypass
or percutaneous coronary intervention was recommended for those found
to have advanced or severe CAD. Results of revascularisation procedures
were compared. Statistical analysis used: Chi-square or Fisher exact
chi-square test is used for conditional variables. Independent samples
was analysed by using t-test. Kruskal-Wallis variance test was used if
the variances are not homogeneous according to the Levene test.
Results: No difference was found in both groups except family history
and obesity. Coronary angiographic investigation indicates that 59% of
DIAB group and 38% of NONDIAB group patients have advanced or severe
CAD which has a high probability for myocardial revascularization.
Overall revascularisation rate is 37.8% in DIAB group and 45.7% in
NONDIAB group (p=0,641). Preoperative mortality was found 2.7% in
diabetics and 4.2% in non-diabetics (p=0.342). Conclusions: Leriche
syndrome with diabetes mellitus is more likely to have advanced
coronary disease than those without diabetes mellitus. Coronary
angiography and subsequent revascularisation should be performed only
in those patients who require major vascular surgery
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