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  • ISSN: 2333-6676
    Volume 6, Issue 4
    Review Article
    Asad Ali, Ali Tariq, Waleed Iftikhar, Chandur Bhan, Abdul WahabvArif, Muhammad Abu Zar, Ahmad Kamal, Atif Ameer, Muhammad Bilal Malik, Zohaib Sayyed, Arjan Dass, Vijay Kumar, Syed Haider Ali Shah, Ali Raza, Shahzad Ahmed Sami, and Muhammad Umair Jahangir
    Limitations of percutaneous coronary intervention have been partially overcome with the advent of Drug-eluting stents (DESs), which have offered better results than bare-metal stents (BMSs), and the DESs of second-generation surpass the clinical results of first generation ones. Stent thrombosis (ST) and in-stent restenosis (ISR) are the major late complications of percutaneous coronary intervention. There has been a downward trend in the incidence of ST with the advent of newer stent designs and dual antiplatelet therapy. A few long-term follow-up studies of Bioresorbable Vascular Scaffolds failed to show significant benefits, besides showing an increased incidence of stent thrombosis and thus warrant further research. ISR with bare-metal stent implantation is relatively stable, with an early peak of intimal growth and later regression. In contrast, ISR in the case of DES is characterized by a “late catch-up” phenomenon with intimal hyperplasia during long-term follow-up. Neoatherosclerosis with chronic inflammation has become known to play a major role in late stent failure with both BMSs and DESs.
    Asad Ali*, Zohaib Sayyed, Ali Hanif Bhatti, Maira Nusrat, Atika Jabeen, Mohammad Asim Amjad, Muhammad Bilal Malik, Muhammad Bin Usman, and Mohammad Mohsin Arshad
    Takotsubo cardiomyopathy (TC) is a transient non-ischemic cardiomyopathy, whose frequency has increased rapidly over the past few years. It is characterized by regional left ventricular wall motion abnormality, with a circumferential pattern that spreads beyond a coronary artery supply territory. It can resolve with an almost complete restoration of ventricular function within days to months. TC is more prevalent among postmenopausal women, and less prevalent in Hispanics and African-Americans. It is a heterogeneous syndrome, and several etiologies have been proposed for its pathogenesis. The central hypothesis is supported by catecholamine excess and hyperactivity of the nervous system. The clinical presentation usually overlaps with the presentation of acute coronary syndrome (ACS) which calls for an early diagnosis. In light of this, several laboratory, electrocardiographic and imaging findings have been studied in order to form the clinical diagnosis of Takotsubo Cardiomyopathy.
    Case Report
    Gurkirat Singh*, Hemant Khemani, Zahidullah khan, Vikrant Deshmukh, and Narender Bansal
    Reel syndrome is a very rare cause of pacemaker malfunction. “Reel syndrome” has been described as a variant of twiddler’s syndrome, characterized by reeling-in of the pacemaker lead. It occurs due to the rotation of the pulse generator on its transverse axis with subsequent coiling of the pacemaker leads around the pulse generator, resulting in dislodgement and/or retraction of the pacing lead with loss of pacing function. We report a case of Reel syndrome with a single chamber pacemaker, in which an actively fixated ventricular lead was coiled around the generator.
    Research Article
    Antônio A. P. Fagundes Junior, Liliane Kopel, Claudia Bernoche, Milena F. Macatrao-Costa, Leonardo N. Lopes, Antonio P. Mansur, and Silvia Gelas Lage*
    Background: The intra-aortic balloon pump (IABP) is a common therapy available for ventricular support in critical cardiac patients. The aim of this study was to characterize the effect of IABP on endothelial function, on serum B-type natriuretic peptide (BNP) levels and on central venous oxygen saturation (ScVO2) and arteriovenous carbon dioxide gradient (ΔPCO2) as perfusion tissue markers.
    Methods and results: Twenty-three patients with severe heart failure, mean age 50±13 years, left ventricular ejection fraction of 22±8% were included. All were on IABP support and the protocol considered 3 conditions: 1) IABP ratio 1:1, 2) IABP ratio 1:3 and 3) IAPB ratio 1:1. The period of time between conditions was 20 minutes. In the three conditions the endothelial-dependent flow-mediated vasodilatation (FMD) was measured by ultrasound method. Blood was sampled to determine ScVO2, ΔPCO2 and BNP. FMD was impaired, ΔPCO2 and BNP were high, compatible with severe heart failure, but did not change with IABP variation. ScVO2 (%) was 68.3±10.2 and 61.3±12.5, p<0.002 (condition 1 vs. 2). The values were also significant considering the condition 2 vs. 3 when ScVO2 was 61.3±12.5 and 64.8±9.7, p=0.035 respectively.
    Conclusions: The FMD, ΔPCO2 and BNP were abnormal secondary to decompensated heart failure but did not change with the variation of IABP support. The ScVO2 proved to be a sensitive tissue perfusion marker to evaluate the response of mechanical support even in short periods of time. The ScVO2 may represent an excellent clinical monitoring tool for patients on IABP as well as assistance to their weaning.
    Tyler M. Gunn*, Katie Lippert, Adam J. Dugan, and Sibu P. Saha
    Endovascular repair has become widespread in the treatment of aortoiliac and femoropopliteal disease, however, in common femoral artery (CFA) disease it remains unclear whether endovascular repair is preferred to open common femoral artery endarterectomy. We report a review of 101 patients who underwent unilateral or bilateral common femoral endarterectomies and/or profundaplasties at our institution. Thirty-day operative mortality was 5%. Complications observed included bleeding (3%), pneumonia (3%), deep wound infection (8%), sepsis (3%), stroke (3%) and myocardial infarction (2%). Our patient cohort demonstrates encouraging short and medium-term outcomes in a high-risk patient population.
    Short Communication
    Pierpaolo Chivasso, Roberto Marsico, and Vito Domenico Bruno*
    Post-operative Atrial fibrillation (POAF) is the most common arrhythmia occurring after cardiac surgery,affecting between 30% and 50% of the patients, and it is generally associated with a higher risk of morbidity and mortality, prolonged in-hospital stay and a concomitant increased cost in hospitalisation. The development of POAF is a multifactorial process connected to pre-existent etiological factors, including genetic predisposition, and peri-operative aspectssuch as the use of cardio-pulmonary bypass, the inflammatory response to the operation, cardiac manipulations, type of heart surgery and electrolytes imbalance. Several pathophysiological pathways have been hypothesized, but there is no comprehensive knowledge of the factors leading to this complication. Even in terms of prevention and treatmentthere is no univocal approach. Beta-blocker are used in most of the prevention protocols, but others pharmacological strategies have been considered (i.e. amiodarone, anti-inflammatory drugs and statins). Furthermore, electrolytes correction (mainly potassium and magnesium) seems to have a very important role in POAF. The initial treatment of POAF is aimed to achieve pharmacological ventricular rate control. However, if atrial fibrillation persists for more than 24-48 hours or the patient is haemodynamically compromised despite the attempt of rate control, a rhythm control strategy should be considered, together with an anticoagulation therapy either with warfarin or the new oral anticoagulants which are showing encouraging results both in terms of safety and efficiency. Here, we report a contemporary overview of the incidence, mechanism, predisposing factors, prevention and treatment of POAF after cardiac surgery.
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