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Objectives: Cell transplantation is a novel promising strategy for the treatment of end-stage heart failure. In a rat model of hypertrophic cardiomyopathy, we studied the hemodynamic and molecular effects of intra-coronary delivery of MSC.Methods: Sprague-Dawley rats underwent aortic banding and were followed by echocardiography for development of heart failure. After a decrease in fractional shortening of 25% from baseline, intracoronary randomized injection of MSC (n=28) or PBS (n=20) was performed. Hemodynamic assessment, swim testing to exhaustion and measurement of inflammatory markers was performed prior to sacrifice on post-operative day 7, 14, 21 or 28.Results: MSC injection improved systolic function in the MSC group compared to the control group (mean ± SD, max dP/dt 3048 mmHg/s ± 230 vs. 2169 ± 97 at 21 days, and 3573 ± 741 vs. 1363 ± 322 at 28 days, p<0.001). LVESD was significantly reduced at 28 days in the MSC group compared to the control group (7.0 ± 0.2 vs. 7.4 ± 1.5 mm, p=0.01). Time to exhaustion was similarly increased in the MSC group compared to controls (407 ± 34 seconds vs. 264 ± 24 seconds at 21 days, and 487 ± 35 seconds vs. 306 ± 27 seconds at 28 days, p<0.001).Conclusions: In this model of hypertrophic cardiomyopathy, MSC transplantation during heart failure improved hemodynamic performance, ventricular remodeling and maximal exercise tolerance. These effects were most remarkable at 21 and 28 days. This study suggests a potential use of this treatment strategy for the management of hypertrophic heart failure.

While studying the organotoxicity of etomidate (an intravenous induction agent used principally in anaesthesia) in dogs and cats it was noted that all of them developed haemolysis. Haemolysis was confirmed visually and by the Benzidine test for free haemoglobin in urine. Flame photometric analysis detected elevated serum potassium levels (6-5 mmol/l). Varying doses of etomidate (0.6, 1.2 and 2.4 mg/kg) had similar effects. In a limited group of women undergoing tubectomy, etomidate was used in doses of 0.3 mg/kg for induction, with serial increments of 5 mg. A total dose of 40 mg was given in a 30 min period; a dose-dependent haemolysis occurred, which was confirmed by matching with standard haemolysed serum solutions and correlating with serum potassium levels.Perusal of the literature did not reveal any mention of haemolytic activity. The attention of anaesthetists and clinical pharmacologists should be drawn, through this forum, to this phenomenon, and we would like to exchange data on this untoward effect. We are interested to know of other specific tests, apart from spectrometric and colometric estimation, for detecting minor degrees of haemolysis.

Objectives: Over a period of five months ail patients requiring CABG were subjected to off PUMP CABG regardless of their risk factors such as poor LV, cardiogeuic sHock, etc. This was done to ascertain how many of them required pump support.Methods: 108 unselected consecutive patients are operated on beating heart by a single team of surgeons between Jan 2005. May 2005. 22 patients were ≥ 65 years of age, 46 patients were diabetics, LV function was poor (LVEF ≤ 30%) in 17 patients, redo surgery was performed in 3 patients, 7 patients undervent emergency revascularisation. 19 patients had COAD, preoperative renal dysfunction (creatinine clearance ≤ 40ml/min) was present in is patients and arrytllrnias (AF/frequent VPC) presem in 9 patients. Strategies used to prevent conversion to on pump were i> Pre operative pharmacological manipulation ii> Intraopertaive prevention of arrylhmias iii> Technical manipulation in large heart by using star fish positioner iv> RV filling was achieved by tilling head end downwards instead of fluid infusion v> In gross cardiomegaly requiring grnfting to left circumflex branches, left thoracab was preferred vi> Special technique was used to dissect intramyocardial arteries on beating heart. Results: Out of 108 patients, only 3 patients were convened to pump support (2.72%, one case of redo). There was no evidence of periopertaive myocardial infarction based on ECG and cardiac enzyme, changes. One patient had reexploration for bleeding and one patient expired due to sepsis and there was no neurological problem. Survivors were discharged from the hospital between 7-8 days post operatively.Conclusions: In patients willI CAD. OPCAB can be performed with an acceptable mortality and morbidity. By using a definite set of strategies, conversion to pump support in OPCAB patient can be reduced to less than 3%.