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   2003| July  | Volume 6 | Issue 2  
    Online since January 22, 2008

 
 
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ORIGINAL ARTICLES
Antegrade versus antegrade with retrograde delivery of cardioplegic solution in myocardial revascularisation. A clinical study in patients with triple vessel coronary artery disease.
OP Sanjay, SV Srikrishna, P Prashanth, P Kajrekar, V Vincent
July 2003, 6(2):143-8
PMID:17827576
The effects of antegrade and antegrade with retrograde delivery of cardioplegic solution were evaluated in 60 patients who underwent myocardial revascularisation. All patients had triple vessel coronary artery disease and underwent revascularisation using arterial and vein grafts. Myocardial protection consisted of administration of the St.Thomas' Hospital cardioplegic solution, topical slushed ice and systemic hypothermia (28 degrees C-30 degrees C). The patients were categorised into: group A (n=30), who received antegrade cardioplegia alone, and group B (n=30), who received antegrade and retrograde cardioplegia. With the exception of the total dose of cardioplegic solution ('p'=0.02), there was no significant difference between the two groups. Cardiac function was assessed before and after the patient was weaned from the cardio-pulmonary bypass. There was a significant increase in the right atrial pressure and a significant decrease in the mean arterial pressure from the baseline ('p'<0.05), 10 minutes after cardiopulmonary bypass in group A. All patients in-group B had a spontaneous return to sinus rhythm after release of the aortic cross clamp, whereas 3 patients in group A required defibrillation to restore sinus rhythm. Intra aortic balloon pump support was necessary in 4 patients in group A, as against 1 patient in group B to terminate the cardiopulmonary bypass. The clinical outcome was similar in both groups. We conclude that the use of a combination of retrograde and antegrade cardioplegia facilitates early recovery of left ventricular function after coronary artery bypass grafting.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,262 296 -
Use of Arginine Vasopressin in the Management of Vasodilatory Shock After CABG - A Clinical Tria.
OP Sanjay, K Kilpadi, P Prashanth, V Vincent, BC Thejas
July 2003, 6(2):132-5
PMID:17827574
Vasodilatory shock requiring treatment with catecholamines occurs in some patients following cardiopulmonary bypass. We investigated the use of vasopressin in the treatment of this syndrome. Forty patients with a left main coronary artery disease and a poor left ventricular function (ejection fraction <30%) were studied. Only those patients (n=12, 30%) in whom difficulty was experienced in maintaining a mean arterial pressure of > 60 mm Hg and a systemic vascular resistance of greater than 900 dynes.sec.cm5 on maximal doses of pharmacological and mechanical support were selected. Patients underwent a standard cardiac anaesthesia protocol. All patients had a Swan-ganz catheter inserted pre-operatively. Arginine vasopressin was administered as a bolus of 0.015 units/kg intravenously followed by an infusion of 0.03 units/kg/hour. This dose increased the mean arterial pressure from 67+/-7 to 95+/-5 mm Hg and the systemic vascular resistance from 860+/-55 to 1502+/-71 dynes.sec.cm-5. It was also associated with a decrease in pharmacological support. All subjects responded to vasopressin administration. Vasopressin is an effective pressor in vasodilatory shock after cardiopulmonary bypass.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,277 254 -
Preoperative autologous plateletpheresis in patients undergoing open heart surgery.
Akhlesh S Tomar, Deepak K Tempe, A Banerjee, R Hegde, A Cooper, SK Khanna
July 2003, 6(2):136-42
PMID:17827575
Blood conservation is an important aspect of care provided to the patients undergoing cardiac operations with cardiopulmonary bypass (CPB). It is even more important in patients with anticipated prolonged CPB, redo cardiac surgery, patients having negative blood group and in patients undergoing emergency cardiac surgery. In prolonged CPB the blood is subjected to more destruction of important coagulation factors, in redo surgery the separation of adhesions leads to increased bleeding and difficulty in achieving the haemostasis and in patients with negative blood group and emergency operations, the availability of sufficient blood can be a problem. Harvesting the autologous platelet rich plasma (PRP) can be a useful method of blood conservation in these patients. The above four categories of patients were prospectively studied, using either autologous whole blood donation or autologous platelet rich plasma (PRP) harvest in the immediate pre-bypass period. Forty two patients were included in the study and randomly divided into two equal groups of 21 each, control group (Group I) in which one unit of whole blood was withdrawn, and PRP group (Group II) where autologous plateletpheresis was utilised. After reversal of heparin, autologous whole blood was transfused in the control group and autologous PRP was transfused in the PRP group. The chest tube drainage and the requirement of homologous blood and blood products were recorded. Average PRP harvest was 643.33 +/- 133.51 mL in PRP group and the mean whole blood donation was 333.75 +/- 79.58 mL in the control group. Demographic, preoperative and intra operative data showed no statistically significant differences between the two groups. The PRP group patients drained 26.44% less (p<0.001) and required 38.5% less homologous blood and blood products (p<0.05), in the postoperative period. Haemoglobin levels on day zero (day of operation) and day three were statistically not different between the two groups. We conclude that autologous plateletpheresis is a better method of blood conservation in terms of better haemostasis, and less requirement of blood and blood products in the postoperative period as compared with the autologous whole blood donation. This technique can be especially useful in the above-mentioned categories of patients.
[ABSTRACT]   Full text not available  [PDF]  [PubMed]
  1,197 277 -
EDITORIALS
Bristol heart scandal : no coming back.
Ashwini Kumar Pawade
July 2003, 6(2):110-6
PMID:17827571
Full text not available  [PDF]  [PubMed]
  806 168 -
REVIEW ARTICLES
A review of ischaemia-reperfusion injury in the cardiorespiratory system.
R Desilva, J Dunning, A Trull, A Vuylsteke
July 2003, 6(2):126-31
PMID:17827573
Full text not available  [PDF]  [PubMed]
  560 292 -
Perioperative Beta blockades : facts and controversies.
Martin J London
July 2003, 6(2):117-25
PMID:17827572
Full text not available  [PDF]  [PubMed]
  555 288 -
INTERESTING IMAGES
Submitral aneurysm of the left ventricle.
P Vaijyanath, M Nair, A Jain, N Singh
July 2003, 6(2):171-2
PMID:17827582
Full text not available  [PDF]  [PubMed]
  634 208 -
LETTERS TO EDITOR
High Thoracic Epidural Analgesia for OPCAB via Mid Sternotomy in Spontaneously Breathing Patients.
A Gupta
July 2003, 6(2):173-173
PMID:17827584
Full text not available  [PDF]  [PubMed]
  674 146 -
CASE REPORTS
The precipitous decrease in pulmonary artery pressure by administration of bolus dose of heparin.
D Arora, A Kumar, P Tewari
July 2003, 6(2):160-2
PMID:17827580
Full text not available  [PDF]  [PubMed]
  641 143 -
TUTORIAL
Thoracic epidural analgesia in cardiac surgery.
Y Mehta, V Kulkarni
July 2003, 6(2):175-82
PMID:17827585
Full text not available  [PDF]  [PubMed]
  491 244 -
EDITORIALS
Emerging trends and new paradigms in academic cardiac anaesthesia.
K Mohandas
July 2003, 6(2):107-9
PMID:17827570
Full text not available  [PDF]  [PubMed]
  473 162 -
ORIGINAL ARTICLES
Improving the management of the diabetic patient having heart surgery.
A Cohen, R Latimer, A Vuylsteke
July 2003, 6(2):149-51
PMID:17827577
Full text not available  [PDF]  [PubMed]
  476 152 -
LETTERS TO EDITOR
In response.
M Chakravarty, V Jawali, TA Patil
July 2003, 6(2):173-4
PMID:17827583
Full text not available  [PDF]  [PubMed]
  439 94 -
CASE REPORTS
Congenital tricuspid stenosis and membranous right ventricular outflow tract obstruction in an adult.
V Mehta, Partho P Sengupta, A Banerjee, R Arora, V Datt
July 2003, 6(2):152-5
PMID:17827578
Full text not available     [PubMed]
  456 0 -
INTERESTING IMAGES
Giant atherosclerotic coronary artery aneurysm in a young adult.
Vineet Kumar Jain, Umamahesh C Rangasetty, S Rastogi, V Trehan
July 2003, 6(2):169-70
PMID:17827581
Full text not available     [PubMed]
  394 0 -
CASE REPORTS
Patent Foramen Ovale and Serpentine like Thrombus in the Left Ventricular Outflow Tract and the Pulmonary Artery - A Case Report.
A Fiehn, U Haupt, B Bassti
July 2003, 6(2):156-9
PMID:17827579
Full text not available     [PubMed]
  363 0 -