Sukru Gur

Effects of CPAP on right ventricular myocardial performance index in obstructive sleep apnea patients without hypertension

ObjectivesObstructive sleep apnoea (OSA) might cause right ventricular dysfunction and pulmonary hypertension. We aimed to determine the effects of nasal continuous positive airway pressure (CPAP) therapy on right ventricular myocardial performance index (MPI) in OSA patients without hypertension.Methods49 subjects without hypertension, diabetes mellitus, any cardiac and pulmonary disease had overnight polysomnography and echocardiography. In 18 moderate-severe OSA (apnea-hypopnea index ≥ 15) patients, right ventricular free wall diameter (RVFWD) was measured by M-mode, and right ventricular MPI was calculated as (isovolumic contraction time+ isovolumic relaxation time) / pulmonary ejection time using Doppler at baseline and after 6 months CPAP therapy.ResultsMean age was 46.5 ± 4.9 year. Patients had high body mass index (BMI: 30.6 ± 4,0 kg/m2), but there was no change in either BMI or blood pressures after 6 months. Right ventricular end-diastolic and end-systolic diameters were in normal limits at baseline, and did not change after CPAP usage. Baseline RVFWD (7.1 ± 2.1 mm) significantly decreased after CPAP therapy (6.2 ± 1.7 mm, p < 0.001). 15 of patients (83%) had right ventricular diastolic dysfunction at baseline, and it was completely improved in 11 of them (73%) by CPAP usage. Right ventricular global dysfunction was shown in 11 patients (61%) with a high MPI (62.2 ± 9.3%) at baseline; and MPI was significantly decreased after CPAP therapy (47.3 ± 8.4%, p < 0.0001), and it was completely corrected in 4 of them (36%).ConclusionCPAP therapy significantly decreases RVFWD and improves right ventricular diastolic and global functions (MPI) in OSA patients without hypertension.

Tirofiban-induced acute profound thrombocytopenia after primary angioplasty.

Glycoprotein IIb/IIIa inhibitors are used in the acute coronary syndromes and percutaneous coronary intervention as antiplatelet agents. However, these agents induce thrombocytopenia in approximately 1% to 5% of patients, and may lead to bleeding complications. Abciximab is associated with higher incidence of thrombocytopenia than eptifibatide and tirofiban. We describe a case of acute profound thrombocytopenia due to on tirofiban treatment in a patient who underwent primary angioplasty.

A Spontaneous Coronary Artery Dissection Case Noticed during a Primary PCI

Spontaneous coronary dissections (SCAD) can be asymptomatic or can manifest itself as any of the clinical spectrum of the ischemic heart disease. In this report, we present a 65 year old man presented with myocardial infarction in whom coronary angiography a nonocclusive SCAD was noticed in addition to a very late stent thrombosis and make a brief overview of the treatment for SCAD.

30-year patency of a saphenous vein graft in coronary bypass graft surgery.

3 74-year-old man was admitted to our institute complaining of angina pectoris. Electrocardiograhy revealed sinus rhythm with left bundle branch block. e had a 30-year history of acetylsalicylic acid use. Thirty years previously, an anastomosis had been created etween the ascending aorta and the left anterior descendng artery (LAD) using a saphenous vein graft. Angiograhy showed significant lesions in the right coronary and ircumflex coronary arteries. The proximal LAD artery was ompletely occluded, but the previously performed aortoAD bypass was working perfectly (Fig 1A, Angiographic mage; B, diameters of vessels. 1 saphenous vein graft; 2 the proximal LAD; 3 the distal LAD; 4 6F Judkins atheter; * proximal anastomosis; ** distal anastomois). The right coronary artery and circumflex lesions were uccessfully treated with stents. The best predictor of the graft patency is the diameter f the vessel. For saphenous vein grafts performed to the AD, the 10-year patency is 90% for vessels exceeding 2.0

A rapid decrease in pulmonary arterial pressure by noninvasive positive pressure ventilation in a patient with chronic obstructive pulmonary disease

The natural history of chronic obstructive pulmonary disease (COPD) is characterized by progressive decrements in expiratory airflow, increments in end-expired pulmonary volume, hypoxaemia, hypercapnia and the progression of pulmonary arterial hypertension (PAH). Noninvasive positive pressure ventilation (NPPV) treatment is increasingly used for the treatment of acute and chronic respiratory failure in patients with COPD. NPPV can increase PaO 2 and decrease PaCO 2 by correcting the gas exchange in such patients. The acute effect of NPPV on decreasing PAP is seen in patients with respiratory failure, probably due to the effect on cardiac output. Here, a case with COPD whose respiratory acidosis and PAH rapidly improved by NPPV was presented and therefore we suggested to perform an echocardiographic assessment to reveal an improvement of PAH as well as respiratory acidosis, hypercapnia and hypoxemia with that treatment.