Context:Recent upsurge in referral of patients with compromised left ventricular (LV) function for cardiac surgery has led to an increasing use inotropes to achieve improvement of tissue perfusion in the perioperative period.Aims and Objectives:To compare the hemodynamic effects and immediate postoperative outcomes with levosimendan and dobutamine in patients with moderate to severe LV dysfunction undergoing off-pump coronary artery bypass grafting (OPCAB).Settings and Design:University teaching hospital, randomized control study.Materials and Methods:Eighty patients were randomly divided into two groups of 40 each. Group I received levosimendan at 0.1 μg/kg/min and Group II received dobutamine at 5 μg/kg/min. Hemodynamic data were noted at 30 min, during obtuse marginal grafting, 1, 6, 12, and 24 h after surgery. Heart rate (HR), mean arterial pressure (MAP), pulmonary capillary wedge pressure (PCWP), cardiac index (CI), systemic vascular resistance index (SVRI) and pulmonary vascular resistance index (PVRI), left ventricular stroke work index (LVSWI) and right ventricular stroke work index (RVSWI), mixed venous oximetry (SvO2), and lactate were measured.Statistical Analysis Used:Chi-square and Student's t-test.Results:The HR, MAP, PCWP, SVRI, and PVRI were lower in Group I when compared to Group II. Group I patients showed a statistically significant increase in LVSWI, RVSWI, and CI, when compared to Group II. Comparatively, Group I patients maintained higher SvO2 and lower lactate levels. Duration of ventilation, Intensive Care Unit (ICU), and hospital stay were lower in Group I.Conclusions:Levosimendan was associated with statistically significant increase in indices of contractility (CI, LVSWI, and RVSWI) and decrease in PCWP during and after OPCAB. Levosimendan group had lower incidence of atrial fibrillation, shorter length of ICU, and hospital stay.

Diyafram yırtığı potansiyel olarak yaşamı tehdit eden bir klinik durumdur. Karın ve göğüse yönelik yüksek basınç-lı künt veya penetran yaralanmanın bir sonucu olarak oluş-maktadır. Diyaframın akut travmatik yırtığı, gözden kaçırı-labilir ve yaralanma ile tanı arasında sıklıkla gecikme bulunur. Hepatik koruma ve sağ hemidiyafragmaya ilişkin artmış direnç nedeniyle, sağ taraflı yırtık daha az yaygındır. Bu yazıda, travmadan 72 saat sonra nefes darlığı yakınması ile hastanemize yatırılan 28 yaşındaki bir erkek olgu sunuldu. Klinik bulgu ve semptomların spesifik olmaması nedeniyle, hastanın helikal bilgisayarlı tomografisi çekildi; gö-rüntülemede hepatotoraksla birlikte diyafram yırtığı bulunduğunu gösterdi. Diyafram yırtığını onarmak üzere acil torakotomi yapıldı. Ameliyat sonrası sorunsuz geçti ve hasta üç hafta sonra taburcu edildi.Anahtar Sözcükler: Edinsel diyafragmatik fıtık; diyafram yırtığı; travma.Diaphragmatic rupture is a potentially life-threatening clinical situation. It occurs as a result of high-velocity blunt or penetrating injury to the abdomen and thorax. Acute traumatic rupture of the diaphragm may go undetected, and there is often a delay between the injury and diagnosis. Right-sided rupture is less common due to hepatic protection and increased strength of the right hemidiaphragm. We report the case of a 28-year-old man who was admitted with breathlessness to our hospital, 72 hours after trauma. Since clinical signs and symptoms were nonspecific, helical computed tomography was done, which revealed diaphragmatic rupture with hepatothorax. Emergency thoracotomy was done to repair diaphragmatic rent. The postoperative period was uneventful, and the patient was discharged three weeks later.

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