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  • ISSN: 2333-6676
    Volume 5, Issue 7
    Case Report
    Moacyr Magno Palmeira*, Jaques da Silva Neves, Kleber Ponzi Pereira, Amanda Monteiro Carmona Suelen da Silva Andrade, Hellen Yuki Umemura Ribeiro, Fernando Octavio Machado Juca Neto, and Ivone Aline da Silva Rodrigues
    We present the case of a patient with the left Sinus of Valsalva Aneurysm (SVA), complaining of precordial pain suggesting myocardial ischemia.
    Case Report: A 34-year-old man, with a clinical picture of intense precordial pain, related to physical efforts, with ECG showing blockage of the left bundle branch, including diffuse and non-specific alterations of ventricular repolarization and effort testing with positive result for myocardial ischemia. He underwent an aortic and coronary artery angiography which showed image of unruptured left Sinus of Valsalva Aneurysm, and normal anatomy of the coronary arteries.
    Discussion: The most frequent symptoms are dyspnea, chest pain and palpitations. The patient reported precordial pain, palpitation, and dyspnea when making physical efforts. In the left SVA, the complications usually occurred in the atrium and right ventricle, left atrium or pericardium which may lead to cardiac tamponade, besides an association with interventricular septal defect or aortic valve prolapse. In the case here reported, we did not diagnose the mentioned complications. The diagnosis was made through clinical exam, echocardiogram test and aorta and coronary angiogram. The angiogram confirmed the diagnosis, demonstrated the normal anatomy of coronary circulation, the location of the aneurysm, and ruled out any possibility of possible complications.
    Conclusions: SVA is a rare condition that requires clinical investigation, ECG, echocardiogram, and aorta and coronary angiogram for diagnosis, confirmation or exclusion of complications, and use of an adequate therapy.
    Ajay Raj, Siva Subramaniyan*, and Athar Kamal
    Significant left main coronary artery (LMCA) stenosis is not rare, occurring among a reported 3% to 10% of patients undergoing coronary angiography. Unprotected LMCA intervention remains a clinical challenge and have poor prognosis. If this happen in acute STEMI then it usually results in death of the patient even before reaching the hospital. In this case we report a 50-year-old patient with acute anterior wall STEMI in cardiogenic shock because of LMCA 100% occlusion and the patient improved and discharged in stable condition after a successful angioplasty followed by stenting.
    Research Article
    Jian Ping Liu, Bella T. Altura, and Burton M. Altura*
    The present study was designed to evaluate the effects and mechanisms of action of hypochlorite (OCl-) on isolated segments of rat aortic rings (RAR). In the absence of any vasoactive agent, OCl- failed to alter the basal tension. In phenylephrine-precontracted RAR, OCl- elicited concentration-dependent relaxations. Effective concentrations producing approximately 50% of maximal relaxation (EC50) to OCl- were 0.382 and 0.377µM in intact and denuded RAR, respectively, No differences in the relaxation responses were found between RAR with or without endothelium, Methylene blue (MB) or 1H-(1, 2,4) oxadiazolo-(4,3-a) quinoxalin-1-one inhibited the relaxations induced by OCl-. Tetraethylammonium chloride decreased the OCl--induced relaxations in a concentration-dependent manner. However, OCl- had no effect on RAR precontracted by high K, Addition of calyculin A decreased the OCl--induced relaxations in a concentration-dependent manner. OCl- failed to alter Ca2+-induced contractions of K+-depolarized aortic rings. Ca2+-free buffer did not attenuate the relaxant effect of OCl-. But, rapid removal of extracellular Ca2+ as well as buffering intracellular Ca2+ with the membrane-permeable Ca2+ chelator, BAPTA-AM, attenuated most of the relaxant effects of OCl-. Thapsigargin, caffeine plus ryanodine, or heparin all markedly attenuated OCl--induced relaxations. L-arginine, but not either L-NAME or indomethacin, attenuated the relaxant effects of OCl-. A variety of specific pharmacological agents and antagonists did not influence the effects of OCl-. Our results suggest that OCl--triggered relaxations are mediated by elevation of cGMP levels, membrane hyperpolarization via K+-channel activation, activation of myosin phosphatase activity, InsP3-mediated intracellular Ca2+ release from the SR and, most likely, a Ca2+-Ca2+ release from the SR.
    Eugene Vernyuy Yeika*, Charles Mve Mvondo, Jacques Cabral Tchoumi Tantchou, Jean Claude Ambassa, and Marcelin Ngowe Ngowe
    Objective: We sought to determine the clinical outcomes of patients with pre-operative pulmonary hypertension (PH) undergoing left-sided valvular surgery (LVS) and to assess whether pre-operative PH is associated with poor outcomes.
    Methods: We retrospectively studied 282 files of patients who underwent LVS at the Shisong Cardiac Centre from January 2010 to December 2015 and excluded 26 files. PH was diagnosed using transthoracic echocardiography as pulmonary artery systolic pressure = 35mmHg. Participants with PH were compared to those without PH using the chi-square test for frequencies and student's t-test for means.
    Results: The mean age of the participants was 29.9 ± 16.6 years and 52.7% were women. The prevalence of PH in patients who underwent LVS was 83.2%. Compared to patients without PH, patients with PH were more in New York Heart Association - Functional Class (NYHA-FC) III and IV (82.2% versus 41.9%, p < 0.001), had lower systolic function (mean left ventricular ejection fraction (LVEF): 57.2 ± 14.5% versus 62.7 ± 12.5%, p = 0.031), had higher incidence of combined left-sided valvular diseases (LVD) (25% versus 9%, p = 0.042), longer intensive care unit stay (72.8 ± 43.4 versus 55.1 ± 26.6 hours, p = 0.010), higher incidence of postoperative events: operative mortality (6.6% versus 0.0%, p = 0.021); bleeding incidence (29.1% versus 20.9%, p = 0.024) , arrhythmias (26.8% versus 9.3%, p = 0.014), and pleural effusion (9.4% versus 4.7%, p = 0.041). Cox regression multivariate analysis demonstrated that the following factors were independent predictors of operative mortality: NYHA-FC III and IV (p = 0.003), poor LVEF (p < 0.001), PH (p < 0.001) and combined LVD (p = 0.042).
    Conclusion: Although this study demonstrates that pre-operative PH is common in patients undergoing LVS in sub-Saharan Africa and increases operative morbidity and mortality. Differences in the pattern of cardiovascular diseases and the prevalence of risk factors in this sub region warrants for more studies and the development of a preoperative risk stratification model for cardiac surgery for this sub region.
    Ahmed Abdelaziz Emara*, Mohamed Abdelaziz Moharam, and Ahmed Esmael Reyad2
    Background: Leptin is a hormone secreted from adiopose tissue and increased in obese patients in which there is increased risk of atherosclerotic coronary disease which can be assessed by coronary angiography.
    Objective: The aim of this study is to assess the correlation between the level of plasma leptin hormone in diabetic patients with atherosclerotic coronary artery disease and extent of coronary artery lesion by coronary angiography.
    Methods: A total of 50 diabetic patients with coronary artery disease were studied for assessment of level of plasma leptin hormone and correlation to the extent of coronary artery disease by angiography.
    Results: There was positive correlation between the level of leptin hormone and extent of coronary artery disease.
    Conclusion: The study suggests that leptin is a significant cardiovascular risk factor for atherosclerotic CAD independent of traditional cardiovascular risk factors. Leptinemia is associated with several biochemical disorders, suggesting that leptin may be a pathogenetic factor in cardiovascular disease.
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