Gábor Kecskés

Influence of dextran-70 on systemic inflammatory response and myocardial ischaemia-reperfusion following cardiac operations

IntroductionExperimental studies have demonstrated that dextran-70 reduces the leukocyte–endothelium interaction, but clinical evidence is still lacking. Our objective was to justify the anti-inflammatory effect of dextran-70 following cardiac operations.MethodsForty patients undergoing coronary bypass surgery (n = 32) or aortic valve replacement (n = 8) were enrolled in this prospective, randomized, double-blind study. Two groups were formed. In group A (n = 20), dextran-70 infusion was administered at a dose of 7.5 ml/kg before the initiation of cardiopulmonary bypass and at a dose of 12.5 ml/kg after the cessation of cardiopulmonary bypass. Group B served as a control with identical amounts of gelatin infusion (n = 20). The plasma concentration of procalcitonin, C-reactive protein, IL 6, IL 6r, IL 8, IL 10, soluble endothelial leukocyte adhesion molecule-1, soluble intercellular adhesion molecule-1, cardiac troponin-I and various haemodynamic parameters were measured in the perioperative period. Multivariate methods were used for statistical analysis.ResultsIn group A, lower peak (median) plasma levels of procalcitonin (0.2 versus 1.4, p < 0.001), IL 8 (5.6 versus 94.8, p < 0.001), IL 10 (47.2 versus 209.7, p = 0.001), endothelial leukocyte adhesion molecule-1 (88.5 versus 130.6, p = 0.033), intercellular adhesion molecule-1 (806.7 versus 1,375.7, P = 0.001) and troponin-I (0.22 versus 0.66, p = 0.018) were found. There was no significant difference in IL 6, IL-6r and C-reactive protein values between groups. Higher figures of the cardiac index (p = 0.010) along with reduced systemic vascular resistance (p = 0.005) were noted in group A.ConclusionOur investigation demonstrated that the use of dextran-70 reduces the systemic inflammatory response and cardiac troponin-I release following cardiac operation.Trial registration numberISRCTN38289094.

Left Ventricular Aneurysm

A 62-year-old man presented with chest discomfort and fatigue. He had been diabetic for 22 years and he suffered an acute myocardial infarction 18 years earlier. Chest radiography (Figure 1A) and computed tomography showed marked calcification on the left ventricular silhouette. The echocardiogram confirmed the diagnosis of left ventricular aneurysm and documented a laminated thrombus and proved a 27% ejection fraction. Coronary angiography demonstrated triple-vessel disease. Under cardiopulmonary bypass and crystalloid cardioplegia, a huge thrombosed and heavily calcified aneurysm was resected (Figures 1B and 1C). Repair was achieved by resection of the extended endocardial calcification, with preservation of the myocardium, and linear approximation with Teflon strips (Figure 1D). The right and circumflex coronary artery were revascularized with saphenous vein grafts. Five years later the patient underwent bilateral amputation of the limbs for a progressive atherosclerosis of the lower extremities, and seven years after the operation the patient is angina free, but has slight limitation of physical activity with prosthetic limbs. His control echocardiogram proved a 33% ejection fraction.