According to our results, we think that nebivolol may be safer and preferable in order to diminish graft spasm in patients undergoing coronary artery bypass graft surgery due to the NO-mediated vasodilating effect.

Objective: The internal thoracic artery (ITA) is the conduit of choice for coronary artery bypass grafting (CABG). To avoid spasm of the ITA various topical vasodilators have been suggested either intraluminally or by topical application. In order to describe the best vasodilating agent for preparation of the ITA, a randomized double-blind placebo controlled clinical work was performed in a group of CABG patients. Methods: Three hundred consecutive patients submitted for elective first time coronary artery bypass grafting were randomly subdivided into five groups. The first measurement was performed shortly after the internal thoracic artery was dissected from the chest wall and the second just prior to performing distal anastomosis to the left anterior descending coronary artery. During the time interval between the two measurements topical vasodilator has been injected into the endothoracic fascia of the ITA using the following drugs: papaverine 2 mg/ml, nitrogly-cerin 1 mg/ml, nitroprusside 0.5 mg/ml, mixed solution include sodium nitroprusside (1 mg/ml) and diltiazem (0.5 mg/ml) and normal saline 0.9%. Results: No statistically significant differences were found between the groups in respect to age, body surface area, cardiopulmonary bypass time, cross clamping time, and time interval between the two flow measurements. Mean arterial pressure at the time of the first and second internal thoracic artery flow measurements did not show statistically significant differences either within or between the groups. In all five groups, the free flow of the internal thoracic artery increased significantly with time. However, no statistically significant differences were shown between the five groups with respect to second flow. Conclusions: We suggest that preparation of the ITA by topical vasodilators injection into the endothoracic fascia does not result in a significantly superior free flow than placebo

Bu çalışmada koroner arter baypas greftleme yapılan hastalarda L-karnitinin ameliyat sonrası kardiyak performans, morbidite ve komplikasyonlar üzerindeki etkisi değerlendirildi. Ça lış m a pla nı: Nisan 2005 -Haziran 2008 tarihleri arasında koroner arter baypas greftleme planlanan toplam 60 hasta (36 erkek, 24 kadın; ort. yaş 60.6 yıl; dağılım 57-65 yıl) prospektif olarak üç farklı miyokard koruma stratejisinden birine randomize edildi. Grup A'ya (n=20) antegrad kristaloid kardiyopleji, Grup B'ye (n=20) antegrad kan kardiyoplejisi ve Grup C'ye (n=20) karnitin ile birlikte antegrad kan kardiyoplejisi uygulandı. Laktat dehidrogenaz (LDH), kreatinin fosfokinaz (CPK), kreatinin fosfokinazmiyokardiyal bant (CK-MB) ve Troponin-I için ameliyat sırasında koroner sinüsten ve postoperatif periferik venöz hattan KPB öncesi, KPB'da ve postoperatif 1, 6, 12, 24 ve 48 saat sonra kan numuneleri alındı. CPK, CK-MB ve Troponin-T seviyelerinin seviyeleri immünoassay yöntemi ile incelendi. Bul gu lar: Karnitin verilen hastaların kalp debisi, kardiyak indeksi, sağ ventrikül ve sol ventrikül atım işi kardiyopulmoner baypastan hemen sonra ve ameliyat sonrası birinci saatte anlamlı olarak düzeldi (p= 0.01). Troponin-T düzeyleri ameliyattan 12 saat sonra tüm hastalarda azalırken, bu değişim en belirgin Grup C'de idi (p=0.001). So nuç: Kardiyopleji sırasında intravenöz karnitin takviyesi, koroner arter baypas greftleme sonrası kardiyak fonksiyon ve metabolik parametrelerin iyileşmesinde daha iyi sonuçlar vermektedir.Anah tar söz cük ler: Kardiyopleji; komplikasyon; koroner arter baypas greftleme; L-karnitin.

Isolated tricuspid valve infective endocarditis (TVIE) is a rare clinical condition. Thus, there is no common consensus for the treatment options for TVIE. Vegetectomy and valvulectomy, valve repair, and valve replacement, which are controversial in regard to hemodynamic consequences in right-sided low-pressure system and long-term prognosis. We present 2 young intravenous drug users with TVIE and our surgical strategy.

No abstract