Circulation journal : official journal of the Japanese Circulation Society
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Randomized Controlled Trial Comparative Study
Efficacy of continuous low-dose hANP administration in patients undergoing emergent coronary artery bypass grafting for acute coronary syndrome.
Low-dose continuous human atrial natriuretic peptide (hANP) administration during cardiac surgery has been reported on previously. In the present study, the efficacy of the therapy during emergent coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) is investigated. ⋯ It is therefore considered that hANP might not only be effective for overcoming some major shortcomings of cardiopulmonary bypass, but also might be effective to attenuate ischemia-reperfusion injury, protect the myocardium, have an anti-arrhythmic effect, and suppress left ventricular remodeling.
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Cardiopulmonary bypass may exacerbate myocardial damage in compromised left ventricles. Early and mid-term outcomes of off-pump coronary artery bypass grafting (OPCAB) vs on-pump coronary artery bypass grafting (On-pump CABG) were compared in patients with poor left ventricular dysfunction, using an analysis of a propensity score matching. ⋯ Coronary artery bypass grafting in patients with poor left ventricular dysfunction improved myocardial function. Postoperative respiratory failure was significantly related to the cardiopulmonary bypass for surgical myocardial revascularization. Off-pump and On-pump surgical revascularization resulted in equivalent mid-term outcomes.
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This study evaluated the right ventricular end-diastolic volume index (RVEDVI) as a marker of the hemodynamic response to a fluid challenge in the postoperative care of cardiac surgery patients. ⋯ After cardiac surgery, RVEDVI reflected fluid responsiveness only to a limited degree. Patients should not be resuscitated to an absolute RVEDVI alone and empirical fluid challenge should still be required.
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Controlled Clinical Trial
Prognostic predictors of sinus rhythm control by amiodarone and electrical cardioversion in patients undergoing percutaneous transluminal mitral valvuloplasty for rheumatic atrial fibrillation.
Conversion to sinus rhythm (SR) is rarely attempted in patients with rheumatic atrial fibrillation (AF) because the length of AF duration and the dilation of left atrium (LA) make maintenance of SR difficult. In this study, predictors of the successful maintenance of SR with amiodarone and electrical cardioversion in rheumatic AF patients receiving percutaneous transluminal mitral valvuloplasty (PTMV) were identified. ⋯ In rheumatic AF patients receiving PTMV, the successful maintenance of SR with amiodarone and electrical cardioversion can be predicted by the degree to which LA size is reduced and MV area is increased.
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Transthoracic 2-dimensional (D) echocardiography (echo) is often used to assess tricuspid regurgitation (TR) after implantation of permanent pacemakers. However, its ability to define the precise anatomical relationship between the tricuspid valve and the pacemaker lead is quite limited. ⋯ Three-D echo precisely depicted the entrapment of the lead shaft in the fused and fibrotic septal and posterior tricuspid leaflets. The patient underwent tricuspid valve annuloplasty and the symptoms of right heart failure improved soon after the operation.