Grigore Tinica

Echocardiographic predictors of adverse short-term outcomes after heart surgery in patients with mitral regurgitation and pulmonary hypertension.

BACKGROUND Pulmonary hypertension (PH) is a frequent occurrence and a negative prognostic indicator in patients with mitral regurgitation. Preoperative PH causes higher early and late mortality rates after heart surgery, adverse cardiac events, and postoperative systolic dysfunction in the left ventricle (LV). METHODS The research consisted of a retrospective study of a group of 171 consecutive patients with mitral regurgitation and preoperative PH who had undergone mitral valve surgery between January 2008 and October 2011. The PH diagnosis was based on echocardiographic evidence (systolic pulmonary artery pressure [sPAP] >35 mm Hg). The echocardiographic examination included assessment of the following: LV volume, LV ejection fraction (LVEF), sPAP, right ventricular end-diastolic diameter, right atrium area indexed to the body surface area, the ratio of the pulmonary acceleration time to the pulmonary ejection time (PAT/PET), tricuspid annular plane systolic excursion (TAPSE), determination of the severity of the associated tricuspid regurgitation, and presence of pericardial fluid. Surgical procedures consisted of mitral valve repair in 55% of the cases and mitral valve replacement in the remaining 45%. Concomitant coronary artery bypass grafting (CABG) surgery was carried out in 52 patients (30.41%), and De Vega tricuspid annuloplasty was performed in 29 patients (16.95%). The primary end point was perioperative mortality. The secondary end points included the following: pericardial, pleural, hepatic, or renal complications; the need for a new surgical procedure; postoperative mechanical ventilation >24 hours; length of stay in the intensive care unit; duration of postoperative inotropic support; need for an intra-aortic balloon pump; and need for pulmonary vasodilator drugs. RESULTS The mortality rate was 2.34%. In the univariate analysis, the clinical and echocardiographic parameters associated with mortality were preoperative New York Heart Association (NYHA) class IV, the PAT/PET ratio, TAPSE, the indexed area of the right atrium, and concomitant CABG surgery. In the multivariate analysis, the indexed area of the right atrium and concomitant CABG surgery remained statistically significant. The multivariate analysis also showed the indexed area of the right atrium, LVEF, presence of pericardial fluid, preoperative NYHA class, and concomitant CABG surgery as statistically significant for the secondary end point. The receiver operating characteristic (ROC) curves identified an sPAP value >65 mm Hg to have the highest specificity and sensitivity for the risk of perioperative death in mitral regurgitation patients (area under the ROC curve [AUC], 0.782; P < .001) and identified an sPAP value of 60 mm Hg as the secondary end point (AUC, 0.82; P < .001). Severe PH (sPAP >60 mm Hg) is associated with a significant increase in the mortality rate; a longer stay in the intensive care unit; a mechanical ventilation duration >24 hours; lengthy inotropic support; renal, hepatic, and pericardial complications; and a need for endothelin receptor antagonists, phosphodiesterase type 5 inhibitors, and/or prostanoids, both in the general group and in patients with preserved systolic functioning of the left ventricle. CONCLUSIONS PH is a strong short-term negative prognostic factor for patients with mitral regurgitation. The surgical procedure should be performed in the early stages of PH. Echocardiographic examination has useful, simple, and reproducible tools for classifying operative risks. An ischemic etiology and a need for concomitant CABG surgery are additional risk factors for patients with mitral regurgitation and PH.

Patch abscess after a closure of an atrial septal defect

Surgical atrial septal defect closure with a patch is one of the simplest interventions in cardiac surgery. However, patch infection could be a serious complication. A 34-year-old man was referred to our service 7 years after surgical closure with a Dacron patch of an ostium primum septal defect and mitral cleft closure. …

Outcomes and predictors of recurrences after pulmonary vein isolation by cryoballoon or radiofrequency catheter atrial fibrillation ablation

Aim: Catheter-based pulmonary vein isolation (PVI) has become a new option treatment for drug-resistant and symptomatic paroxysmal atrial fibrillation (AF). We aimed to assess the outcomes after radiofrequency and cryoballoon catheter AF ablation. Material and methods: We performed a single-center prospective clinical study enrolling patients who underwent catheter ablation for paroxysmal AF between 2013 and 2015. The main objective was the outcomes after AF ablation by cryoballoon or radiofrequency energy. Follow-up was performed at 3, 6 and 12 months after ablation. Results: A total of 85 patients were included: 64 assigned to radiofrequency and 21 to cryoballoon ablation. Overall success rate at 3, 6 and 12 months post-ablation was 62%, 76% and 75%, respectively. Redo procedure was required in 8 patients (10.3%) at 6 months. Success rate at 12 months was non-significantly higher in radiofrequency ablation group (76% versus 62%; p=0.56). Complication rates were equivalent, without life treating or permanent sequels. Men gender, AF duration, obesity and sleep apnoea syndrome were clinical predictors of AF recurrence at 12 months after procedure. Conclusions: Cryoballoon and radiofrequency ablation appear to be safe and effective procedures for AF treatment, with similar success rate. Men gender, AF duration, obesity and sleep apnea syndrome seem to be associated with AF recurrence after ablation.

Asymptomatic Coronary Artery Disease in Type 2 Diabetes Mellitus Patients Compared to a Non-Diabetic Control Group

238 Acta Endocrinologica (Buc), vol. X, no. 2, p. 238-247, 2014 *Correspondence to: Raluca Ozana Chistol MD, “Prof.Dr. George I.M. Georgescu” Institute for Cardiovascular Diseases, Radiology, B-dul Carol I, no. 50, Iasi, 700503, Romania, E-mail: ralucachistol@gmail.com Abstract Background. Coronary artery disease (CAD), often asymptomatic, is the most common cause of morbidity, mortality and costs in diabetes. Early detection of CAD in patients with diabetes may be of paramount importance and substantially improve the outcome in diabetic patients. Objective. The aims of the current study were to determine if there are significant differences concerning the prevalence of occult CAD in asymptomatic type 2 diabetic patients compared to asymptomatic nondiabetic patients. Design, subjects and methods. The authors retrospectively reviewed a group of 120 non-diabetic (77 men, 43 women, mean age 61±10.2 years) and 120 diabetic (81 men, 39 women, mean age 58±11.4 years) asymptomatic patients that underwent coronary computed tomography angiography (CCTA) for various reasons between January 2013 and January 2014. Results. Coronary plaques were identified in 105 diabetic patients (87.5%) and in 75 non-diabetic patients (62.5%) the prevalence being significantly different (p=0.023). Regarding plaque composition and degree of stenosis, we found a higher prevalence of calcified (p=0.016) and significantly stenotic (≥50% luminal narrowing) plaques (p=0.008) in the diabetic group. Agatston calcium score, relevant for atherosclerotic plaque load, was higher (p=0.005) in type 2 diabetic patients (350.3) compared to non-diabetic patients (158.7). Conclusion. CCTA could represent a screening method able to detect silent atherosclerotic plaques thus contributing to the prevention of acute coronary syndrome (ACS) by an early and adequate treatment of CAD. Obstructive atherosclerotic plaques can be accurately identified using CCTA, limiting the use of invasive imaging methods and selecting patients that could benefit of coronary revascularization.