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

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>Twenty patients that had received atorvastatin treatment for at least 15 days prior to the operation and 20 patients who had not received any antihyperlipidemic agent prior to surgery were included in this study. CK-MB and troponin I levels were measured at baseline and 24 hours after the operation. Perioperative variables were also recorded.</p> <p>Results</p> <p>Twenty-four hours after the operation, troponin I and CK-MB levels were significantly lower in the atorvastatin group: for CK-MB levels, 12.9 ± 4.3 versus 18.7 ± 7.4 ng/ml, p = 0.004; for troponin I levels, 1.7 ± 0.3 versus 2.7 ± 0.7 ng/ml, p < 0.001. In addition, atorvastatin use was associated with a decrease in the duration of ICU stay.</p> <p>Conclusions</p> <p>Preoperative atorvastatin treatment results in significant reductions in the levels of myocardial injury markers early after on-pump CABG operation, suggesting a reduction in perioperative ischemia in this group of patients. Further studies are needed to elucidate the mechanisms of these potential benefits of statin pretreatment.</p

Optimization of Y-shaped micro-mixers with a mixing chamber for increased mixing efficiency and decreased pressure drop

In this study, Y-shaped micromixers with mixing chamber design optimized as rotation and chaotic advection in the fluid domain increase with the chamber. Motivated by the advantages of Y-shaped mixers, a parametric study was performed for inlet angles (a, b), inlet channel eccentricities (x-ecc, z-ecc) and length scale ratios (L1/L2, D1/D2, and Vsp). z-eccentricity is introduced in addition to x-eccentricity to create a design that further enhances the swirl and chaotic advection inside mixing chamber for the first time. The results reveal that the maximum mixing efficiency can be achieved for Reynolds number of 81 and a, b, x-ecc, z-ecc, D1/D2, and L1/L2 values of 210◦, 60◦, 20 lm, 20 lm, 1.8, and 4, respectively. In addition, the proposed Y-shaped micromixer leads to a lower pressure drop (at least 50% reduction for all Reynolds numbers) in comparison to competing design. The maximum reduction in pressure drop is 72% less than the curved-straight-curved (CSC) (Re ¼ 81) with mixing efficiency of 88% and pressure drop of 9244.4 Pa. Overall, an outstanding mixing efficiency was offered over a wide range of Reynolds numbers with distinctly low pressure drop and a compact micromixer design, which could be beneficial for a wide variety of applications where volume and pumping power are limited

Predictive value of platelet to lymphocyte ratio and mean platelet volume in atrial fibrillation after isolated coronary artery bypass graft operation

Aim: The relationship between inflammation and the development of atrial fibrillation and the relationship between platelet tolymphocyte ratio and mean platelet volume in relation to inflammation were investigated in patients with atrial fibrillation afterisolated coronary artery bypass graft operation.Material And Methods: Clinical and laboratory data of 132 patients, who did not have preoperative atrial fibrillation and underwentisolated coronary artery bypass graft operation using cardiopulmonary pump, were analyzed retrospectively. Patients were dividedinto two groups as patients with developed atrial fibrillation and those without atrial fibrillation. Concomitant diseases, preoperativedrug use, echocardiographic and angiographic findings, preoperative, intraoperative and postoperative laboratory parameters wereobtained from medical records and compared statistically.Results: Of the 132 patients, 68 with atrial fibrillation (mean age: 68.3/-10.7 years, 50 males and 18 females) and 64 patientswithout atrial fibrillation (mean age: 64.5/-9.8 years, 55 males and 9 females) were identified, and difference in the mean agewas statistically significant (p0.016). Postoperative platelet to lymphocyte ratio and mean platelet volume values (280.3/-112.3;9.9/-1.7) were also significantly higher in those with atrial fibrillation group than preoperative values (129.2/-49.3; 9.6/-1.6,p0.0001, p0.0009).Conclusıon: According to our study higher values of postoperative platelet to lymphocyte ratio and mean platelet volume arecorrelated with development of atrial fibrillation after coronary artery bypass graft operation

Sutureless Aortic Valve Replacement with Minimally Invasive Method: Case Report

Kliniğimize Aort Darlığı (AD) tanısıyla kabul edilen iki hastamıza, ileri yaş ve klasik cerrahi riskinin yüksek olması nedeniyle anterior torakotomi ile minimal invaziv girişim yapılarak dikişsiz aort kapağı implantasyonu yapılmıştır. Minimal invaziv girişimin ileri yaş ve yüksek riskli ciddi aort darlığı olan hastalarda, klasik cerrahiye oranla çok daha uygun bir cerrahi tedavi seçeneği olduğu kanısındayız.Two patients accepted to our clinic with the diagnosis of aortic stenosis were considered to have high risk for classic surgery and were planned to undergo aortic valve replacement by a minimally invasive procedure with anterior thoracotomy. We believe that, the minimally invasive procedure is much more convenient than classical surgical techniques in patients having high risk for severe aortic stenosis

Early Surgical Results of Patent Ductus Arteriosus in Premature Infants

Amaç: Prematür bebeklerde sık görülen, soldan sağa şant ve mortalite ilemorbiditenin önemli bir nedeni olan patent duktus arteriozusun, mekanikventilatörde uzun süre takipli, bronkopulmoner displazi veya respiratuardistres sendromu gibi respiratuar problemleri olan veya medikal tedaviyerağmen patent duktus arteriozusları kapanmayan hastalarda cerrahi ile erkendönemde kapatılmasının, doğum sonrası dönemde gelişebilecekkomplikasyonların önlenmesi açısından güvenilir bir yöntem olduğunuliteratür destekli sunmaktır.Gereçve Yöntem: Necmettin Erbakan Üniversitesi Meram Tıp Fakültesi KalpDamar Cerrahisi bölümünde 2006-2015 yılları arasında yapılan, prematürdoğum öyküsü olan ve ek kardiyak patolojisi olmayan 32 patent duktusarteriozus vakası çalışmaya dahil edildi.Bulgular: Çalışmaya dahil edilen 32 hastanın 14’ü (%43,7) kız, 18 ‘i (%56,3)erkekti. Operasyon öncesi en sık görülen rahatsızlık respiratuar distressendromu idi (n20). Hastaların 22 tanesi(%68,7) pediatrik yoğun bakımdaentübe takip edilmekteydi. Cerrahi prosedür; medikal tedavi ile duktuslarıkapanmayan veya intrakranial kanama, böbrek yetmezliği veyatrombositopeni gibi medikal tedavinin kontrendike olduğu vakalarauygulandı.Serimizde eksitus oranı %15,6 idi (n5). Mekanik ventilatördenayrılma süreleri ortalama 6,2 gündü. Postoperatif ekokardiyografikontrollerinde erken dönemde yineleyen patent duktus arteriozus görülmedi.Sonuç:Prematür bebeklerde patent duktus arteriozusa bağlı doğum sonrasıgelişebilecek mortal ve morbid tabloları engellemek için patent duktusarteriozus, medikal tedavinin başarısız olduğu veya genel durumu kritikmekanik ventilatör bağımlı infantlardaşanta bağlı ikincil organ yetmezliğigelişmeden önce postnatal erken dönemde güvenli bir şekilde kapatılabilir.Objective:Our aim is to evaluate the closure of patent ductus arteriosusthrough surgery at an early stage, commonly seen in premature infants and aleading cause of left-to-right shunt and mortality/morbidity, as a safe modalityto prevent complications that may develop in postnatal preiod in patients withbronchopulmonary displasia or respiratory distress syndrome followed up inmechanical ventilation, and whose ductus arteriosus can not be closed despitemedical treatment.Material and Methods:Thirty two cases of patent ductus arteriosus withpremature birth history and no additional cardiac pathology, performed in theDepartment of Cardiovascular Medical School, Necmettin Erbakan Universitybetween 2006-2015 were included into the study.Results:Of the 32 patients, 14 (43,7%) were females and 18 (56,3%) weremales. The most frequently seen preoperative disorder was respiratorydistress syndrome(n20). Twenty-two (68%) of the patients were following asintubated in newborn intensive care unit. Surgical procedure was performedin patients whose ductus were not closed via medical treatmentorin whommedical treatment was contraindicated for problems such as intracranialhemorrhage, renal failure or thrombocytopenia. Excitus rate was 15,6% (n5)in our series. Removal time of mechanical ventilation was average 6,2 days.Postoperative echocardiography showed no recurrence of patent ductusarteriosus.Conclusion:Prevention of postnatal mortality and morbidity due to patentductus arteriosus in premature infants can be achieved by early surgicalclosure during postnatal early period before secondary organ failure due toshunting develops and infants with critical general status-dependent onmechanical vantilation-,and for whom medical treatment is unsuccessful

Koroner arter baypas greft cerrahisi yapılan diyabet hastalarında renal doz dopaminin renal tübüler fonksiyon üzerine etkisi

Amaç: Bu çalışmada koroner arter baypas greftleme (KABG) yapılan diyabet hastalarında renal doz dopamin infüzyonunun profilaktik kullanımının klinik sonuçları değerlendirildi.Çalışmaplanı:Bu prospektif randomize çalışmada elektif KABG yapılması planlanan 40 ardışık diyabet hastası iki eşit gruba randomize edildi: grup 1'e anestezi indüksiyonundan itibaren 48 saat süreyle renal dozda (2.5-4.0 mg/kg/dk.) dopamin infüzyonu verildi; grup 2 ise tedavi edilmemiş kontrollerden oluşuyordu. Kardiyopulmoner baypas için aortik ve sağ atriyal kanülasyonu ile standart sternotomi tekniği uygulandı.Bul gu lar: Günlük idrar çıkışı, sıvı dengesi, serum kreatinin, kan üre düzeyleri ve kreatinin klirensi üç ve beşinci günlerde ölçüldü. Kontrol grubunda ameliyat sonrası üçüncü ve beşinci günlerde kreatinin klirens düzeyleri sırasıyla 24.812.3 mL/dk ve 18.110.1 mL/dk azaldı. Dopamin grubunda ameliyat sonrası üçüncü ve beşinci günlerde kreatinin klirens düzeyleri sırasıyla, 7.710.8 mL/dk. (p0.005) ve 10.711.7 mL/dk. (p0.001) arttı. Kontrol grubuna kıyasla, grup 1'deki hastaların serum kreatinin düzeyinde üçüncü ve beşinci günlerde daha az artış görüldü (p0.001).So nuç: Renal tübüler fonksiyonun göstergesi olan kreatinin ve kreatinin klirens düzeyleri, anestezi indüksiyonun başladığı zaman renal doz dopamin infüzyonu ile pozitif etkilendi. Verilerimiz, özellikle diyabet hastalarında ameliyat sonrası renal fonksiyonların yeniden normalleşmesine katkıda bulunabilir.Background: This study aims to evaluate clinical results of the prophylactic use of renal dose dopamine infusion in diabetic patients undergoing coronary artery bypass grafting (CABG). Methods: In this prospective randomized study, 40 consecutive diabetic patients who were scheduled for elective CABG were randomized into two equal groups: group 1 received dopamine infusion at renal dose (2.5-4.0 mg/kg/min) starting from induction of anesthesia for 48 hours; group 2 consisted of untreated controls. Standard sternotomy technique using aortic and right atrial cannulation was performed for cardiopulmonary bypass. Results: Daily urine output, fluid balance, serum creatinine, blood urea levels and creatinine clearance were measured at three and five days. In the control group, third and fifth postoperative day, creatinine clearance levels decreased about 24.8±12.3 mL/min and 18.1±10.1 mL/min, respectively. In the dopamine group, creatinine clearance levels in the third and fifth postoperative days increased by 7.7±10.8 mL/min (p0.005) and 10.7±11.7 mL/min (p0.001), respectively. Group 1 patients demonstrated less increase in serum creatinine level at three and five days than the controls (p>0.001). Conclusion: Creatinine and creatinine clearance levels, suggestive of renal tubular function, were positively affected by renal dose dopamine infusion started at time of anesthesia induction. Our data may help us to re-normalize the renal functions in the postoperative period in diabetic patients, particularly

Acquired cardiac hypertrophy with outflow tract obstruction in a patient with severe Takayasu arteritis

Takayasu arteritis with coronary artery involvement is rare and its association with secondary cardiac hypertrophy with severe outflow tract obstruction is not common. We describe a case of Takayasu arteritis, diagnosed 10 years ago, whose coronary artery involvement and obstructive cardiac hypertrophy are ascertained after our investigations