Charilaos-Panagiotis Koutsogiannidis

Pericardial fat is strongly associated with atrial fibrillation after coronary artery bypass graft surgery

OBJECTIVES Recent evidence suggests that pericardial fat may represent an important risk factor for cardiovascular disease because of its unique properties and its proximity to cardiac structures. It has been reported that pericardial fat volume (PFV) is associated with atrial fibrillation (AF). The purpose of this study was to investigate the association between PFV and new-onset AF following coronary artery bypass graft surgery (CABG). METHODS PFV was measured using computed tomography in 83 patients with coronary artery disease scheduled to undergo elective isolated on-pump CABG. Patient characteristics, medical history and perioperative variables were prospectively collected. Any documented episode of new-onset postoperative AF until discharge was defined as the study end point. RESULTS Twenty-eight patients (33.7%) developed postoperatively AF during hospital stay. There was no significant difference in demographics and comorbidities among patients that maintained sinus rhythm (SR) and their AF counterparts. In univariate analysis, patients with postoperative AF had significantly more pericardial fat compared with SR patients (195 ± 80 ml vs 126 ± 47 ml, P = 0.0001). Larger left atrial diameter was also associated with postoperative AF (42.4 ± 6.9 mm vs 39.3 ± 4.8 mm, P = 0.017). Additionally, the prebypass use of calcium channel-blocking agents was independently associated with a lower incidence of postoperative AF, confirmed also by multivariate analysis (P = 0.035). In multivariate logistic regression analysis, PFV was the strongest independent variable associated with the development of postoperative AF (odds ratio: 1.018, 95% confidence interval: 1.009-1.027, P = 0.0001). The best discriminant value assessed by receiver operating characteristic analysis was 129.5 ml (sensitivity 86% and specificity 56%). CONCLUSIONS PFV is strongly associated with AF following CABG, independently of many traditional risk factors. Our findings suggest that PFV may represent a novel risk factor for postoperative AF. However, the role of pericardial fat in AF mechanism needs to be further delineated.

Noninvasive Ventilation for Post-Pneumonectomy Severe Hypoxemia

ARDS remains a lethal complication after major lung resections. The reported mortality ranges from 50% to 100%, with increased incidence and mortality rates in pneumonectomy patients. The pathogenesis of early ARDS is still not fully understood, and the majority of patients will require mechanical ventilation. A review of the literature reveals that the role of noninvasive ventilation (NIV) in ARDS after lung resection is unclear, in contrast to its well established benefits in other types of respiratory failure. NIV is a technique of augmenting alveolar ventilation delivered by face mask, without introducing an endotracheal tube. NIV may reduce the need for endotracheal mechanical ventilation and improve clinical outcome in patients with acute respiratory failure after lung resection, avoiding complications related to intubation. We present a case of early ARDS following left-sided pneumonectomy, where bi-level positive airway pressure ventilation prompted a successful outcome.

Delayed Presentation of Diaphragmatic Rupture: An Unusual Case of Dyspnea

Diaphragmatic injuries are relatively rare, and they are the result of penetrating or blunt trauma. Blunt diaphragmatic rupture occurs mainly from high-speed motor vehicle crashes. Sudden increase in intra-abdominal pressure may cause a diaphragmatic tear and visceral herniation. The magnitude of

Decreased DNA Disruption in the Porcine Neocortex with Erythromycin Preconditioning during Prolonged Hypothermic Circulatory Arrest: Evidence for Neuroprotection

We have previously reported that the neocortex is selectively vulnerable to injury in an acute porcine model of hypothermic circulatory arrest (HCA) at 18°C. In view of recent evidence showing that pharmacologic preconditioning with a single dose of erythromycin induces tolerance against transient global cerebral ischemia in rats, we hypothesized that erythromycin would reduce the number of apoptotic neurons in the neocortex in an acute porcine model of HCA at 18°C.

Tailoring Noninvasive Ventilation Management in Non-ICU Settings and the Cardiac Surgery Context

Most respiratory therapists agree that noninvasive ventilation (NIV) has brought a revolution in respiratory failure.[1][1] This rapidly expanding treatment strategy supports gas exchange and improves functional status of patients, shortens ICU and hospital stay, reduces mortality, and decreases

Surgical treatment of atrial septum lipomatous hypertrophy associated with syncopal attacks

Lipomatous hypertrophy of atrial septum (LHAS) is a rare benign cardiac condition characterized by fatty tissue infiltration located in the atrial septum. We presented a rare case of LHAS resulting in recurrent syncopal attacks.

Profound Hypothermia Provides Neuroprotection Following Hypothermic Circulatory Arrest: Ultrastructural Observations.

Objective: To assess whether cooling to 10°C can reduce neurological injury during 75 minutes of hypothermic circulatory arrest (HCA) compared to cooling to 18°C. Methods: Twelve domestic swine were used for this prospective blind randomized study. The animals were divided into 2 groups: Group A (n=6) underwent hypothermic circulatory arrest at 18oC for 75 min, and Group B (n=6) underwent hypothermic circulatory arrest at 10oC for 75 min. At the end of the experiment, the brains were removed and immersed in paraformaldehyde. All brains were dissected in the sagital plane. Tissue blocks from the left hemisphere were cut to encompass the sensory neocortex. Results: The selected area was identified with a dissecting microscope. Samples were examined in a blind fashion using electron microscope. Two investigators were instructed to find 10 representative neurons and analyze electron micrographs of these neurons for evidence of nuclear and cytoplasmic changes. Similarly, each investigator was instructed to examine the perinuclear neuronal mitochondria for abnormalities in mitochondrial distribution. Significant differences were observed between the 2 groups in mitochondria and rough endoplasmic reticulum (RER). In 5 of the 6 animals treated with 18oC HCA, neurons had slightly dilated RER, Golgi apparatus and mitochondria. In all 6 animals treated with 10oC HCA, the structure of the cytoplasmic organelles was intact, with no apparent dilatation (p=0.015). Conclusion: This study adds further support that hypothermia at 10°C exerts better cellular protection than hypothermia at 18°C, as evidenced by these electron microscopy findings.

Routine innominate artery cannulation for elective ascending aortic surgery. A single-centre experience.

Innominate artery cannulation is indicated in operations for acute and chronic aortic disease and also in case of porcelain aorta or reoperations. We routinely used innominate artery cannulation in 81 elective operations which included ascending aorta replacement.

Atypical Pattern of Lung Involvement in Pacemaker Endocarditis

Pacemaker endocarditis has a high rate of morbidity and mortality and is associated with substantial health-care cost. To maximize the effectiveness of treatment, diagnosis of pacemaker endocarditis should be made as early as possible. Medical treatment alone is not successful, and the removal of the entire artificial pacing system is often required. We present a case of a female patient with a permanent transvenous pacemaker, recurring episodes of fever and chills, general malaise, and a computed tomography image of a solitary tumor-like lesion indicating pneumonia. The symptoms subsided with empirical antibiotics but without improvement in the radiologic images. A wedge resection of the lesion by thoracotomy was performed, revealing a necrotic lung lesion compatible with pulmonary infarct. Transesophageal echocardiography showed a mass that was adherent to the pacemaker lead. The therapeutic approach consisted of surgical removal of the complete pacing system along with long-term antibiotic therapy and implantation of a new device with an epicardial lead. Serial follow-up echocardiograms for a 1-y period did not show any recurrence, and the subsequent course was uneventful.

Erythromycin induced neuroprotection during prolonged deep hypothermic circulatory arrest in an acute porcine model

Methods Piglets were treated with erythromycin (25 mg/kg, iv) (n = 8) or vehicle (n = 6) and subjected to 75 minutes of DHCA at 18°C, 12 hours after pretreatment. Three served as normal controls. After gradual rewarming, treatment animals were sacrificed and brains were perfusion-fixed and cryopreserved. Motor cortex was dissected from the left hemisphere and paraffin embedded for histologic staining with hematoxylin and eosin (HE). To assess neuronal damage, HE-stained paraffin sections (10 μm) were examined by light microscopic examination at x400 magnification. Layer V of the motor cortex was counted. Neuronal injury was recorded when there was evidence of eosinophilic cytoplasm, cytoplasmic vacuolation, cell body shrinkage or nuclear pyknosis. Neuronal injury was scored on a scale of 0-5.