The Association between Lifestyle-related Risk Factors and Coronary Artery Disease in Residents of Yazd Province: A Case-control Study

Background: This study was conducted to investigate the relation between risk factors related to lifestyle and coronary artery disease (CAD) in residents of Yazd province. Methods: In this hospital-based case-control study performed in Yazd province, 250 patients with CAD were compared with 250 controls matched for age and sex. Data were collected by using a researcher- made questionnaire. Data analysis was performed using Chi-square and Conditional Multiple Logistic Regression and through SPSS16. Results: History of Consumption of less than three servings of fruit in week, with an odds ratio of 8.4 (95%CI: 1.56-45.18) and more than three times egg in week with an odds ratio of 4.05 (95%CI: 1.13-14.5, P=0.03) increased the chance of getting CAD. However, no significant relationship was found for history of consumption of oil, dairy, red meat, fried foods and fast foods. The number of daily smoked cigarettes was the only non-nutritional factor that showed significant relationship with CAD (P=0.01). Conclusion: Overall, insufficient intake of fruits, high consumption of egg and the number of cigarettes smoked daily were identified as the most important life style-related risk factors for getting CAD. Therefore, measures for decreasing these risk factors in Yazd Province are necessary

Comparison of aspirin plus heparin with heparin alone on asymptomatic perioperative deep vein thrombosis in candidates for elective off-pump coronary artery bypass graft: A randomized clinical trial

Background: Symptomatic or asymptomatic deep vein thrombosis (DVT) is a commoncomplication following coronary artery bypass graft (CABG), in which less than 1% of thesepatients suffer from clinically evident pulmonary embolism (PE). DVT and PE can increaseother morbidities of coronary revascularization from short to long period, but no clear consensusstill exists regarding proper thromboprophylaxis strategy in the literatures. This study wasdesigned to compare the anti-platelet prophylaxis of aspirin plus heparin with heparin alone onasymptomatic perioperative DVT in patients that are candidates for elective off-pump CABG.Methods: One hundred and twenty patients, who are candidates for elective off-pump CABG, wererandomly assigned to two groups: the aspirin plus heparin group (Group 1, n = 60) that received80 mg daily aspirin orally and 5000 U unfractionated heparin per 8 h subcutaneously fromadmission to discharge time, and the heparin group (group 2, n = 60) that received same doseof heparin alone. All patients underwent right and left leg venous ultrasound examinationduring hospitalization, after which post-operative off-pump CABG complications such as deepvein thrombosis, bleeding and pulmonary embolism were evaluated in this study cases.Results: The mean age of the patients was 62.10 ± 10.71 years with a male to female ratioof 2.24. Asymptomatic DVT occurred in 12 (10%) patients who underwent electiveoff-pump CABG. DVT was found more in Group 2 (16.6%) as compared to Group 1 (3.3%)with statistical signifi cant difference (p = 0.015). Bleeding was detected in 5 (4.1%) cases inthe patients sampled in this study (p = 0.34), 4 cases of which are from Group 1 and 1 casefrom Group 2. However, PE was shown in none of this study cases.Conclusions: The incidence of DVT decreased more with aspirin plus heparin as comparedto heparin alone in patients who underwent elective off-pump CABG. As regards the resultsobtained in this study, more studies need to be conducted to establish this strategy for prophylaxisof DVT in CABG

Effect of Prophylactic Low Dose of Methylprednisolone on Postoperative New Atrial Fibrillation and Early Complications in Patients with Severe LV Dysfunction Undergoing Elective Off-Pump Coronary Artery Bypass Surgery

Atrial fibrillation (AF) is the most common arrhythmia after cardiothoracic surgery. AF following coronary artery bypass graft (CABG) is associated with an increase in morbidity, mortality, hemodynamic instability, thromboembolic events, severity of heart failure and ICU and hospital stay. Corticosteroids have a variety of beneficial effects on recovery after elective surgery. This study was designed to test the hypothesis that low dose of Methylprednisolone (MP) can affect post-CABG AF and early complications in patients with severe left ventricle dysfunction who underwent elective off-pump coronary artery bypass. A total of 120 patients with LV dysfunction undergoing elective off- pump CABG randomly received either MP or placebo. Diabetic patients and those who were receiving corticosteroids were excluded. The MP group received 5mg/kg of MP intravenously after induction of anesthesia and the placebo group received an equal volume of normal saline. We evaluated Post-CABG variables including incidence, duration and frequency of AF recurrence and early morbidity such as bleeding, infection, vomiting, renal and respiratory dysfunctions, ICU or hospital stay and early mortality. The mean age of patients was 62.11 ± 12.34 years with the 2.4 male to female ratio. AF occurred in 23(19.2%) patients. No significant difference in the incidence of new AF was found between the placebo (21.7%) and MP group (16.7%) (P=0.47). MP did not affect postoperative bleeding, infection, vomiting, renal and respiratory dysfunction and mortality; however, MP significantly reduced ICU and hospital length of stay. MP did not affect the incidence, duration and frequency of AF recurrence in patients with severe LV dysfunction undergoing off-pump CABG. However, MP could reduce ICU and hospital stay significantly in these patients

N-acetylcysteine instead of theophylline in patients with COPD who are candidates for elective off-pump CABG surgery: Is it possible in cardiovascular surgery unit?

Background: Forced expiratory volume in one second (FEV1) is a good predictor of chronic obstructive pulmonary disease (COPD). COPD is characterized by a chronic limitation of airflow. This study was designed to compare the effects and complications of theophylline alone, N-acetylcysteine (NAC) alone, and a combination of the two drugs on the rates of FEV1 in patients with COPD who were candidates for off-pump coronary artery bypass graft (CABG) surgery. Methods: This clinical trial was performed on 100 patients who had a smoking history of 27 pack years with a range of 20 to 40 pack years but were not heavy smokers and were candidates for elective off-pump CABG surgery in Afshar Cardiovascular Hospital, Yazd, Iran. The patients with a history of asthma and bronchospasm and non-COPD respiratory disorders were excluded. There were three groups, that is, the theophylline group (n=33) that received theophylline 10 mg/kg TDS after consumption of food, NAC group (n=33) who received NAC 10-15 mg/kg BD after consumption of food, and the combined group (n=32) who received theophylline and NAC together. Data were analyzed by analysis of variance (ANOVA), Chi-square, and exact test for quantitative and qualitative variables. Results: One hundred patients with COPD enrolled in this study as possible candidates for CABG surgery. Average age of the patients was 60.36±10.21 years. Of the participants, 83 (83.3%) were male and 17 (17%) were female. Rate of postoperative FEV1 to basal FEV1 was 0.76±0.32, 0.66±0.22, and 0.69±0.24 in the treatments with theophylline, NAC, and the combination, respectively. Theophylline, NAC, and a combination of these drugs can decrease the rate of postoperative FEV1 compared to basal FEV1 significantly. (P=0.0001) Conclusion: Theophylline alone, NAC alone, and a combination of these drugs improve pulmonary function, and there are no significant differences between these protocols. Stomach discomfort and cardiac complications in treatment with theophylline alone is significantly higher than NAC alone and the combination

Intra‑operative grading of coronary artery atherosclerosis associated with homocysteine levels in postmenopausal women undergoing elective off‑pump CABG surgery

Background: Atherosclerosis is one of the common causes of morbidity and mortality, in postmenopausal women. Homocysteine, a sulfur‑containing amino acid product of methionine metabolism, may play an important role in the development of cardiovascular diseases. This study was designed to evaluate the relationship between intra‑operative grading of coronary artery atherosclerosis and homocysteine level in postmenopausal women who were candidates for off‑pump coronary bypass graft surgery (CABG). Materials and Methods: In this cross‑sectional study, 136 postmenopausal women (with the mean age of 54.9±4 years) were enrolled as candidates for elective off‑pump CABG. For each patient the extent and severity of atherosclerosis was assessed by intra‑operative grading (IOG) and Gensini score system. Total homocysteine was determined with ELISA method after 12 hours of fasting. The patients were classified into two groups (diffuse vs. discrete) based on intra‑operative findings. Finally the relation between age, IOG, and Gensini score with homocysteine level was assessed by ANOVA, T‑test, and Tukey HSD test. Results: There was a positive correlation between intra‑operative grading and homocysteine level in both groups (P=0.005). The association between Gensini score and homocysteine was significant in higher levels of hyperhomocysteinemia (P < 0.05). The homocysteine level also increased with age; therefore, patients were classified into two categories (<54 years and ≥54 years) by Levene test. Statistical analysis indicated no relationship between IOG, Gensini score, and homocysteine level in the patients who were younger than 54 years (P=0.3, P=0.2), but significant relation was detected between IOG, Gensini score, and homocysteine in the patients who were older than 54 years with diffuse or discrete lesions in coronary arteries (P=0.001, P=0.001). Conclusion: According to our findings, homocysteine level increases in post‑menopausal women that can be an important risk factor for atherosclerosis and cardiovascular diseases.Keywords: Coronary artery atherosclerosis, homocysteine, intra‑operative grading, menopause, off‑pump coronary bypass surgeryNigerian Medical Journal | Vol. 53 | Issue 4 | October-December | 201

Endovascular Treatment of Aortobronchial Fistula Secondary to Coronary Artery Bypass Graft (CABG)

Aortobronchial fistula (ABF) is a rare and late complication of cardiac surgery. If untreated, mortality rate is approximately 100% secondary to exsanguinations haemoptysis. Early diagnosis and treatment are essential for successful management. Open surgical repair is associated with high morbidity and mortality rate, ranging from 25% to 41%. Endovascular treatments of ABF is a less invasive treatment modality and have become an important alternative to open surgical intervention in aortic pathologies. We present a case of ABF that successfully is managed by endovascular approach

Klebsiella pneumoniae Pseudoaneurysm of the Ascending Aorta after Coronary Artery Bypass Graft

"nMycotic pseudoaneurysm of the ascending aorta is rare in patients undergoing coronary artery bypass graft (CABG) and usually caused by staphylococcus aureus. We describe a patient with a mycotic pseudoaneurysm of the ascending aorta at the proximal vein graft anastomosis site after CABG. Culture from the sinus tract of the sternum and from the aneurysm sac was Klebsiella pneumoniae. Surgical technique was patch repair of aorta under hypothermic circulatory arrest. He is asymptomatic at 24 months follow-up

Immediate, Short, Intermediate and Long-Term Results of Balloon Valvuloplasty in Congenital Pulmonary Valve Stenosis

Transluminal balloon valvuloplasty is an alternative to surgical valvotomy for congenital pulmonary valve stenosis. The aim of this study was to evaluate the long term results (to 13.5 years) of balloon pulmonary valvuloplasty. From June 1998 to January 2012, percutaneous balloon pulmonary valvuloplasty for congenital pulmonary valve stenosis was performed in 98 patients (50 males, 48 females, with a median age of 6.75 years) underwent balloon valvuloplasty of pulmonary valve stenosis. Follow-up was performed based on the Doppler echocardiographic data and clinical findings. Forty three of ninety eight patients were 10 years of age or older. The mean peak to peak pressure gradient across pulmonary valve before and immediately after balloon pulmonary valvuloplasty (BPV) was 88.7±36.4 mmHg and 21.8±15.9 mmHg (P<0.001) respectively. Doppler pressure gradient across pulmonary valve before BPV, at 3 month (short term), at 1 year (intermediate term) and long–term follow–up were 93.2±41.3 mmHg, 18.7±15.8 mmHg (P<0.001), 15.8±13.1 mmHg (P<0.001) and 13.6±7.4 mmHg (P<0.017) respectively. Mild pulmonary regurgitation (PR) was observed in 55 (57%) patients immediately after BPV and 30 (31%) patients at late follow up. Rupture of the right ventricular outflow tract was the major complication in two patients with fatal event. Short, intermediate and long-term results of BPV for typical valvular pulmonary stenosis are excellent. Therefore, it can be considered as treatment of choice for patients with typical valvular pulmonary stenosi

Sex hormone levels and sexual dysfunction in men after coronary artery bypass graft

Background: Sexual dysfunction is one of the most common problems in men after coronary artery bypass graft (CABG). Etiology of sexual dysfunction in these patients may be psychological or organic due to hormonal changes. Objective: The purpose was to evaluate the incidence and type of sexual dysfunction and changes in serum concentration of sex hormones in male patients undergoing on-pump CABG. Materials and Methods: In this before and after study we enrolled 40 men aged less than 70 years who were candidate for on-pump CABG. Interviews were done by a physician before and 12 weeks after the operation in regard to the impact of surgery on their sexual activities. The serum levels of 6 sex hormones were also determined. The statistical tests used for data analysis included analysis of variance, McNemar's test and chi-square analysis. Results: The mean±SD age of the patients was 51.27±7.86 years. Incidence of sexual dysfunction was 22.5% (9 cases) before and 47.7% (19 cases) after operation. Types of sexual dysfunction were premature ejaculation (5% before, 2.5% after), impotence (7.5% before, 12.5% after) and loss of libido (10% before, 32% after). The level of sex hormones were generally decreased after operation but it was statistically significant only for estrogen (p-value=0.02). Conclusion: Sexual dysfunction and reduction in serum level of sex hormones are common in patients before on-pump CABG and mostly get worse after surgery. Complementary studies are suggested for prevention and treatment of sexual dysfunction