Journal of Cardiovascular Medicine and Surgery

Keywords: Pulmonary Arterial Hypertension; Cardio-Vascular Rehabilitation; Exercise Training; Exercise Rehabilitation. 

Right atrial (RA) myxoma is a benign cardiac tumour commonly found in middle age group with female preponderance.The gradual enlargement of RA myxoma impairs the RA and right ventricle (RV) inflow. We report a giant RA myxoma in an elderly woman in her 8th decade of life, presented with rare complication of pulmonary embolism leading to hemoptysis. The perioperative management of these patients emphasized careful positioning during induction and maintenance to prevent hemodynamic compromise. Drugs causing venodilatation should be used with caution. The cardiac surgeon and anaesthesiologist should anticipate the possibility of emergent CPB and make arrangements before induction of anaesthesia. Intraoperative transesophageal echocardiography monitoring is recommended to aid in recognizing and avoiding tumour embolization.

Keywords: Right Atrial Myxoma; Geriatric Age; Atrial Fibrillation; Hemoptysis; Pulmonary Artery Hypertension.  

Omentin-1 is a novel adipokine that is highly expressed in visceral adipose tissue. Omentin-1, has appeared to show cardioprotective nature in several studies. The aim of this study was to review the existing literature from clinical studies on the role played by omentin-1 in the context of cardiovascular disorders. A total of 14 articles were finalized from the 1158 articles that were screened using the search terms “omentin AND cardiovascular disease”. Omentin-1 is found in lower concentrations in diseased individuals (CAD or risk factors of CAD), and the concomitant presence of CAD and metabolic syndrome or diabetes further suppresses omentin-1 concentration indicating that omentin-1 is an important regulatory molecule in pathways key to the development of cardiovascular disease. Omentin -1 was found to have a moderate correlation with inflammatory biomarkers. Omentin-1 levels were found to predict CAD severity even when adjusted for multiple risk factors. Lower levels of omentin-1 were also found to have a five times higher risk of cardiovascular events in patients with heart failure. The main limitations existing in the literature are the lack of well designed prospective cohort studies that explore the utility of omentin-1 in CVD and the inter study variability in the concentration of omentin-1 across several studies. Much translational work needs to be carried out before omentin-1 measurement becomes an important tool in clinical medicine. Keywords: Omentin-1, cardiovascular disease, risk, biomarker, diabetes, metabolic syndrome  

Keywords: Cardiovascular Rehabilitation; Exercise Training; Peripheral Vascular Disease; Intermittent Claudication. 

Key Messages: Closed mitral valvotomy remains a simple, safe, and effective means of treating mitral stenosis in regions where socioeconomic changes have not yet reduced the incidence of rheumatic heart disease and where resources for its treatment are limited there is still a place for this procedure. 

 Back ground: Arterial switch operation for correction of transposition of great arteries requires long duration of cardiopulmonary bypass (CPB) support. The subsets of patients for arterial switch operation (ASO) are neonates and infants. Hypothermic CPB can lead to severe vasoconstriction in small vessels and hamper the tissue perfusion in small children. Phenoxybenzamine because of its potent vasodilatory effect will help in improving microcirculatory perfusion to the vital organs during CPB and reduce reperfusion injury. Method: In a prospective study, 45 infants undergoing ASO were divided into 3 groups 15 patients in each group. Group 1 and 2 received phenoxybenzamine 1mg/kg and 0.5mg/kg respectively during CPB and Group 3 was the control group who did not receive phenoxybenzamine. The effect of phenoxybenzamine was assessed by monitoring aortic line pressure, mean arterial pressure, nasopharyngeal and rectal temperatures, venous oxygen saturation, cerebral oxygenation by near infrared spectroscopy and base deficit were measured at 10 minutes interval during CPB in 3 groups. Result: Patients of group 1 and 2 showed significant fall in aortic line pressure and mean arterial pressure (p<0.05-0.000) compared to group 3. Group 1 and 2 had higher venous oxygen saturation and cerebral oxygenation (p<0.04-0.001) compared to Group 3. The temperature gradient was lower in Group 1 and 2 (p=0.01-0.004). The base deficit was more in Group 3 patients (p=0.005). Group 1 children had lower aortic line pressure and mean arterial pressure than Group 2 (p=0.000), with higher venous oxygen saturation and cerebral oxygenation (p=0.000). Conclusions: Phenoxybenzamine during CPB produces lower aortic line and facilitates for higher pump flow; resulting in higher venous and cerebral oxygenation, faster cooling and re-warming, and less base deficit. Phenoxybenzamine in a dose of 1mg/kg was more effective than 0.5mg/kg.

 Aims: The objective of the study was to identify the impact of elevated haemoglobin A1c (HbA1c) and related co-morbidities on morbidity and mortality of patients undergoing coronary artery bypass grafting. Settings and Design: This was a prospective study in which 126 patients that underwent isolated, elective, off pump CABG from October 2010 to October 2012. Methods and Material: 126 patients undergoing coronary artery bypass grafting (CABG) were enrolled and preoperative HbA1c levels were obtained. The Portland protocol for insulin was used to achieve tight glucose control. The multivariate risk factors for morbidity and mortality were analyzed. Statistical analysis used: Statistical analysis was performed with the SPSS software package (version 16.0, SPSS Inc, Chicago, IL). The normality of the continuous variables was tested by using Kolmogorov-Smirmov Z test. Tests used were unpaired t-test for continuous variables and chi square test for dichotomous/categorical variables. A p value less than .05 was taken as significant. Results:  In-hospital mortality was significantly higher for patients with HbA1c e” 7% and also the incidences of post-operative morbidities were significantly increased. These patients had more blood loss and received more blood products and had prolonged ventilatory time and spent more time in the hospital Conclusions: HbA1c may be a more accurate predictor of outcomes than merely a diagnosis of diabetes and is associated with adverse events after coronary artery bypass grafting. 

 Not Provided.

This editorial aimed to provide an overview of recent scientific advances in the field of cardiovascular medicine and surgery (CVMS) and implicate evidence-informed role for the Journal of Cardiovascular Medicine and Surgery (JCVMS). Cardiovascular disorders were associated with higher mortality rate; practice-based evidence for perioperative and postoperative antibiotic therapy in cardiac surgery; efficacy of surgical septal myectomy for obstructive hypertrophic cardiomyopathy; role of regenerative medicine and stem cell transplantation in CVMS; professional associations and societies’ guidelines and recommendations for indications for coronary angiography and coronary revascularization surgeries, and diagnostic catheterization. Amidst the emerging scientific developments, there is still a huge demand for establishing evidence, which should be exploited well by JCVMS. 

Keywords: Evidence-Informed Cardiovascular Medicine and Surgery; Cardiothoracic Science; Cardiothoracic Research; Evidence-Based Practice. 

This letter to editor aimed to question the role of exercises in treatment of people with co-morbid diabetes and hypertension as a twin non-communicable disorder through an overview of studies from PubMed. Limited and insufficient evidence existed for the efficacy of exercises, with two systematic reviews finding supervised structured exercises to produce beneficial effects on blood pressure and serum cholesterol. 

Keywords: Diabetic Hypertension; Hypertensive Diabetes; Non-Communicable Disorders; Exercise Rehabilitation.