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  • ISSN: 2333-6676
    Volume 4, Issue 4
    Research Article
    Rehab Ibrahim Yaseen*, Mahmoud Soliman, Ahmed Ashraf Reda, Hazim Khamis, and Ahmed Gaballa
    Background: The significance of coronary artery stenosis of intermediate severity (diameter stenosis of > 40% to < 70%) was difficult to be determined. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those simply need appropriate medical therapy. This study aims to assess the functional significance of intermediate coronary lesions in coronary angiography invasively and non –invasively.
    Methods: 30 patients with intermediate coronary stenosis in coronary angiography were subjected to non-invasive stress imaging either exercise myocardial perfusion imaging (MPI) or dobutamine stress echocardiography and the results were compared with results of Intravascular Ultrasound and & Fractional Flow Reserve.
    Results: In our study we found that among 14 patients with FFR value < 0.8; 12 patients had reversible ischemia in stress test. Additionally among 16 patients with FFR value > 0.8; 14 patients had negative stress test. FFR value had sensitivity and specificity 85.7% & 87.5% respectively to predict result of non-invasive stress test with a predictive value PPV & NPV 85.7% & 87.5% respectively with accuracy 86.7%. On the contrary by comparing minimal luminal area measured by IVUS with the results of non-invasive stress test there was no statistically significant difference between two groups. However the best cut-off value for minimal luminal area (MLA) measured by IVUS which was concordant with ischemic FFR value (< 0.8) was < 4.5 mm2 with sensitivity and specificity 57.1% &56.3% respectively and predictive values PPV = 53.3% and NPV = 60%.
    Conclusion: In patients with intermediate coronary lesions, FFR is a useful index for functional assessment of severity of coronary artery stenosis in comparison to non-invasive stress test and can be used as a guide before coronary revascularization. The best cut-off value for minimal luminal area measured by IVUS was < 4.5 mm2
    Kazuo Komamura*, Akihisa Hanatani, Hatsuko Ishibashi-Ueda, Masahiro Higashi, Akihiko Taguchi, Kenji Kangawa, Takeshi Nakatani, and Kunio Miyatake
    Background: End-stage heart failure with idiopathic dilated cardiomyopathy (DCM) has no therapeutic options other than heart transplantation. We investigated whether exogenous insulin-like growth factor-1 (IGF-1) could improve cardiac function and symptoms in end-stage DCM patients on the waiting list for heart transplantation.
    Methods and Results: Recombinant IGF-1 was administered daily for three months to consecutive eight heart-transplant candidates with end-stage DCM. Cardiac catheterization, myocardial biopsy, echocardiography, magnetic resonance imaging, exercise test and neurohumoral blood samplings were conducted at baseline, at the end of three-month subcutaneous IGF-1 treatment and at the three-month follow-up. Ventricular mass index (91 ± 22 to 99 ± 27g/m2, p=0.003) and ejection fraction (18 ± 8 to 23 ± 7%, p=0.016) were increased at the end of treatment, and returned to baseline at the follow-up. However, New York Heart Association functional class (3.4 ± 0.5 to 2.3 ± 0.5, p=0.012) and brain natriuretic peptide (304 ± 264 to 150 ± 168 pg/mL, p=0.012) were improved at the end of treatment, and remained improved (2.1 ± 0.4, 166 ± 131 pg/mL, respectively) even at the follow-up. After treatment, a left ventricular assist device was removed from one patient. Two patients were withdrawn from the waiting list for heart transplantation.
    Conclusions: A three-month administration of recombinant IGF-1 to the patients on the waiting list with end-stage DCM might result in improvement in cardiac function and symptoms. IGF-1 therapy might be a novel treatment for bridge to transplant or recovery.
    Review Article
    Abdikarim ABDI and Bilgen Basgut*
    Since the turn of the twentieth century, morphine, an opioid analgesic, has played an integral role in the management of pain in myocardial infarction (MI). This is attributed to morphine’s effect on reducing blood pressure, slowing heart rate, and relieving anxiety, which may decrease myocardial oxygen demand, added to the fact that morphine has been studied extensively in pain management in many settings. For this morphine kept considered amongst the first line therapies and most effective for acute pain management in MI patients according to many guidelines.
    However, observational data suggest that morphine administration during acute myocardial infarction (AMI) may have negative consequences, while this practice also lacks supporting rigorous evidence or studies designed to assess the effect of morphine administration. Added to this recent evidence uncovered that morphine may impede gastrointestinal absorption of oral antiplatelet drugs important in reducing mortality in AMI.
    These observations permit a comprehensive evaluation of the rationality of administration of morphine in AMI, and whether better alternatives are available in currently used analgesics or by using a morphine non-interacting P2Y12 receptor inhibitor for AMI patients.
    In this review we discuss the rationality of morphine use according to recent evidence and the side effects and drug-drug interactions of morphine affecting MI patient with the present alternatives based on the findings of experimental, observational and randomized clinical studies.
    Case Report
    Steven L. Long, Richard Paul Whitlock, and Jon-David R. Schwalm*
    Takotsubo cardiomyopathy (TTC) can lead to severe but reversible heart failure, which necessitates apt management of acute hemodynamic instability. We report the case of a 42-year-old woman who developed reverse-TTC secondary to a pheochromocytoma. While being persistently hypertensive, she decompensated into fulminant pulmonary edema, and was managed successfully with placement of an Impella® percutaneous ventricular assist device (pVAD). Through a rare variant of TTC, this case highlights the role of pVAD’s in supporting severe left ventricular dysfunction that is otherwise refractory to medical therapy.
    Louay M. Habbab* and F. Victor Chu
    Redo mitral valve (MV) surgery via sternotomy in the presence of dense adhesions can be associated with significant complications:including injuries to the heart:great vessels and patent coronary artery grafts:that can increase morbidity and mortality. Although less likely to occur during minimally invasive MV surgery:adhesion-related injuries can be more difficult to repair because of limited surgical field. We report an 88-year-old obese male patient with sleep apnea and previous coronary artery bypass graft (CABG) surgery who presented with severe mitral regurgitation and patent grafts. He underwent minimally invasive mitral valve repair (MVr) through right mini-thoracotomy (RMT) under direct vision:during which the patent right coronary artery (RCA) graft the right atrial appendage and the aorta were injured and subsequently successfully repaired in a systematic fashion that did not preclude an adequate repair of the MV. We also summarize the results of reported redo MV surgery through RMT studies that included patients with previous CABG surgery to demonstrate that the performance of this procedure in a very elderly patient with multiple risk factors for redo cardiac surgery:not included in these studies:is challenging yet possible.
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