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2014| July-September | Volume 17 | Issue 3
Online since
July 3, 2014
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JANAK MEHTA AWARD
Prediction of postoperative atrial fibrillation after coronary artery bypass grafting surgery: Is CHA
2
DS
2
-VASc score useful?
Deepak Borde, Uday Gandhe, Neha Hargave, Kaushal Pandey, Manish Mathew, Shreedhar Joshi
July-September 2014, 17(3):182-187
DOI
:10.4103/0971-9784.135841
PMID
:24994728
Aims
and
Objectives:
Postoperative atrial fibrillation (POAF) is the most common arrhythmia after coronary artery bypass grafting (CABG) surgery. The identification of patients at risk for POAF would be helpful to guide prophylactic therapy. Presently, there is no simple preoperative scoring system available to predict patients at higher risk of POAF. In a retrospective observational study, we evaluated the usefulness of CHA
2
DS
2
-VASc score to predict POAF after CABG.
Materials
and
Methods:
After obtaining approval from Institutional Review Board, 729 patients undergoing CABG on cardiopulmonary bypass (CPB) were enrolled. Patients were followed in the postoperative period for POAF. A multiple regression analysis was run to predict POAF from various variables. The area under the receiver operating characteristic (ROC) curve was calculated to test discriminatory power of CHA
2
DS
2
-VASc score to predict POAF.
Results:
POAF occurred in 95 (13%) patients. The patients with POAF had higher CHA
2
DS
2
-VASc scores than those without POAF (4.09 ± 0.90 vs. 2.31 ± 1.21;
P
< 0.001). The POAF rates after cardiac surgery increased with increasing CHA
2
DS
2
-VASc scores. The odds ratio for predicting POAF was highest with higher CHA
2
DS
2
-VASc scores (3.68). When ROC curve was calculated for the CHA
2
DS
2
-VASc scores, area of 0.87 was obtained, which was statistically significant (
P
< 0.0001).
Conclusions:
The CHA
2
DS
2
-VASc score was found useful in predicting POAF after CABG. This scoring system is simple and convenient to use in the preoperative period to alert the clinician about higher probability of POAF after CABG surgery.
[ABSTRACT]
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8
5,221
487
ORIGINAL ARTICLES
Modified Blalock Taussig shunt: Comparison between neonates, infants and older children
Sarvesh Pal Singh, Sandeep Chauhan, Minati Choudhury, Vishwas Malik, Sachin Talwar, Milind P Hote, Velayoudham Devagourou
July-September 2014, 17(3):191-197
DOI
:10.4103/0971-9784.135847
PMID
:24994729
Objective:
The aim was to compare various pre-and post-operative parameters and to identify the predictors of mortality in neonates, infants, and older children undergoing Modified Blalock Taussig shunt (MBTS).
Materials and Methods:
Medical records of 134 children who underwent MBTS over a period of 2 years through thoracotomy were reviewed. Children were divided into three groups-neonates, infants, and older children. For analysis, various pre-and post-operative variables were recorded, including complications and mortality.
Results:
The increase in PaO
2
and SaO
2
levels after surgery was similar and statistically significant in all the three groups. The requirement of adrenaline, duration of ventilation and mortality was significantly higher in neonates. The overall mortality and infant mortality was 4.5% and 8%, respectively.
Conclusion:
Neonates are at increased risk of complications and mortality compared with older children. Age (<30 days), weight (<3 kg), packed red blood cells transfusion >6 ml/kg, mechanical ventilation >24 h and post shunt increase in PaO
2
(P
Diff
) <25% of baseline PaO
2
are independent predictors of mortality in children undergoing MBTS.
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7
6,537
702
REVIEW ARTICLES
Glycemic control in cardiac surgery: Rationale and current evidence
G Girish, Saket Agarwal, Deepak Kumar Satsangi, Deepak Tempe, Nilanjan Dutta, Himanshu Pratap
July-September 2014, 17(3):222-228
DOI
:10.4103/0971-9784.135873
PMID
:24994733
Studies in cardiac surgical patients have shown an association of hyperglycemia with increased incidences of sepsis, mediastinitis, prolonged mechanical ventilation, cardiac arrhythmias and longer intensive care and hospital stay. There is considerable controversy regarding appropriate glycemic management in these patients and in the definition of hyperglycemia and hypoglycemia or the blood sugar levels at which therapy should be initiated. There is also dilemma regarding the usage of "tight glycemic control" with studies showing conflicting evidences. Part of the controversy can be explained by the differing designs of these studies and the variable definitions of hyperglycemia and hypoglycemia.
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6
7,443
771
Hypertrophic cardiomyopathy part II - Anesthetic and surgical considerations
Praveen Kerala Varma, Suneel Puthuvassery Raman, Praveen Kumar Neema
July-September 2014, 17(3):211-221
DOI
:10.4103/0971-9784.135852
PMID
:24994732
Hypertrophic cardiomyopathy (HCM) poses many unique challenges regarding the conduct of anesthesia and surgery. Adequate preload, control of sympathetic stimulation, heart rate, and increased afterload are required to decrease the left ventricular outflow tract obstruction. Comprehensive intraoperative transesophageal echocardiography (TEE) examination confirms the diagnosis, elucidates the pathophysiology, and identifies the various anomalies of mitral valve apparatus and allows assessment of the adequacy of surgery. In this review, we focus on the preoperative assessment, conduct of anesthesia and comprehensive TEE examination of patients presenting for surgery with HCM. The various surgical options are extended myectomy and resection, plication and release.
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14,720
1,325
LETTERS TO EDITOR
In response to "Post extubation negative pressure pulmonary edema due to posterior mediastinal cyst in an infant": Is there reasonable evidence?
Mukul C Kapoor
July-September 2014, 17(3):249-250
DOI
:10.4103/0971-9784.135890
PMID
:24994741
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2
2,088
129
ORIGINAL ARTICLES
Phenylephrine postconditioning increases myocardial injury: Are alpha-1 sympathomimetic agonist cardioprotective?
Iordanis Mourouzis, Theodosios Saranteas, Heidi Ligeret, Christophe Portal, Philippos Perimenis, Constantinos Pantos
July-September 2014, 17(3):200-209
DOI
:10.4103/0971-9784.135850
PMID
:24994731
Objective:
We studied effects of phenylephrine (PHE) on postischemic functional recovery and myocardial injury in an ischemia-reperfusion (I-R) experimental model.
Materials and Methods:
Rat hearts were Langendorff-perfused and subjected to 30 min zero-flow ischemia (I) and 60 min reperfusion (R). During R PHE was added at doses of 1 μM (
n
= 10) and 50 μM (
n
= 12). Hearts (
n
= 14) subjected to 30 and 60 min of I-R served as controls. Contractile function was assessed by left ventricular developed pressure (LVDP) and the rate of increase and decrease of LVDP; apoptosis by fluorescent imaging targeting activated caspase-3, while myocardial injury by lactate dehydrogenase (LDH) released during R. Activation of kinases was measured at 5, 15, and 60 min of R using western blotting.
Results:
PHE did not improve postischemic contractile function. PHE increased LDH release (IU/g); 102 ± 10.4 (Mean ± standard error of mean) control versus 148 ± 14.8 PHE (1), and 145.3 ± 11 PHE (50) hearts, (
P
< 0.05). PHE markedly increased apoptosis. Molecular analysis showed no effect of PHE on the activation of proapoptotic c-Jun N-terminal kinase signaling; a differential pattern of p38 mitogen activated protein kinase (MAPK) activation was found depending on the PHE dose used. With 1 μM PHE, p-p38/total-p38 MAPK levels at R were markedly increased, indicating its detrimental effect. With PHE 50 μM, no further changes in p38 MAPK were seen. Activation of Akt kinase was decreased implying involvement of different mechanisms in this response.
Conclusions:
PHE administration during reperfusion does not improve postischemic recovery due to exacerbation of myocardial necrosis and apoptosis. This finding may be of clinical and therapeutic relevance.
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2,903
212
CASE REPORTS
Coronary artery bypass grafting in a patient with protein S deficiency: Perioperative implications
Baskaran Balan, Suresh Chengode, Hilal Al Sabti, Ram Narayan Rao
July-September 2014, 17(3):232-236
DOI
:10.4103/0971-9784.135875
PMID
:24994735
Protein S (PS) along with activated protein C plays an important role in the down-regulation of
in vivo
thrombin generation. Its deficiency can cause abnormal and inappropriate clot formation within the circulation necessitating chronic anticoagulation therapy. The risk of developing thrombotic complications is heightened in the perioperative period in patients undergoing cardiac surgery with cardiopulmonary bypass (CPB). Heparin resistance is very rare in these patients, especially when antithrombin levels are near normal. Management of CPB in this scenario is quite challenging. We report the perioperative management, particularly the CPB management, of a patient with type I PS deficiency and incidentally detected heparin resistance, who underwent coronary artery bypass grafting with CPB.
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207
Asymptomatic type B right atrial thrombus in a case with protein S deficiency
Rajinder Singh Rawat, Yatin Mehta, Dheeraj Arora, Naresh Trehan
July-September 2014, 17(3):237-239
DOI
:10.4103/0971-9784.135877
PMID
:24994736
Thirty seven year old asymptomatic male underwent routine medical examination which revealed an abnormal mass in the right atrium. Family history was not suggestive of any cardiac or malignant disease. Detailed investigation detected deficiency of protein S, which is a vitamin K dependent protein and a cofactor for activated protein C mediated cleavage of factor Va and VIIIa. The deficiency of protein S predisposes to venous thrombosis. Further investigation revealed that it was an organized calcified thrombus in right atrium occupying almost whole of the cavity. Various approaches including surgical excision, thrombolysis and anticoagulation has been used to manage such thrombosis. However therapeutic approach is still a question of debate. Atriotomy and excision of mass was done using cardiopulmonary bypass.
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1
3,156
190
INTERESTING IMAGES
Aortopulmonary window and double outlet right ventricle: A rare combination
Sambhunath Das, Kalpna Irpachi, Rajat Kalra, Balram Airan
July-September 2014, 17(3):245-246
DOI
:10.4103/0971-9784.135887
PMID
:24994739
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1
2,586
156
Contrast-induced hyperdense pulmonary and cardiac field during computerized tomographic examination
Murali Chakravarthy, Rajathadri Hosur, Sumant Pargaonkar, Chidananda Harivelam, Pradeep Srinivasan
July-September 2014, 17(3):247-248
DOI
:10.4103/0971-9784.135888
PMID
:24994740
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1
1,888
138
LETTERS TO EDITOR
Positive end-expiratory pressure valve malfunctioning detected by capnography and airway pressure waveform
Sohan Lal Solanki, Jeson R Doctor, Vijaya P Patil, Meenal Rana
July-September 2014, 17(3):255-257
DOI
:10.4103/0971-9784.135896
PMID
:24994745
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1
2,954
197
Left ventricular failure and left ventricular inferior wall hypokinesia following terlipressin injection
Tanmoy Ghatak, Banani Poddar, Samir Mahindra
July-September 2014, 17(3):257-259
DOI
:10.4103/0971-9784.135897
PMID
:24994746
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1
6,603
169
BOOK REVIEW
Problem based transesophageal echocardiography
Praveen Kumar Neema
July-September 2014, 17(3):260-261
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1,505
205
CASE REPORTS
"Air embolism during fontan operation"
Madan Mohan Maddali, Eapen Thomas, Mohd M Malik
July-September 2014, 17(3):229-231
DOI
:10.4103/0971-9784.135874
PMID
:24994734
In patients with a right to left intracardiac shunt, air embolism results in an obligatory systemic embolization. Nonembolization of entrained air is described in a child with a single ventricle physiology who had earlier undergone bidirectional Glenn shunt construction and Damus-Kaye-Stansel anastomosis. The air entrainment was detected by intra-operative transesophageal echocardiography. The combined effect of a "diving bell" phenomenon and mild aortic valve regurgitation are suggested as the reasons for the confinement of air into the ventricle preventing catastrophic systemic embolization.
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2,698
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EDITORIAL
My journey as chief editor and future vision
Praveen Kumar Neema
July-September 2014, 17(3):179-181
DOI
:10.4103/0971-9784.135838
PMID
:24994727
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2,653
165
ERRATUM
Erratum
July-September 2014, 17(3):259-259
DOI
:10.4103/0971-9784.135900
PMID
:24994747
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1,512
101
INTERESTING IMAGES
Mitral regurgitation secondary to infective endocarditis of the mitral valve in a patient with cor triatriatum sinistrum
Amit Bardia, Mario Montealegre-Gallegos, Khurram Owais, Feroze Mahmood
July-September 2014, 17(3):240-241
DOI
:10.4103/0971-9784.135880
PMID
:24994737
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2,112
141
A child with a ventricular septal defect associated with left ventricular outflow tract obstruction
Soumendu Pal, Dheeraj Sharma, Sandeep Khandelwal, Manuj Bansal, Sunil K Nanda, Prabhat Dutta
July-September 2014, 17(3):242-244
DOI
:10.4103/0971-9784.135886
PMID
:24994738
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INVITED COMMENTARY
Phenylephrine in cardiac surgery: Will it have a place?
Mukul Chandra Kapoor
July-September 2014, 17(3):209-210
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7,239
333
Prediction of postoperative atrial fibrillation after cardiac surgery: Light at the end of the tunnel?
Praveen Kerala Varma
July-September 2014, 17(3):187-190
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2,402
230
LETTERS TO EDITOR
Authors' reply: How much evidence is the evidence for a case report?
Prakash K Dubey
July-September 2014, 17(3):250-251
DOI
:10.4103/0971-9784.135891
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1,304
101
In response to "Postoperative Takotsubo syndrome": The role of atropine, dopamine and noradrenaline in the management of Takotsubo syndrome
John E Madias
July-September 2014, 17(3):251-252
DOI
:10.4103/0971-9784.135892
PMID
:24994742
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1,768
135
Authors' reply
Shilpa Bhojraj, Shirish Sheth, Dev Pahlajani
July-September 2014, 17(3):252-252
DOI
:10.4103/0971-9784.135893
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1,243
115
In response to "Magnets and implantable cardioverter defibrillators: What's the problem?"
Rajnish Kumar
July-September 2014, 17(3):252-254
DOI
:10.4103/0971-9784.135894
PMID
:24994743
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2,012
145
In response to "Global left and right ventricular dysfunction after tranexamic acid administration in a polytrauma patient". Reactions to tranexamic acid: More similarities than differences
Subramanian Senthilkumaran, Ramalingam Vadivelu, Vennimalai Yadav Velkumar, Ponniah Thirumalaikolundusubramanian
July-September 2014, 17(3):254-255
DOI
:10.4103/0971-9784.135895
PMID
:24994744
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1,783
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ORIGINAL ARTICLES
Modified Blalock Taussig shunt: Comparison between neonates, infants and older children
K Muralidhar
July-September 2014, 17(3):197-199
PMID
:24994730
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32,265
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© Annals of Cardiac Anaesthesia | Published by Wolters Kluwer -
Medknow
Online since 5
th
January, 2008