Talat Tavlı

Evaluation of Myocardial Contractility Determination with Tissue Tracking Echocardiography after Levosimendan Infusion in Patients with Poor Left Ventricular Function and Hemodynamics

BACKGROUND The aim of this study was to assess the effect of conventional inotropic drugs compared to levosimendan using tissue tracking echocardiography in the early postoperative period for patients with low ejection fraction undergoing coronary artery bypass graft (CABG) surgery. METHODS We prospectively analyzed 115 patients (69 male, 46 female) who planned for elective coronary artery bypass surgery with low ejection fraction, ≤% 30, from September 2012 to December 2013. Patients were divided into two groups. Levosimendan was used at a loading dose of 15 μg/kg/min for the first twenty minutes, and continued at a maintenance dose of 0.2 μg/kg/min six hours before the anesthetic induction in group I (n = 47, 23 male, mean age 67.16 ± 4.72 years). Dopamine at 10 μg/kg/min and/or dobutamine at 10 μg/kg/min were used at the time of weaning from cardiopulmonary bypass in group II (n = 68, 47 male, mean age 65.43 ± 6.12 years). The patients were evaluated preoperatively and on the fifth postoperative day by transthoracic echocardiography. Patients were also evaluated just before the cardiopulmonary bypass and at the 12th and 24th hours on the first postoperative day by transesophageal echocardiography. Student t test and χ2 test were used for statistical analyses. RESULTS There were no significant differences in demographics and preoperative hemodynamic parameters between groups I and II. Hemodynamic and echocardiographic parameters were significantly better in group I receiving levosimendan, compared to group II. CONCLUSION Levosimendan enhances functional myocardial tissue mass and ensures positive hemodynamic effect in the early postoperative period in patients with low ejection fraction undergoing elective CABG.

Use of guideliner cathater in saphenous vein graft: A case report

Guideliner catheter (Vascular Solutions, Minneapolis, MN) is a novel, rapid exchange system which allows deep intubation and facilitate equipment delivery through the complex coronary lesions. We describe the use of this device in a percutaneous intervention of a native diagonal lesion through tortious and calcific saphenous vein graft.

Role of Autonomic Dysfunction and Relation with Diastolic Dysfunction in Resistant Hypertensives

PP-017 There may be a role of autonomic dysfunction and sympathetic overactivity in the development of hypertension. The risks of cardiovascular events and target organ damage are much more in resistant hypertension. In recent years; renal denervation therapies have become more popular for drug-

Decision making and results of coronary artery bypass grafting for patients with poor left ventricular function.

BACKGROUND The aim of this study is to determine the results of coronary artery bypass surgery in patients with a low ejection fraction. Between January 2007 and January 2011, 3556 consecutive patients who underwent coronary artery bypass grafting at the Cardiovascular Surgery Clinic at Sifa University Hospital, Izmir, Turkey, were analyzed retrospectively. METHODS The patients were divided into 2 groups. Patients undergoing isolated first-time elective coronary bypass surgery were classified according to their preoperative ejection fraction; Patients in Group I had an ejection fraction between 20% and 35% with poor left ventricular function (n = 1246; 695 men and 551 women; mean age, 62.25 ± 5.72 years, range, 47-78 years). Control patients in Group II underwent elective coronary artery bypass grafting at the same time and had left ventricular ejection fraction between 36% and 49% (n = 2310; 1211 men and 1099 women; mean age, 61.83 ± 8.12 years, range, 41-81 years). The mean follow-up time for all patients was 24 ± 9.4 months (range, 12-48 months). Patients were followed postoperatively at the end of the first month and every 6 months. The left ventricular ejection fraction was assessed by transthoracic echocardiography. RESULTS The mean number of distal anastomoses, myocardial infarction, and mean age was not significantly different between the 2 groups; however, cross-clamp time was longer in Group I. Patient recovery time was significantly longer in Group I. Morbidity (14.5% in Group I versus 7.4% in Group II, P < .005) and mortality (1.76% versus 0.30%, P < .005) were higher in Group I. During late follow-up, the 2-year survival rate (85.1% versus 94.5%) and 2-year event-free rate (77.6% versus 86.9%) were significantly lower in Group I when compared to Group II. Postoperative left ventricular ejection fraction values were significantly superior in Group I compared to Group II. CONCLUSION Coronary artery bypass grafting can be safely performed in patients with low ejection fraction with minimal postoperative morbidity and mortality. The viable myocardium could be reliably determined by positron emission tomography. Low ejection fraction patients could greatly benefit from coronary bypass surgery regarding postoperative ejection fraction, increased long-term survival, improvement in New York Heart Association classification, and higher quality of life.

Diagnosis of a huge right atrial thrombus during coronary artery bypass graft surgery.

Patient: Male, 73 Final Diagnosis: Coronary artery thrombosis Symptoms: Angina pectoris • short of breath Medication: — Clinical Procedure: CABG Specialty: Cardiology Objective: Management of emergency care Background: Intra-operative formation of a thrombus in the right heart is rare and might be unrecognized. However, it can be associated with severe consequences, including pulmonary embolism and death. Case Report: We report the case of a 73-year-old man who presented to the cardiologist with angina pectoris and rare shortness of breath. Coronary artery bypass grafting (CABG) was performed due to multi-vessel disease. Because of hemodynamic insufficiency, an intra-operative transesophageal echocardiogram (TEE) was performed and a huge free-floating thrombus was detected. Multiple thrombi were removed from the right heart and pulmonary arteries. The patient died after cardiopulmonary bypass support and 12 hours of intensive care. Conclusions: In this case report, we emphasize the importance of the TEE during the preoperational period and during CABG, as well as in the preoperative evaluation of pulmonary hypertension.