[Anesthetic management with ATP for endovascular thoracic aortic repair].
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Abstract:
A 78-year-old man with thoracic aortic aneurysm was scheduled for endovascular stent-graft surgery without cardiopulmonary bypass. He had a history of myocardial infarction five months before and echocardiography revealed ejection fraction of 37%. Deployment of the stent-graft was performed during third degree atrioventricular (A-V) block of 32 seconds produced by adenosine 5'-triphosphate (ATP) 30 mg. There were no complications during this procedure. ATP is a convenient and suitable agent to produce transient A-V block for the precise deployment of the stent-graft in these patients with severe cardiopulmonary complications.Keywords:
Atrioventricular block
Thoracic aortic aneurysm
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Coronary arteries
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Unstable angina
Brain natriuretic peptide
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Objective To investigate the effect of percutaneous coronary intervention on plasma BNP levels and prognosis in patients with acute right ventricular myocardial infarction combining left ventricular inferior wall or anterior wall myocardial infarction.Methods A total of 175 patients of acute right ventricular infarction with left ventricular inferior wall or anterior wall myocardial infarction were divided into two groups:left ventricular inferior wall myocardial infarction group and left ventricular anterior wall myocardial infarction group.The plasma BNP level,myocardium enzyme,hemodynamics and coronary artery disease were compared between two groups.The plasma BNP level and prognosis were compared before and after primary PCI or delayed PCI treatment.Results The plasma BNP level,peak values of CK and CK-MB,pulmonary systolic pressure,the degree of infarct-related coronary artery and the incidence of 2 vessels infarction in patients with left ventricular anterior wall myocardial infarction were higher than those in patients with left ventricular inferior wall myocardial infarction(P0.05).The plasma BNP levels of the patients were reduced after primary PCI or delayed PCI(P0.05),but the reduced level was higher in the patients after primary PCI(P0.05).The mortality was higher in patients with no-PCI than that in the other patients(P0.05).Conclusion The plasma BNP level in the left anterior wall myocardial infarction patients with acute right ventricular myocardial infarction is higher,and the degree of coronary stenosis is more serious.The plasma BNP levels in the patients after primary PCI decrease significantly.The patients with no-PCI has higher mortality.
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Left ventricular remodeling (LVR), an increase in left ventricular end-diastolic volume index > or = 20%, is an adverse consequence of myocardial infarction. The aim of this study was to assess the association between LVR and adiponectin, which has been shown to protect against myocardial ischemia-reperfusion injury.In 75 patients echocardiographic examination was performed one year after ST-segment elevation myocardial infarction, successfully treated with primary percutaneous coronary intervention (pPCI). Two groups of patients were analyzed: those with LVR (n = 15) and those without LVR (n = 60).The predictors of LVR were: anterior myocardial infarction, glucose at admission, baseline C-reactive protein, adiponectin, and echocardiographic parameters: left ventricular end-diastolic and end-systolic volume indices, ejection fraction < 40% and left ventricular wall motion score index (WMSI) at discharge. On multivariable regression analysis, lower adiponectin level (OR = 0.67, 95% CI 0.49-0.91, p < 0.05) and higher WMSI (OR = 20.14, 95% CI 2.62-154.82, p < 0.01) were the only independent negative predictors of LVR. The optimal cut-off for adiponectin for predicting LVR was < or = 4.7 mg/mL (sensitivity: 73%, specificity: 85%) and this level increased the risk of LVR 15-fold (95% CI 4.05-59.87, p = 0.0001).Baseline low blood adiponectin concentration, along with WMSI, can be considered as a predictor of the LVR in male patients one year after myocardial infarction and pPCI.
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OBJECTIVE To study the association between the plasma concentration of brain natriuretic peptide and severity?left ventricular function?prognosis in patients with acute myocardial infarction(AMI). METHODS Sixty-three patients with acute myocardial infarction were enrolled in this study. The plasma concentration of BNP were measured at 24 hours after infarction. The infarction areas were measured according to the electrocardiogram. Left ventricular function was evaluated by echocardiography with the parameters of left ventricular ejection fraction (LVEF)after one week. Patients were followed up for three months,and their main adverse cardiac events (angina pectoris,sudden death et al) in patients of AMI were observed. RESULTS The concentration of BNP in patient with AMI was related with severity of the disease,the BNP increasd (P0.01),with the enlargement of infarction areas while with the decrease of LVEF,the BNP increased (P0.05). The development of any clinical main adverse cardiac events (depth/CHF/reinfarction) occurred more frequently in patients with a higher plasma BNP level(P=0.02). CONCLUSION Plasma concentration of BNP in patients with AMI might be a reliable biochemical marker for predicting the severity and prognosis of this disease.
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Unstable angina
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Homocysteine is considered to be a risk factor, or an indicator of risk, for the development of cardiovascular disease. Little data is available on its significance in patients with previous myocardial infarction. The aim of our study was to assess the plasma level of homocysteine and its relationship with the severity of heart failure in patients with chronic myocardial infarction.We studied 144 patients with previous myocardial infarction. Patients were divided into two groups according to the presence or absence of heart failure, as certified by clinical evidence of heart failure and by echocardiographic criteria for left ventricular systolic dysfunction.Of the patients with prior myocardial infarction (144; 63.6 ± 9.6 years) included in the study, 65 had heart failure. The mean level of homocysteine was significantly higher in the heart failure group (18.9 mmol/L) than in the non-heart failure group (14.1 mmol/L; p ≤ 0.001). Our study demonstrated that there is a statistically significant correlation between homocysteine plasma levels and the severity of heart failure in patients with prior myocardial infarction. Homocysteine levels have proved to become higher with NYHA class progression. A significant cross-sectional correlation has been assessed between homocysteine and tissue Doppler echocardiography parameters.Increased plasma homocysteine levels independently correlate with the severity of heart failure in patients with chronic myocardial infarction. We suggest that homocysteine can be used in clinical practice as a valuable heart failure risk marker in patients with chronic myocardial infarction.
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