Barcin Ozcem

Assessment of protective effects of methylprednisolone and pheniramine maleate on reperfusion injury in kidney after distant organ ischemia: a rat model.

BACKGROUND Ischemia/reperfusion (I/R) injury of tissues is a common problem that cardiovascular surgeons are faced with. Suppression of inflammation, which plays an important role in the pathogenesis of I/R injury, may reduce this damage. The aim of this study is to investigate the protective effects of methylprednisolone (MP)--a potent anti-inflammatory agent--and pheniramine maleate (FM)--an antihistamine that also has some anti-inflammatory effects--on reperfusion injury of kidneys developing after ischemia of the left lower extremity of rats. METHODS Twenty-eight randomly selected male Sprague-Dawley rats weighing 320 to 370 g were divided into four groups, each consisting of seven rats. Group 1 was the control group. Group 2 was the sham group. Rats in group 3 were subjected to I/R and given FM, and rats in group 4 were subjected to I/R and given MP. A tourniquet was applied at the level of the left groin to subjects in group 2 after induction of anesthesia. One hour of ischemia was performed, and no drug was administered. In group 3, half of a total dose of 10 mg/kg FM was administered before ischemia, and the remaining half was given intraperitoneally before reperfusion. In group 4, subjects received a single dose of 50 mg/kg MP intraperitoneally in the 30th minute of ischemia. Kidneys of all subjects were removed after 24 hours. Extracted tissues were investigated regarding histological and biochemical parameters. RESULTS Malondialdehyde--the end product of lipid peroxidation as an important indicator of I/R injury--levels were significantly lower in group 3 than in group 2 (P < 0.05). Malondialdehyde levels were also lower in group 4 than in group 2, but this difference was insignificant (P > 0.05). Superoxide dismutase and glutathione peroxidase enzyme activities were found to be significantly higher in group 3 than in group 2 (P < 0.05). However, there was no difference between group 4 and group 2 in terms of these activities. Histological examination demonstrated that both MP and FM had protective effects against I/R injury, but this effect was more potent for FM than for MP. CONCLUSIONS FM has a protective effect against reperfusion injury in rat kidney after distant organ ischemia.

Relationship between Vitamin D and the development of atrial fibrillation after on-pump coronary artery bypass graft surgery.

Summary Background: Vitamin D deficiency is associated with many diverse cardiovascular disorders, such as hypertension, heart failure, stroke, coronary artery disease and atrial fibrillation. The relationship between Vitamin D and the development of atrial fibrillation after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between Vitamin D and the development of postoperative atrial fibrillation (POAF) after CABG. Methods: Medical records of consecutive patients who underwent CABG surgery were retrospectively reviewed for the development of atrial fibrillation in the postoperative period. Vitamin D, other biochemical parameters, and clinical and echocardiographic parameters were evaluated in all patients. The independent variables for the development of postoperative atrial fibrillation were defined and their predictive values were measured. Results: The study group consisted of 128 patients, of whom 41 (32%) developed POAF. Age, diabetes mellitus, chronic obstructive pulmonary disease, history of transient ischaemic attack/stroke, heart failure, left atrial diameter, platelet:largecell ratio, and creatinine, urea, uric acid, calcium and potassium levels were identified as important variables for the development of POAF. However, with logistic regression analysis, chronic obstructive pulmonary disease (OR: 28.737, 95% CI: 0.836–16.118, p < 0.001), heart failure (OR: 15.430, 95% CI: 0.989–7.649, p = 0.006), diabetes mellitus (OR: 11.486, 95% CI: 0.734–11.060, p = 0.001) and left atrial diameter (OR: 1.245, 95% CI: 0.086–6.431, p = 0.011) appeared as independent variables predicting the development of POAF. Conclusion: In our study, although there was a significant negative correlation between Vitamin D and left atrial diameter, Vitamin D level was not an independent predictor for POAF.

Is SYNTAX Score Predictive of Atrial Fibrillation After On-Pump Coronary Artery Bypass Graft Surgery?

Background and Objectives The relationship of synergy between percutaneous coronary intervention with taxus and cardiac surgery (SYNTAX) score and development of atrial fibrillation (AF) after coronary artery bypass surgery (CABG) has not been studied. Therefore, we assessed the relationship between the SYNTAX score and development of AF after CABG (POAF). Subjects and Methods The medical records of consecutive patients, who underwent CABG surgery from January 2013 to September 2015, were retrospectively reviewed for the development of AF in the postoperative period. SYNTAX score, clinical and echocardiographic parameters were evaluated. The independent variables for the development of POAF were defined and their predictive values were measured. Results The study group consisted of 106 patients, of which 36 (34%) developed POAF. Age, hypertension, stroke, chronic obstructive pulmonary disease (COPD), heart failure (HF), diabetes mellitus (DM), left atrial diameter, neutrophil/lymphocyte ratio, platelet large cell ratio, creatinine, blood urea nitrogen and SYNTAX score were identified as important variables for the development of POAF. However, in logistic regression analysis COPD (OR=19.313, 95% CI=2.416-154.407, p=0.005), HF (OR=28.362, 95% CI=2.034-395.515, p=0.013), SYNTAX score (OR=0.863, 95% CI=0.757-0.983, p=0.026), and DM (OR=20.770, 95% CI=3.791-113.799, p<0.001) appeared as independent variables predicting the development of POAF. In receiver operation characteristic analysis, SYNTAX score (≥22.25) (AUC=0.777, 95% CI=0.676-0.877, p<0.001) was one of the strongest predictors for the development of POAF. Conclusion The SYNTAX score level was independently associated with the development of AF after CABG.

α-tocopherol and ascorbic acid in early postoperative period of cardiopulmonary bypass

Aim To investigate whether &agr;-tocopherol and ascorbic acid have effect on the suppression of inflammation in the early postoperative period after open heart surgery. Methods A total of 59 patients who had undergone cardiopulmonary bypass (CPB) in the Cardiovascular Surgery Department of a tertiary center between June 2008 and December 2008 were retrospectively investigated. The study group consisted of 34 patients (25 men, 9 women) to whom ascorbic acid (500 mg/day) and &agr;-tocopherol (300 mg/day) were administered on the day of operation (0th day) and the first four consecutive postoperative days. In contrast, 25 controls (20 men, 5 women) received no additional anti-inflammatory medications. The two groups were compared in terms of demographics, blood parameters such as C-reactive protein (CRP) and white blood cell (WBC) count, and durations of cross-clamp and CPB. Results In the control group, CRP levels were found to be increased on the first postoperative day (P < 0.001) and CRP levels were correlated with triglyceride levels on the day of operation (P = 0.009) and the first postoperative day (P = 0.021). On the second postoperative day WBC count was found to be decreased (P = 0.008) and correlated with glucose level (P < 0.005). In the study group, CRP levels were found to be inversely correlated with serum high-density lipoprotein (HDL) (P = 0.049) on the first postoperative day and directly correlated with triglyceride levels on the second postoperative day (P = 0.017). Blood glucose levels were found to be increased on the first postoperative day (P = 0.021) and a correlation was detected between WBC count on the fourth postoperative day and doses of ascorbic acid and &agr;-tocopherol (P = 0.027). Conclusion Suppression of the systemic inflammatory response to CPB is a double-edged sword and whether this suppression aids in the attenuation of morbidity and mortality is obscure. In this respect, ascorbic acid and &agr;-tocopherol seem to display some anti-inflammatory effect, but further studies are necessary to reveal the actual therapeutic potential and the complex mechanism related to biochemical and inflammatory parameters.

Are all antegrade cerebral perfusion techniques equal

periods. Cannulation of the right brachial artery makes the monitorization of the arterial pressure from the right radial artery impossible. In that case, direction of the blood flow will be from the head towards the aortic arch. Suturing an artificial graft to the right subclavian artery in an end-to-side fashion gives us a chance to monitor the arterial pressure from the right radial artery. In addition, it will regulate the kinetic energy of the blood flow antegradely. Suturing an artificial graft to the carotid arteries again in an end-to-side fashion would cause increased perfusion of the body during the cooling down and warming up processes in comparison to cerebral perfusion since cerebral vascular resistance would direct the blood flow to the lower resistant area, namely extracranial vasculature. This technique is unacceptable, particularly where autoregulatory mechanisms of cerebral perfusion get affected by vasoactive agents and temperature. Moreover, we think that the results of this study would be influenced by several factors: there are significant differences between left and right carotid artery cannulation (LCA and RCA) groups in terms of temperature, cardiopulmonary bypass time and flow indices during cerebral perfusion. It is not clear whether cerebral perfusion was monitored and cerebral oxygen saturation was intervened in during cooling down and warming up periods. Again, the temperature gradient between body and circulating blood during the warming up period is an important factor. These factors should be standardized. The effects of cerebral perfusion could be assessed by psychological tests and also by the detection of glucose hypometabolic areas with PET scan. We think that the right carotid artery would be more suitable for cannulation in comparison to the left carotid artery because, during cooling down and warming up periods (high flow index), the direction of the blood flow will be away from the brain and blood pressure would be monitored via the right radial artery.

Predictors of poor coronary collateral development in patients with stable coronary artery disease: Neutrophil-to-lymphocyte ratio and platelets.

We read with great interest the paper titled “Predictors of poor coronary collateral development in patients with stable coronary artery disease: Neutrophil-to-lymphocyte ratio and platelets” by Akın et al. (1) that was published in the April issue of the Anatol J Cardiol 2015; 15: 218-23. In this original article, the authors revealed that the neutrophil/ lymphocyte (N/L) ratio is independently associated with the presence of coronary collateral circulation (CCS) in patients with stable angina pectoris. Also, they found that an N/L ratio higher than 2.55 could predict a good collateral circulation with 76% sensitivity and 63% specificity using ROC analysis. Data in current scientific literature reveal that CCS is associated with metabolic syndrome and serum cholesterol levels (HDL and especially triglyceride) (2, 3). There are similar findings in the present study (1). In particular, the study found that a lower triglyceride level is significantly related with good CCS and is an independent predictor in multivariate regression analysis. Exercise has a positive effect on the lipid profile, and it does improve metabolic syndrome parameters. Furthermore, Wang et al. (4) showed in their study that diet and exercise improve the N/L ratio. The study also demonstrated that a decrease in the N/L ratio is positively correlated with interleukin-6 levels. As a result, they concluded that diet and exercise have a positive impact on proinflammatory mediators. The positive impact of exercise on CCS development has been well known for some time (5). As the positive effect of exercise on lipid parameters and the N/L ratio is already known, the questions that come to our mind are whether patients who have good CCS exercise more, and could a lower triglyceride level and a lower N/L ratio be related to exercise? However, for us to answer these questions, more information about the functional status and exercise capacity of the study patients is required, and this was not mentioned in the article. Furthermore, body mass index data for these patients are unavailable. In our opinion, the findings from this study could be related to the amount of exercise, and further studies in this area could answer this question.

Preventive Effect of Preoperative Vitamin D Supplementation onPostoperative Atrial Fibrillation

Objective To assess the relationship between preoperative vitamin D (vitD) supplementation and the development of postoperative atrial fibrillation (POAF). Methods The study group consisted of 328 consecutive patients. The ınfluence of preoperative vitD supplementation on POAF was reviewed in 136 patients who underwent coronary artery bypass graft surgery with vitD insufficiency (n=80) and vitD deficiency (n=56). Patients were assigned to receive either oral vitD (50.000 U) (treatment group, n=68) or not (control group, n=68) 48 hours before surgery. Patients were followed up during hospitalisation process with respect to POAF. Results There was no significant difference between treatment and control groups with regards to age, gender, diabetes mellitus, smoking history, chronic obstructive pulmonary disease, left atrial diameter, and biochemical parameters. Also, there was no significant difference between these groups with regards to mean vitD level on both insufficiency and deficiency patients (24.6±3.7 vs. 24.9±3.9 ng/ml P=0.837, 11.4±4.9 vs. 10.9±5.2 ng/ml P=0.681, respectively). Although the occurrence of POAF was not significantly different among treatment and control groups in patients with vitD insufficiency (31% vs. 33% P=0.538), there was a significant difference between the two groups regarding to POAF in patients with vitD deficiency (18% vs. 29% P=0.02). Conclusion Although preoperative vitD supplementation was not found to be associated with prevention of POAF in patients with vitD insufficiency, it was found to be strongly associated with prevention of POAF in those with vitD deficiency.

The relation between vitamin B12 and SYNTAX score

BACKGROUND Vitamin B12 is required in the metabolism of homocysteine. Vitamin B12 deficiency has been implicated in endothelial dysfunction and cardiovascular disease via hyperhomocysteinaemia. However, the association of vitamin B12 and the severity of coronary artery disease has not been studied to date. AIM This study was conducted with the aim of evaluating the relationship between vitamin B12 and SYNTAX score. METHODS Medical records of consecutive patients who underwent coronary artery bypass grafting surgery were retrospectively reviewed. The study group consisted of 127 patients. Vitamin B12, other biochemical parameters, clinical and echocardiographic parameters, and SYNTAX score were evaluated for all patients. RESULTS Patients with vitamin B12 deficiency had a higher prevalence of cardiovascular risk factors such as diabetes mellitus, and history of transient ischaemic attack/stroke and heart failure. The SYNTAX score was significantly higher in patients with vitamin B12 deficiency (29.2 ± 4.9 vs. 22.5 ± 4.5, p < 0.05). CONCLUSIONS In our study, we found a significant relationship between vitamin B12 deficiency and SYNTAX score, demon-strating the severity and complexity of coronary artery disease.

Spider-Like Coronary Anatomy; the True Spider!

A 55 year-old man was admitted to the hospital with typical chest pain; the ECG and cardiac biomarkers were normal. He had a history of hypertension and coronary angiography (CAG) a year ago due to unstable angina pectoris and a drugeluting stent was implanted at the left anterior descending (LAD) coronary artery. CAG was performed at admission due to persistent chest pain and a single right coronary ostium was seen at the right coronary sinus, where LAD artery, left circumflex coronary (LCx) artery and right coronary artery (RCA) arose altogether. Non-significant plaques were seen at LAD and LCx, whereas RCA was obstructed from the middle segment and retrograde perfusion was observed (Figure 1A and 1B). The patient was treated conservatively and reported no chest pain 12 months later. The single coronary ostium is classified into 20 categories based on the ostiums location and our patient had characteristics of type IID3 (Figure 1C). Although type IID coronary anomaly has been described before, it has been reported only once and this is the second case of literature showing a single coronary ostium originating from the right coronary ostium.

Successful resection and reconstruction of primary cardiac lymphoma

Primary cardiac lymphoma (PCL) is one of the rarest tumors of the heart. The most common type is diffuse, large B-cell lymphoma. Most often, the right atrium and the right ventricle are involved, and if not diagnosed and treated in time, it can be fatal. In this case, a female patient underwent an urgent operation for a large, infiltrative, right atrial mass. Extensive resection of the lateral walls of both atria and the interatrial septum as well as reconstruction were performed successfully. The pathological evaluation suggested PCL. The aim of this case is to raise awareness of this disease and to highlight clinical and surgical approaches.