Ahmet Feyzi Abacilar

Levosimendan Use Decreases Atrial Fibrillation in Patients after Coronary Artery Bypass Grafting: A Pilot Study

BACKGROUND Atrial fibrillation (AF) often occurs after coronary artery bypass grafting (CABG) and can result in increased morbidity and mortality due to complications. In the present study, our goal was to investigate whether the use of levosimendan can reduce the frequency of AF after coronary artery bypass grafting in patients with poor left ventricle function. MATERIAL AND METHODS To investigate the effectiveness of levosimendan in the prophylaxis of AF, we conducted a prospective, randomized, placebo-controlled clinical study on 200 consecutive patients in whom we performed elective CABG operations. Baseline characteristics were similar in both groups. A control group of 100 patients were treated with placebo (500 mL saline solution), whereas the levosimendan group (n = 100 patients) was treated with levosimendan. High-sensitivity C-reactive protein, cardiac troponin, and creatine kinase–MB levels were measured before surgery and 5 days postoperatively. RESULTS AF occurred in 12% of the levosimendan group and 36% of the control group. The occurrence of AF was significantly lower in the levosimendan group (P < 0.05). The duration of AF in the levosimendan group was significantly shorter than that in the control group (4.83 ± 1.12 and 6.50 ± 1.55 hours, respectively; P = 0.028). Our research showed that C-reactive protein was higher postoperatively in the control group than in the levosimendan group (P < 0.05). CONCLUSIONS The incidence of postoperative AF in the levosimendan group was reduced significantly in patients with poor left ventricle function after CABG operations.

Comamonas testosteroni endocarditis in Turkey: A case report and review of the literature

Introduction: Comamonas testosteroni is a gram-negative bacillus which commonly occurs in various environments worldwide. Comamonas testosteroni is rarely recognized as a human pathogen. The case we report is the first Comamonas testosteroni endocarditis in Turkey and the fourth case in the world. Case Presentation: A 51-year-old male patient with a history of chest pain, dyspnea, and tachycardia was admitted to our hospital. Coronary angiography and echocardiography results revealed mobile lesions and plaques in aortic valve. Cardiovascular surgery was performed; aortic valve vegetation was detected and the aortic valve was excised. Aerobic culture was studied. After the biochemical identification tests and the use of VITEK-2 Compact (Biomerieux, France) automated microbial identification system, pathogenic bacteria was identified as Comamonas testosteroni. The patient who had no risk factors was diagnosed with endocarditis and treated with Ciprofloxacin. The case recovered from Comamonas testosteroni infection. Conclusion: There has been an increase in bacterial infections caused by Comamonas testosteroni and antibiotic resistance of the bacteria. For this reason, Comamonas testosteroni infections have increasingly become important. There have only been four cases from Turkey so far. This paper also examines the other cases in the literature as a whole.

Evaluation of Myocardial Contractility Determination with Tissue Tracking Echocardiography after Levosimendan Infusion in Patients with Poor Left Ventricular Function and Hemodynamics

BACKGROUND The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery. METHODS We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ≤% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 μg/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 μg/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 ± 4.72 years). Dopamine at 10 μg/kg/min and/or dobutamine at 10 μg/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 ± 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and χ2 test were used for statistical analyses. RESULTS There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II. CONCLUSION Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.

Thrombosed left circumflex artery aneurysm presenting with myocardial infarction

Coronary artery aneurysms are life-threatening conditions that are quite uncommon in adults. They are observed in 1.1% to 4.9% of patients undergoing coronary angiography. They are usually located in the right coronary artery, may sometimes be thrombosed or rupture, and occasionally reach an enormous size leading to compressive symptoms. We report a case of thrombosed left circumflex artery aneurysm presenting with myocardial infarction. The thrombosed aneurysm, which could not be clearly demonstrated by coronary angiography, was definitively diagnosed by coronary computed tomography angiography. No operation was planned owing to total thrombosis of the aneurysm.