Congenital left ventricular diverticulum associated with ASD, VSD, and epigastric hernia

Congenital left ventricular diverticulum is a rare cardiac malformation. Two categories of congenital ventricular diverticulum have been identified with regard to their localization: apical and non-apical. Apical diverticula are always associated with midline thoraco-abdominal defects and other heart malformations. Non-apical diverticula are always isolated defects. Diagnosis is established by imaging studies such as echocardiography, magnetic resonance imaging, or left ventricular angiography. Mode of treatment has to be individually tailored and depends on clinical presentation, accompanying abnormalities, and possible complications. We report a 10-month-old girl with left ventricular apical diverticulum, large atrial septal defect, two small muscular ventricular septal defects, and pulmonary hypertension, associated with epigastric hernia. This patient underwent total surgical repair for intra-cardiac defects as well as diverticular resection

Association of platelet collagen receptor polymorphisms with premature acute myocardial infarction

The impact of platelet collagen receptor polymorphisms in the pathogenesis of myocardial infarction at young age remains unknown. To determine whether either of the two platelet collagen receptor polymorphisms (GP VI T13254C and GP Ia C807T) was associated with premature acute myocardial infarction. One hundred patients with premature acute myocardial infarction and 100 age-matched controls with normal coronary angiograms were studied. Genotyping was done using PCR followed by restriction fragment length polymorphism (RFLP). GP Ia C807T polymorphism was more frequent in the patient group (65) than in the control group (53). However, there was no association between this polymorphism and premature acute myocardial infarction (PU0.08). The prevalence of T13254C polymorphism did not differ between patients (38) and controls (33), and this polymorphism was not associated with premature acute myocardial infarction (PU0.46). Logistic regression analysis also indicated no association between these polymorphisms and premature acute myocardial infarction (C807T with PU0.51 and T13254C with PU0.20). There is no association between GP VI T13254C or GP Ia C807T polymorphisms and premature acute myocardial infarction. © 2012 Wolters Kluwer Health

Coronary graft patency after perioperative myocardial infarction: a study with multislice computed tomography‏

A total of 55 consecutive patients who experienced perioperative myocardial infarction (MI) after coronary artery bypass grafting were studied using multislice computed tomography (MSCT) angiography to evaluate for graft patency. The MSCT detected acute graft occlusion in 23% grafts. Of the 55 patients, 40% patients had occluded grafts and perioperative MI in the area of the grafted vessels; remaining 60% had patent grafts with infarction in the area of the grafted vessels. Compared with the patients with patent grafts, those with occluded grafts had a higher blood sugar level. In addition, graft occlusion was higher in grafts with severe distal disease. Among the patients with patent grafts, luminal stenosis of the native vessels supplying the infarcted myocardium was higher than that in the native vessels supplying the non-infarcted myocardium. In conclusion, MSCT is feasible for the assessment of graft patency in the setting of perioperative MI. Graft occlusion is detected in less than half of the cases and usually occurs in the grafts with severe distal involvement and the patients with uncontrolled hyperglycemia. In patients with patent grafts, the severity of luminal stenosis of the native grafted vessel is the main predisposing factor for perioperative MI

Modified Blalock-Taussig shunt and giant perigraft reaction

This is a case of a modified Blalock-Taussig shunt, which was complicated by perigraft transudative, fibrinous fluid accumulation and recurrence after surgical intervention. Follow-up and expectant management of the patient was successful. Our experience regarding this complication is presented

Evaluation of post-radiofrequency myocardial injury by measuring cardiac troponin I levels

Background: The aim of this study was to investigate the extent of myocardial injury created by radiofrequency (RF) ablation. We assessed the changes in levels of cardiac biochemical markers in patients who underwent RF ablation and we sought to evaluate the utility of cardiac troponin I (cTnI) in detecting minor myocardial injury following RF ablation and determine its procedural correlates. Methods: We analyzed the data of 115 consecutive patients who underwent RF ablation. The target sites of RF ablation were slow pathway in 56, left atrioventricular (AV) annulus in 31, right AV annulus in 14, atrial wall in 3, ventricular wall in 6 and AV node in 3 patients. The levels of creatine kinase (CK), CK-MB, cTnI and myoglobin were compared with procedural data and targeted arrhythmia. Results: Post-RF ablation the concentration of cTnI, CM-MB, CK and myoglobin were significantly different than those of the initial sample. The mean and peak cTnI levels were raised above normal in 63 patients (54.8). Mean levels of cTnI correlated with the site of RF ablation, being significant for slow pathway ablation, ventricular tachycardia and left AV annulus. We also found a significant association of mean CK-MB, CK levels and left AV annulus. Conclusion: Our results indicate that radiofrequency ablation results in only minor injury. This marker is effective for detection of RF current induced myocardial injury. Lesions applied to the mitral annulus at the ventricular endocardium are associated with significantly greater myocardial damage. © 2006 Elsevier Ireland Ltd. All rights reserved

Optimal β-blocker for prevention of atrial fibrillation after on-pump coronary artery bypass graft surgery: Carvedilol versus metoprolol

Background: Atrial fibrillation (AF) is the most common arrhythmia after coronary artery bypass graft (CABG) surgery. It has been shown that prophylactic oral β-blocker administration reduces the incidence of post-CABG AF. However, the optimal β-blocker has not been identified. Objective: This study sought to determine whether oral carvedilol (with its unique anti-inflammatory and antioxidant properties) is more effective than oral metoprolol for prevention of AF after CABG surgery. Methods: Between April 2006 and December 2006, 120 patients (63 men, mean age 61 ± 9.4 years) who were scheduled to undergo their first on-pump CABG were enrolled in this study. The patients were randomized in a prospective 1:1 manner to receive either oral carvedilol (n = 60) or oral metoprolol (n = 60). The end point of the study was the occurrence of the new-onset AF during the first 5 days aftere CABG. Results: AF occurred in 29 of 120 patients (24.0). The incidence of postoperative AF was 15.0 (9 of 60) in the carvedilol group and 33 (20 of 60) in the metoprolol group (P = .022). The carvedilol group was treated with mean daily dose of 46 ± 9 mg and metoprolol group with mean daily dose of 93 ± 11 mg. There were no differences between the study groups regarding any known preoperative, perioperative, or postoperative characteristics (all values were P >.05). No significant adverse effect was observed in either group. Conclusion: This prospective study suggested that oral carvedilol is more effective than oral metoprolol in the prevention of AF after on-pump CABG. It is well tolerated when started before and continued after the surgery. However, further prospective studies are needed to clarify this issue. © 2007 Heart Rhythm Society

Mortality and morbidity after aortic root replacement: 10-year experience

Aortic root reconstruction remains a challenging surgical procedure. This retrospective study was carried out to evaluate the early and long-term outcomes of aortic root replacement over a 10-year period. There were 83 patients with a mean age of 43.2 ± 14 years (range, 10 to 78 years). Type A aortic dissection and Marfan syndrome were found in 28 and 24, respectively. The most common technique used for repair of this condition was the Bentall operation. The mean duration of follow-up was 29.6 ± 28 months, ranging from 1 to 120 months. Hospital (30-day) mortality was 13.3 (11 patients). Two patients died during the late follow-up. The mortality was significantly higher in patients presenting with cardiogenic shock, those with long cardiopulmonary bypass and crossclamp times, and the group who had concomitant coronary artery bypass grafting. Emergency operation was not a significant risk factor for early death in our patients. The most common complications were bleeding and neurological sequelae. Aortic root replacement can be achieved with acceptable mortality and morbidity in a high-risk group of patients. Improvements in the outcome may be achieved by faster transport of patients in cardiogenic shock, and by reducing the cardiopulmonary bypass and crossclamp times

Predictors of early graft patency following coronary artery bypass surgery

Background: The long-term success of coronary artery bypass graft surgery (CABG) is dependent on graft patency after the operation. Early occlusion (within the first week) affects the long-term results. Therefore, we sought to determine pre-operative, intraoperative, and perioperative factors associated with early coronary graft patency. Methods: Between March 2007 and March 2008, 107 consecutive patients (81 men, 26 women, mean age 60 ± 9 years) who underwent CABG were included in this study. The enrolled patients underwent 16-slice computed tomography angiography one week after CABG. Results: Based on the multislice computed tomography, acute graft occlusion was detected in 32 (8.7 of all) grafts, including 26 of 250 (10) in venous grafts and 6 of 116 (5) in arterial grafts. In univariate analysis, patients with patent coronary grafts had a lower serum glucose level (119 ± 30 vs. 141 ± 65 mg/dL, p = 0.02) and longer partial thromboplastin time (34 ± 11 vs. 30 ± 2 s, p = = 0.04). In addition, pump time was significantly longer in patients with occluded grafts than in those with patent grafts (119 ± 43 vs. 102 ± 32 min, p = 0.04). Those with longer pump time required more coronary grafts (pump time � 120 min for 3.5 grafts vs. pump time < 120 min for 2.9 grafts, p = 0.02). Of the multiple pre-operative, intraoperative, and perioperative characteristics of the patients who underwent successful CABG, serum glucose level (OR: 2.014, 95 CI: 1.002-3.026, p = 0.002) and pump time < two hours (OR: 1.502, 95 CI: 1.001-2.030, p = 0.003) were the only predictors of coronary graft patency seven days after surgery in multivariate analysis. Conclusions: Our study demonstrated that the patients with successful CABG and patent coronary grafts within the first week after surgery had optimal blood glucose control and pump time < two hours. © 2010 Via Medica