The comparative effects of esmolol and amiodarone on isolated coronary artery bypass grafts

Background/aim: Esmolol and amiodarone are two most commonly used antiarrhythmic drugs in coronary artery bypass grafting (CABG) surgery. Nevertheless, blockade of beta-2 receptors by increasing doses raise concerns about possible vasospasms. We studied the vasoactive effects of amiodarone and esmolol on left internal mammary artery (LIMA), radial artery (RA), and saphenous vein (SV) grafts. Materials and methods: After determining the presence of functional smooth muscle and endothelial layers, the responses of submaximally preconstricted graft samples were recorded in a tissue bath system. A total of 96 graft samples from 40 patients were used: 16 LIMA, 16 RA, and 16 SV grafts for each drug. Esmolol and amiodarone were added to reservoirs separately, starting from a concentration of 10-8 M until a concentration of 10-4 M. Results: Although both drugs caused vasodilatation, amiodarone exhibited a more potent vasodilatory effect than esmolol (P < 0.0001 for LIMA, P = 0.0128 for RA, and P < 0.0001 for SV). The vasodilatation rates with esmolol were 48.99 +/- 1. 2.28% in LIMA, 49.77 +/- 3.03% in RA, and 41.90 +/- 4.05% in SV grafts and with amiodarone they were 71.65 +/- 5.18% in LIMA, 58.61 +/- 5.87% in RA, and 65.07 +/- 4.09% in SV grafts. Conclusion: This in vitro study revealed that even increasing doses of both drugs induce vasodilatation of CABG grafts, with amiodarone having a more potent vasodilatory effect than esmolol

Is using metaproterenol sulfate reliable in hypertension management during the coronary artery bypass graft surgery in terms of graft patency?

Introduction: Coronary artery bypass graft (CABG) surgery that is a basic revascularization method is used commonly and hypertension appears frequently during and after CABG operations. In the treatment of hypertension, metaproterenol sulfate (MS) is one of the main agents; however, the effects of this agent on grafts are not known at an adequate level. The aim of the present study was to determine whether MS could be used safely in CABG operations by examining its effects on coronary grafts. Material and Methods: This cross-sectional, prospective, experimental study was conducted at a university hospital. In this study, internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) graft materials were studied in organ bath in patients who underwent CABG surgery between 2013 and 2016. In the organ bath, 10-6 phenylephrine was added to the grafts to ensure that the ITA, RA and SV grafts contracted submaximally. Then, by adding MS with the cumulative method, the resulting relaxation results were recorded and dose-response curves were created. The p < 0.05 was considered as significant. Results: A total of 30 patients were included in the study. The average age of the participants was 59.3 (45-81) years. Minimum 1 and maximum 6 grafts (2.96 in average) were taken from all patients. Relaxation response was formed in the ITA at a rate of 40.49% ± 13.52, in the RA at a rate of 28.41% ± 9.08 and in the SV at a rate of 23.87% ± 8.36 by adding MS with the cumulative method. In the statistical work that was done by comparing the relaxation values among the SV grafts, ITA and RA grafts, it was determined that the efficacy of MS in the SV grafts was significantly lower when compared with the ITA and RA grafts. Conclusions: In the present study, it was concluded that the risk of developing vasospasm was low in all three grafts when MS was used in intraoperative and postoperative periods. However, in the long-term, this made us consider that better graft patency rates might be obtained. Multicenter in-vivo studies with larger patient groups are needed to support our findings. © 2021 Via Medica

Eşzamanlı Koroner Arter Baypas ve Plonjan Guatr Cerrahisi

[No Abstract Available

İzole Organ Banyosu Düzeneğinde Esmololün Koroner Arter Bypass Operasyonu Sırasında Kullanılan Radyal Arter, Safen Ven Ve Mammariyan Arter Üzerine Etkilerinin Incelenmesi

GİRİŞ: Koroner arter hastalığı bulunan olgularda beta bloker kullanımı tüm klavuzlar tarafından önerilmektedir. Çalışmamızda selektif beta bloker olan esmolol’ün koroner bypass operasypnu sırasında kullanılan greftler üzerine olan in vitro etkilerinin izole organ banyosu düzeneğinde etkilerinin incelenmesi planlanmıştır. MATERYEL VE METOD Çalışmamızda ocak 2013-2015 arasında kliniğimizde opere olan 15’i kadın 15’si erkek toplam 30 hasta çalışmaya alındı. Yapılan bu çalışmada, esmolol 10-8 M -10-4 M konsantrasyon aralığında izole organ banyosu düzeneğinde radyal arter,safen ven ve mammariyan arter greftleri üzerinde fenilefrin 10-6 ile elde edilen submaksimal kasılma yanıtlarına verdiği gevşeme yanıtları açısından karşılaştırılarak değerlendirildi. SONUÇ: Safen ven grefti esmolol 10-4 maksimum konsantrasyonunda fenilefrin ile elde edilen submaksimal kasılmanın %39.37’si kadar gevşerken bu oran radyal arterde 47.75, mammariyan arterde ise 47.27 olarak saptanmıştır. Arteyel greftler arasında esmolol ile elde edilen gevşeme yanıtları arasında anlamlı fark saptanmaz iken safen ven greftleri ile arteryel greftler arasında anlamlı fark saptanmıştır (P < 0.05). TARTIŞMA: Bu araştırma sonucunda intraoperatif, perioperatif yada postoperatif esmolol perfüzyonu ile internal torasik arter, radyal arter ve safen ven greftlerinde vazospazm gelişiminin önlenebileceğini ve perioperatif morbidite ile mortalitede azalma, uzun dönemde ise daha iyi greft açık kalma oranları elde edilebileceğini düşünmekteyiz.Aim: Beta blocker usage recommending for patient with coranary artery disease patients. The aim of the study is to evaluate the in vitro effects of beta-1 selective blocker ‘’esmolol’’ on internal thoracic artery, radial artery and saphenous vein grafts using the tissue bath. Material and methods: In our study, Thirty (30) consecutive patients (15 women and 15 men) were enrolled in the study between january 2013 and 2015. We investigate esmolol vasorelaxation effect between 10-8 -10-4 M dosage at coronary artery bypass grafts. Results: When the three grafts are compared on the basis of vasorelaxation response, the sahpenous vein group had significantly lower relaxation response compared to the radial artery and internal thoracic artery groups (%39.37, 47.75, 47.27). Conclusion Based on the results of the study, we conclude that, esmolol infusion in the perioperative period is mandatory to diminish the vasospasm of internal thoracic artery, radial artery and saphaneus vein grafts, and hence improve perioperative and long term mortality and morbidity

Symptomatic huge pericardial cyst: a case report

Mediastinal kistler nadir gözlenen, konjenital, neoplastik ve inflamatuar kaynaklı patolojilerdir. Basit perikardiyal kistler tüm yaş gruplarında görülmekle beraber sıklıkla yetişkin yaş grubunda gözlenmektedir. Perikardiyal kistler tüm mediastinal kistler arasında %7 gibi bir oranda gözlenmektedir. Hastaların kliniği sıklıkla asemptomatik seyretmektedir. Semptomlar nadir gözlenmekle beraber %20-30 olguda semptomatik olup ağrı, nefes darlığı, taşipne ve öksürük en sık gözlenen semptomlardır. Kistin kardiyak basısına bağlı olarak hipotansiyon, aritmi, atrial fibrilasyon ya da ani kardiyak ölüm semptomlarda gözlenebilmektedir. X-ray, bilgisayarlı tomografi, ekokardiografi gibi tetkikler ile saptanmaktadır. Yazımızda 35 yaşında, medikal tedaviye dirençli hipotansiyon, aritmi ve nefes darlığı olan, sağ atriuma bası yapan perikardiyal kist olgusunu sunduk.Mediastinal cysts are uncommon and results from congenital, neoblastic or inflamatuar abnormalities. Pericardial cyst may occur in patients of all ages, but commonly present in adults. The overall incidence of pericardial cyst is 7% in mediastinal cysts. The clinical presentation is commonly asymtomatic. Pain, tachpnea, dsypne and cough is the most common symptoms. Tachycardie, hypotansion, arytmi and sudden death are usually because of cardiac compression by the cystic mass.They are commonly found incidentally upon chest radiography, computed tomography or echocardiograph. We present, herein, the case of a 35-year-old female with a symptoms of dsypne, hypotansion and atrial arrhythmia resistant to medical therapies with finding of a pericardial cyst compression to the lateral wall of the right atrium

The effect of distension pressure on endothelial injury and vasodilatation response in saphenous vein grafts: conversion of a bypass graft to a dead pipe

Introduction: Endothelial damage caused by high pressure applied for spasm relaxation during graft preparation is one of the most plausible theories explaining early graft failure. Aim of the study: We aimed to demonstrate the extent of endothelial damage in saphenous vein grafts distended to different pressure levels by using immunohistochemical methods and in vitro tissue baths. Material and methods: Saphenous vein grafts (SVGs) of 25 patients who underwent isolated elective CABG surgery were used in this study. By using a specific mechanism, SVGs were distended to five different pressure levels for two minutes: 0 mmHg, 50 mmHg, 100 mmHg, 200 mmHg, 300 mmHg. In vitro tissue baths and immunohistochemical examinations were performed. Results: None of the grafts distended to 300 mmHg pressure were functional in the tissue bath system. The relaxation response to carbachol of SVGs distended to 0, 50, 100 and 200 mmHg was 97.87 +/- 4.47%, 98.52 +/- 3.95%, 93.78 +/- 3.64%, and 30.87 +/- 4.11%, respectively. There were no statistically significant differences in terms of relaxation responses between samples distended to 0, 50, and 100 mmHg (p = 0.490). The relaxation response of samples distended to 200 mmHg was significantly decreased (p = 0.021). The endothelia of samples distended to 0 mmHg were almost intact in CD31 staining. Endothelial cell loss occurred at all tested distension pressures at different degrees. Conclusion: In vitro and immunohistochemical studies revealed that distending an SVG used for coronary artery bypass grafting with pressures of 100 mmHg or less results in less endothelial damage and increases graft patency

Is using metaproterenol sulfate reliable in hypertension management during the coronary artery bypass graft surgery in terms of graft patency?

INTRODUCTION: Coronary artery bypass graft (CABG) surgery that is a basic revascularization method is used commonly and hypertension appears frequently during and after CABG operations. In the treatment of hypertension, metaproterenol sulfate (MS) is one of the main agents; however, the effects of this agent on grafts are not known at an adequate level. The aim of the present study was to determine whether MS could be used safely in CABG operations by examining its effects on coronary grafts.   MATERIAL AND METHODS: This cross-sectional, prospective, experimental study was conducted at a University hospital. In this study, internal thoracic artery (ITA), radial artery (RA) and saphenous vein (SV) graft materials were studied in organ bath in patients who underwent CABG surgery between 2013 and 2016. In the organ bath, 10-6 phenylephrine was added to the grafts to ensure that the ITA, RA and SV grafts contracted submaximally. Then, by adding MS with the cumulative method, the resulting relaxation results were recorded and dose-response curves were created. The p &lt; 0.05 was considered as significant.   RESULTS: A total of 30 patients were included in the study. The average age of the participants was 59.3 (45–81) years. Minimum 1 and maximum 6 grafts (2.96 in average) were taken from all patients. Relaxation response was formed in the ITA at a rate of 40.49% ± 13.52, in the RA at a rate of 28.41% ± 9.08 and in the SV at a rate of 23.87% ± 8.36 by adding MS with the cumulative method. In the statistical work that was done by comparing the relaxation values among the SV grafts, ITA and RA grafts, it was determined that the efficacy of MS in the SV grafts was significantly lower when compared with the ITA and RA grafts.   CONCLUSIONS: In the present study, it was concluded that the risk of developing vasospasm was low in all three grafts when MS was used in intraoperative and postoperative periods. However, in the long-term, this made us consider that better graft patency rates might be obtained. Multicenter in-vivo studies with larger patient groups are needed to support our findings

Patient satisfaction with hemodialysis catheter in patients with chronic renal failure

Amaç: Kronik böbrek yetmezliği bulunan, renal transplant yapılamayan hastalar hemodiyaliz bağımlı olarak yaşamaktadır. Hemodiyalize giriş yolu olarak arteriovenöz şant (AV) altın standart yöntemlerdir. AV şant açılamayan ya da AV şant mevcut olup henüz olgunlaşmamış hastalarda hemodiyaliz'e girebilmek için hemodiyaliz kateterleri kullanılmaktadır. Hemodiyaliz kateterleri sıklıkla femoral, subklaviyan ve juguler venlere uygulanmakla beraber nadir olarak torakolomber yaklaşımla inferior vena kavaya da takılmaktadır. Çalışmamızda hemodiyaliz amacıyla kullanılan kateterlerin hasta memnuniyeti ve yaşam kalitesine etkilerini incelemeyi amaçladık. Yöntem: Kliniğimizde ocak 2011- mayıs 2012 yılları arasında hemodiyaliz amacıyla arteriyovenöz şant açılan ve katater takılan topla 139 hasta çalışmaya alındı. Hastalardan 91 erkek 48 kadın, yaş ortalaması 60,85 ±14,6 (min: 54, max:83) idi. Hastalar arasında demografik olarak anlamlı fark yoktu. Bu hastalar ile tek tek görülerek takılan kateter ve bölgelere göre menuniyet durumları araştırıldı. Bulgular: Takılan kataterlere bağlı olarak olguların %69.06'da herhangi bir şikayet gözlenmedi. En sık gözlenen şikayet ağrı olup olguların %17.9'da bu şikayet mevcut idi. Diğer şikayetler sırası ile %9.3 olguda görünümünden rahatsız olma ve %3.5 olguda yaşam kalitesinin olumsuz etkilenme olarak belirlendi. Komplikasyon olarak %10.7 oranında katater yeri enfeksiyonu ve %9.3 oranında katater oklüzyonu tespit edildi. Femoral bölgeye takılan kataterlerin enfeksiyon oranı %85 oranında tespit edildi. Sonuç: Kronik böbrek yetmezliği bulunan olgularda hemodiyaliz amacıyla katater takılacağı durumlarda öncelikli olarak juguler bölgenin tercih edilmesi gerektiği, juguler bölgenin uygun olmadığı durumlarda yüksek enfeksiyon oranları sebebiyle subklaviyan bölgenin ve en son seçenek olarak femoral bölgenin tercih edilmesi gerektiğini düşünüyoruz. Katater takılacak bölge ve oluşabilecek şikayetler hakkında hastaların bilgilendirilmesinin hasta memnuniyetini arttıracağı kanaatindeyizPurpose: Patients with chronic renal failure, for whom renal transplantation is not an option, depend on hemodialysis for life. An Arteriovenous shunt is the gold standart access site for hemodialysis. In patients without an AV shunt or with an immature shunt, a hemodialysis catheter is used. Subclavian, femoral and juguler veins are common sites for hemodiaylsis catheter. Patients may have different complaints with the catheter according to the insertion site. In our study, we aimed to investigate the impact of the site of the catheter on patients' comfort and social lives. Method: Between January 2011 and May 2012, 48 women and 91 men (139 patients) who underwent AV shunt operation in our clinic. The mean age of the patients was 60.85&plusmn;14.6(min:54, max:83) years. Every patient was interviewed individually about his comfort and satisfaction with the catheter.There were no statistically significant demographic differences among patients. Results: When insertion of a hemodialysis catheter is planned in patients with chronic renal failure, internal juguler vein is the optimum site and should be preferred in the first line. In cases which juguler vein is not available, subclavian vein is the next preferred site and he femoral vein, due to its high rates of infection, is the last place to choose for the insertion of a hemodialysis catheter. Conclusion: We believe that informing patients about the site of the catheter and the possible disadvantages will improve the patient satisfaction