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   2020| July-September  | Volume 6 | Issue 3  
    Online since September 28, 2020

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Modified bentall and de bono surgery: Experience in a national hospital of Peru
W Samir Cubas, Jaime Vasquez-Arias, Ludwig Caceres-Farfan, Milagros Moreno-Loaiza, Carlos Pachas-Canales, Enrique Velarde-Revilla
July-September 2020, 6(3):129-136
Context: Modified Bentall and De Bono Surgery is the surgical treatment of choice for cardiac pathologies related to the aortic valve, aortic root, and ascending aorta. Aims: The aim of this study is to review and analyze the short- and long-term results with the Modified Bentall and De Bono technique in the Cardiac Surgery Service of a Peruvian National Hospital. Settings and Design: A retrospective study was conducted from April 2000 to July 2019. Subjects and Methods: The main variables studied were grouped into preoperative, operative, and postoperative; also, the Kaplan–Meier survival curve was used to analyze the short- and long-term survival of patients undergoing this kind of surgery. Results: During the study period, 46 patients (male, 89.13% vs. female, 10.87%; mean age: 57.52 ± 19.5 years) underwent Modified Bentall and De Bono surgery with the main operative diagnosis of anuloaortic ectasia and aneurysm of ascending aorta (52.2%). The overall mortality rate associated with surgery was 56.51% (intraoperative, 13.04%; early, 17.39%; and late, 26.08%). In the analysis of the short-term survival, 50% of patients deaths in the early period (≤30 days) occurred in an average of 5.76 days, mainly due to hemodynamic disorders (37.5%); similarly, 50% of patients deaths in the late period (≤30 days) occurred in an average of 3.88 years, mainly due to stroke (41.67%). Cumulative long-term survival rates at 5 years of 71.87%, at 10 and 15 years of 62.5% are reported. Conclusions: Despite having found unsatisfactory numbers that are slightly distant from those reported in the rest of the world, our study has described an initial experience, allowing us to identify a series of factors and opportunities that will serve as a reference to improve the critical points of surgical interventions and the perioperative management of patients with this technique.
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Impact of pets as nonpharmacological antihypertensive maneuver in hypertensive patients
Candan Mansuroglu
July-September 2020, 6(3):93-96
Background: Nearly half of the population has elevated blood pressure in industrialized world.Various lifestyle changes were described as non- pharmacological maneuvers in controlling hypertension. Aim: We planned this study to evaluate the impact of pets as a non- pharmacological antihypertensive maneuver in hypertensive patients. Materials and Method: A total of 5042 hypertensive patients were participated a validated and self applied questionnaire and inquiring current status about having a pet. Results: A total 562 patients consisting of dog owners, cat owners and farm animal owners were enrolled in this study. No-pet owners had mean systolic blood pressure( SBP)- 143. 9 mmHg(141. 3 mmHg – 145. 1 mmHg) and mean diastolic blood pressure( DBP)- 77. 6 mmHg(76. 5 mmHg– 78. 5 mmHg). Cat owners were 339 patients( 6. 05%) had mean SBP- 132. 8 mmHg( 130. 5 mmHg– 135. 3 mmHg) and mean DBP- 74. 7 mmHg( 74. 8 mmHg– 75. 3 mmHg). Dog owners were 158 patients( 2. 82%) had mean SBP- 139. 5 mmHg( 138. 1 mmHg– 141. 2 mmHg) and mean DBP- 77. 2 mmHg( 76. 3 mmHg– 78. 2 mmHg). And farm animal owners were 65 patients ( 1. 1%) had mean SBP- 133. 6 mmHg( 135. 4 mmHg– 139. 8 mmHg ) and mean DBP- 73. 2 mmHg( 74. 2 mmHg– 76. 2 mmHg). Male sex( odds ratio [OR], 1. 17, 95% confidence interval [CI], 1. 07 - 1. 28, P = 0. 002 ), farm animal ownership( OR, 1. 08, 95% CI, 1. 06 -1. 11, P = 0. 003) and aging ( OR, 1. 23, 95% CI, 1. 27 -1. 38, P < 0. 001) were significantly associated with higher blood pressures. Cat owners and farm animal owners used fewer medication( OR 1. 9; 95% CI, 1. 61–2. 72, P = 0. 003) and (OR 2. 09; 95% CI 1. 61–2. 72, P =: 0. 001) respectively. Conclusion: Our study results showed pet ownership were associated with better blood pressure control and less medication. Owning a pet is lower in our country than developed world. This study results can be used to adopt stray animals in metropolitans but it must be kept in mind it is better to choose the appropriate animal to patients' natality.
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Prevalence of J-wave syndrome electrocardiographic patterns in a sample of Azerbaijan's general population
Zumrud Ismibayli, Vefa Nazirova, Ixtiyar Sultanov, Gulshan Suleymanova, Sevda Alqayeva, Farid Aliyev, Konstantinos Kyriazis
July-September 2020, 6(3):97-99
Objective: To this date, there is no information regarding the prevalence of neither the early repolarization syndrome (ERS) nor the Brugada syndrome (BrS) electrocardiographic (ECG) patterns in Azerbaijan. Study Design and Setting: This is a retrospective study of ECG recordings obtained between 2011 and 2012 in one clinical center in Baku, Azerbaijan. The recordings were taken during routine check-ups of 1079 males and females of the general population, with an age range between 23 and 78 years (mean age 44 years). The presence of a J-wave in the lateral, inferior/inferolateral, right precordial, or all leads was evaluated by two independent cardiologists. Results: The J-wave ECG pattern was present in 66 participants (6.12%). The ERS pattern was present in 63 participants (5.84%), more specifically 1.4% – ERS Type 1, 4.4% – ERS Type 2, and 0% – ERS Type 3. The BrS pattern was present in three participants (0.27%), all of which had a Type 2 pattern. Conclusion: The J wave syndrome ECG pattern is not rare in Azerbaijan's general population. The prevalence of both the ERS and the BrS pattern is similar to existing reports from other countries.
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Correlation of optical coherence tomography-derived variables with fractional flow reserve (≤0.8) in patients with coronary artery stenosis: An observational study
Nitin Sonune, Ajay Swamy, Naveen Aggarwal
July-September 2020, 6(3):106-109
Objective: The present study was designed to establish the correlation between anatomical variables analyzed using optical coherence tomography (OCT) and physiological assessment provided by fractional flow reserve (FFR, ≤0.8) in patients with significant coronary artery stenosis. Materials and Methods: This was a prospective, single-center observation study which included total fifty patients who were diagnosed with coronary artery disease in the presence of significant stenosis (>70%) as per coronary angiography. The FFR ≤0.8 was considered as positive with severe stenosis. Minimal luminal area (MLA), minimal luminal diameter (MLD), percent area stenosis, and percent diameter stenosis were calculated as OCT variables in all patients. Results: The mean age of the patients was 56 ± 7.13 years. The mean FFR was found to be 0.72 ± 0.06. The OCT-derived MLA was 1.97 ± 0.53 mm2 and MLD was 1.35 ± 0.22 mm. The Pearson correlation coefficients of OCT-derived MLA (cutoff: 2 mm2) and MLD (cutoff: 1.24 mm) with FFR were 0.21 (P < 0.05) and 0.03 (P < 0.05) with 67% and 71% diagnostic efficiency, respectively. Conclusion: The study identified a significant correlation between OCT-derived MLA (poor)/MLD (moderate) and FFR (≤0.8). Thus, both the techniques, when performed collectively, provide valuable information regarding coronary artery morphology and physiology.
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The predictive value of serum monocyte to high-density lipoprotein ratio for coronary collateral circulation in patients with stable coronary artery disease
Mevlut Demir, Ahmet Korkmaz
July-September 2020, 6(3):100-105
Introduction: Coronary collateral circulation (CCC) is an adaptive response to chronic myocardial ischemia. The monocyte to high-density lipoprotein cholesterol ratio (MHR) has been reported as a new predictor and prognostic indicator of cardiovascular diseases. Objective: In this retrospective study, we aimed to investigate the association between MHR and CCC in stable coronary artery disease (CAD). Materials and Methods: A total of 355 consecutive patients who were admitted to our hospital for coronary angiography with stable angina pectoris with ≥90% stenosis were enrolled into the study. The CCC was graded using the Rentrop Classification: Grade 0-1–2-3. Results: MHR (12.5 ± 4.5 vs. 16.4 ± 5.7, P < 0.01) is significantly higher in the well CCC group than in the poor CCC group. We demonstrated that MHR levels are significantly related with the Rentrop classification of CCC. In the Rentrop III group, the MHR value was significantly higher (P < 0.01) than the Rentrop-0, Rentrop-I, and Rentrop-II group. In the Rentrop II group, the MHR value was significantly higher (p<0.01) than in the group with Rentrop-0 and Rentrop-I. This study showed that, in stable CAD, MHR levels are significantly higher in patients with good CCC than in those with poor CCC. Conclusion: MHR may serve as an independent predictor of good CCC in patients with ≥90% coronary stenosis. Limitations: This study is subject to the limitations inherent to a retrospective study, and the sample size in our study is relatively small.
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Ticagrelor-related complete atrioventricular block in a patient with hypertrophic cardiomyopathy
Ali Karagoz, Gonenc Kocabay
July-September 2020, 6(3):140-141
  1,502 118 -
Pulmonary embolism after successful COVID-19 treatment
Ersan Oflar, Fatma Nihan Turhan Caglar
July-September 2020, 6(3):137-139
The novel COVID-19-related disorders have become a global health problem since the pandemic emerged in China. Herein, we present a case of late pulmonary embolism development after successful COVID-19 treatment. A 45-year-old male was admitted to the emergency department with shortness of breath. He was diagnosed with mild COVID-19 pneumonia 10 days ago which was treated with hydroxychloroquine and oseltamivir for 5 days. He did not receive anticoagulation during this period. His second polymerase chain reaction test for COVID-19 came negative at the day before the second admission. He was diagnosed with pulmonary embolism and received anticoagulation therapy with heparin. COVID-19-related complications appear to still happen after treatment. Hence, follow-up of these patients is essential in order to reduce the burden of COVID-19. Thromboprophylaxis is certainly required during hospitalization. Moreover, the duration of thromboprophylaxis may be extended in some patients.
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Prevalence of paroxysmal atrial fibrillation in patients presenting with embolic stroke of undetermined source
Emad Effat Fakhry, Mohamed Mostafa El Nwagy, Hayam Mohamed Eldamnhoury, Maha Mohamed Mohamed Khalifa
July-September 2020, 6(3):119-123
Background: Cerebrovascular stroke is a major cause of morbidity and disability. Many etiologies may contribute to its presence. Some patients have none of the identifiable risk factors yet face the consequences of stroke or transit ischemic attack. This type of stroke is known as embolic stroke of undetermined source (ESUS). It has a high rate of recurrence due to the presence of an unknown uncorrected etiology. Paroxysmal atrial fibrillation remains a hidden bottom of an iceberg, representing a major hidden etiology of ESUS. We aimed to determine the prevalence of paroxysmal atrial fibrillation in patients with ESUS using 72-h Holter monitoring. Methods: Patients diagnosed with ESUS underwent 72-h Holter monitoring within the 1st week of the incident stroke. Holter monitors determined whether atrial fibrillation (more than 3 s) is present or not. Results: This study included 200 patients with stroke of an undetermined source who underwent 72-h Holter monitoring within 1 week of the incident stroke. The patients' ages ranged between 22 and 77 years (mean age 48.46 ± 12.74 years); 136 were males and body mass index (BMI) ranged from 21 to 35 kg/m2, with a mean BMI of 24.78 ± 2.99 kg/m2. Their left atrial anteroposterior diameter in the parasternal long-axis view ranged from 26 mm to 47 mm, with a mean diameter of 36.08 ± 5.23 mm. Thirty-two out of the 200 patients were diagnosed with paroxysmal atrial fibrillation, representing 16%. There was a statistically significant association between the presence of paroxysmal atrial fibrillation and both age (P = 0.009) and left atrial diameter (P = 0.001). There was an associated finding that needs further investigation regarding the significant association between supraventricular ectopic beats and the presence of atrial fibrillation or stroke. Conclusion: Paroxysmal atrial fibrillation is an important hidden etiology of embolic stroke of undetermined etiology that can be detected early using 72-h Holter monitoring within 1 week of the incident stroke.
  1,423 134 -
Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score independently predicts in-hospital cardiac and 1-year all-cause mortality in noncardiac surgery
Orcun Ciftci, Suzan Keskin, Kaan Okyay, Ibrahim Haldun Muderrisoglu
July-September 2020, 6(3):110-118
Objective: Cardiac adverse events are one of the most-feared complications among patients undergoing noncardiac surgery. Model for end-stage liver disease excluding international normalized ratio (MELD-XI) score has been shown to carry prognostic implications for patients with various cardiac conditions, but it has not been used for patients undergoing noncardiac surgery. We aimed to determine the role of MELD-XI score for the prediction of mortality in high-risk noncardiac surgical candidates. Materials and Methods: Eighty-four patients with high-risk cardiac conditions undergoing elective or urgent noncardiac surgery were reviewed for in-hospital cardiac and 1-year all-cause mortality. MELD-XI score was compared between the surviving and deceased patients. It was correlated with both mortality rates; its predictive power for mortality prediction was tested. Results: The median age was 81 (interquartile range 18) years, and 41 (48.8%) patients were male. All patients had at least one high-risk cardiac condition. Forty patients experienced a cardiac adverse event. Sixteen (19%) patients died at hospital and 40 (47.6%) patients died by 1 year, and both groups had significantly higher MELD-XI scores than survivors (12.23 [6.53] vs. 9.66 [3.81]; P = 0.001 and 10.80 [6.31] vs. 9.70 [3.70]; P = 0.037, respectively). MELD-XI score independently predicted in-hospital cardiac mortality (OR: 1.254 [95% confidence interval [CI]: 1.028–1.530]; P < 0.05) and 1-year all-cause mortality (OR: 1.258 [95% CI: 1.057–1.498; P < 0.01). MELD-XI predicted in-hospital cardiac mortality with a fair sensitivity and a moderate specificity and 1-year all-cause mortality with a fair sensitivity but poor specificity. A MELD-XI score >8.87 was associated with a significantly worse 1-year survival (log rank test, P < 0.05). Conclusion: MELD-XI score is independently associated with in-hospital cardiac and 1-year all-cause mortality among high-risk patients undergoing noncardiac surgery.
  1,377 112 -
Relationship between CHA2DS2-VASc score and echocardiography parameters with ischemic stroke development
Kerem Can Yilmaz, Orcun Ciftci, Kaan Okyay, Serpil Eroglu, Bahar Pirat, Elif Sade, Melek Ulucam, Bulent Ozin, Haldun Muderrisoglu
July-September 2020, 6(3):124-128
Context: Atrial fibrillation (AF) is the most common persistent rhythm disorder that has been shown to be associated with a significant increase in stroke risk. CHA2DS2-VASc is a scoring system to identify the risk of thromboembolism in nonvalvular AF patients. Aims: The aim of our study was to investigate the relationship between the demographic properties, transthoracic and transesophageal echocardiography parameters, the patients' CHA2DS2-VASc scores, and cerebrovascular events. Subjects and Methods: There were 48 patients with previous stroke and 217 patients without. We compared patients' demographic data, echocardiographic parameters, presence of patent foramen ovale (PFO) in transesophageal echocardiography, medications, AF categories, and CHA2DS2-VASc scores. Results: The mean age of the stroke group was 64.8 ± 12.3 years; the mean age of the control group was 63.2 ± 12.8 years (P = 0.417). The CHA2DS2-VASc score was 3.25 ± 2.06 in the stroke group and 2.49 ± 1.54 in the nonstroke group (P < 0.001). As for the presence of PFO, it was present in 45.8% of patients who had a stroke, but only 17.9% in the nonstroke group (P < 0.001). Conclusions: CHA2DS2-VASc score increases the risk of stroke in a broader sense, but not only in patients with AF. It is reasonable to think that the higher the score, the higher the risk of stroke. Furthermore, the presence of PFO in a patient is a facilitating factor for stroke, which may be considered for closure in the case of recurrent stroke episodes.
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