RESEARCH IN CARDIOVASCULAR MEDICINE
Year:2023 | Volume:12 | Issue:3|Papers Count:7

Background and Aims: Infective endocarditis (IE) is associated with several morbidities and high rate of mortality. Predicting these morbidities can be helpful in managing patients and can prevent possible complications, result from IE. In this study, we aimed to evaluate the association between C-reactive protein (CRP), N-terminal pro brain natriuretic peptide (BNP), monocyte to high density lipoprotein (HDL) ratio Charlson comorbidity index, and European System for Cardiac Operative Risk Evaluation (Euro SCORE) in complicated cases of IE. Materials and Methods: This prospective study was conducted on a referral center from January 2017 to December 2020. Patients with definite or possible diagnosis of IE based on the modified Duke criteria were included in this study. Demographic information and serum levels of N-terminal pro BNP, D-Dimer, CRP were evaluated in patients. In addition, we used Charlson comorbidity index and The Euro SCORE for subjective assessment. Results: One hundred and four patients (64 males, median age: 58) included in the final analysis. Intracardiac involvement, central nervous system (CNS) complications and systemic complications were observed in nine patients (9. 7%), 16 patients (15. 4%), and eight patients (7. 7%) respectively. The mortality rate was 14. 4%. D-dimer (P = 0. 008), pro-BNP (P = 0. 008), and Charlson criteria (P = 0. 012) were higher in patients with systematic complications. In addition, NT pro-BNP was significantly associated with CNS complications (P = 0. 04) and D-Dimer level was significantly associated with in-hospital mortality (P = 0. 008). Conclusion: Serum biomarkers such as pro-BNP and D-dimer, and comorbidity indices can be used for risk stratification of patients with IE. The level of pro-BNP is significantly associated with CNS complications and the level of D-dimer is significantly with mortality in patients with IE.

Introduction: The incidence and pattern of neurological complications after congenital cardiac surgery have been changing over the years due to improvement in surgical technique and perioperative management. The aim of this study was to evaluate the incidence and pattern of neurological injury in our institute. Materials and Methods: We retrospectively reviewed all pediatric patients who underwent noncontrast computed tomography of the brain for suspected postoperative neurological injury occurring during the 1st week after pediatric cardiac surgery between April 2016 and February 2020. We identified neurological injury as patients having ischemic infarct and intracranial hemorrhage. Results: A total of 2971 pediatric cardiac surgeries were performed at our institute. Sixty-seven patients (2. 25%) developed neurological injury. Fifty-five patients (82%) developed ischemic infarct while 12 patients (18%) had intracranial hemorrhagic. Pattern of ischemic infarct included global hypoxic injury in 30 patients (54. 5%), posterior cerebral artery territory in 9 patients (16. 3%), middle cerebral artery territory in 8 patients (14. 5%), multiterritory involvement in 5 patients (9. 0%), and anterior cerebral artery territory in 3 patients (5. 4%). In patients with intracranial hemorrhage, 5 patients (7. 4%) developed subarachnoid hemorrhage (SAH), 4 patients (5. 9%) developed subdural hemorrhage, and 3 patients (4. 4%) developed intraparenchymal hemorrhage. Conclusions: Neurological complication accounts for significant morbidity and mortality after congenital cardiac surgery. In our study, ischemic infarct accounted for 82% cases. In ischemic infarct, global ischemia was the most common type and carried high risk of mortality. In hemorrhage group, SAH was the most common finding. Nevertheless, the aim of this study was to characterize the current incidence of acute clinically evident neurologic complications in children undergoing congenital cardiac surgery in a tertiary hospital, although acute neurologic morbidity appears to be appreciably lower than in the past at our institution.

Background: Malignant ventricular arrhythmias are a common cause of death in ischemic heart diseases. Implantable cardioverter-defibrillators (ICDs) demonstrate significant efficacy in reducing mortality linked to ventricular arrhythmias. Statins exhibit the potential to stabilize the atherosclerotic and ischemic burden, thereby potentially manifesting indirect anti-arrhythmic effects. This study evaluated the relationship between statin levels and arrhythmic events in patients with primary prevention ICDs for ischemic cardiomyopathy. Methods: This study was conducted as a retrospective observational study at a single center, involving consecutive patients who were admitted to the cardiology outpatient clinic and underwent primary prevention ICD. The study population was stratified into two groups based on statin usage. Results: This study included a cohort of 80 patients diagnosed with ischemic cardiomyopathy who underwent primary prevention implantation of ICDs. Group 1 consisted of 24 patients who were prescribed low-dose statins, whereas Group 2 consisted of 56 patients who were prescribed high-dose statins. Univariate and multivariate analyses showed that left ventricular ejection fraction and use of low-dose statins were independent predictors of arrhythmic events. Conclusion: The study cohort exhibited comparable clinical and laboratory characteristics, suggesting that statin dosage is associated with malignant arrhythmic events in a homogeneous patient population.

It is extremely rare to encounter primary malignant tumors of the heart. Rhabdomyoma constitutes approximately 20% of all primary malignant tumors of the heart. Rhabdomyoma commonly arises from the ventricular wall, and rarely, they arise from the atrial wall and mimic symptomatic atrioventricular valve stenosis. We describe an extremely rare case of left atrial (LA) rhabdomyosarcoma detected during the transesophageal echocardiography arising from the posterior wall of the left atrium protruding into the left ventricle causing obstruction of the mitral valve. Our case is a rare case of LA rhabdomyosarcoma presenting with mitral inflow obstruction and symptomatically mimicking severe rheumatic mitral stenosis with atrial fibrillation and fast ventricular rate with orthopnea secondary to LA failure and passive pulmonary venous congestion.

Aortopulmonary window (APW) is a rare congenital heart disease. In general, surgical closure is the mainstay of treatment. There are few case reports describing transcatheter closure of an APW. Here we report a case of a APW device closure under general anaesthesia by a multifunctional occluder device in a three-year-old boy.

For patients with a small aorta, surgeons may use techniques such as the Manouguian method in addition to aortic valve replacement (AVR) to prevent patient prosthetic mismatch. These methods have been shown to have good outcomes and few complications. However, in this case presentation, a rare complication occurred in a 47-year-old woman who underwent AVR plus Manouguian surgery. After the surgery, her echocardiography revealed iatrogenic supra-aortic stenosis. The diagnosis was confirmed with computed tomography angiography, and the patient underwent surgery again at the site of the stenosis. Fortunately, the surgery was successful, and the stenosis was completely resolved.

I read with interest the study from Shojaee etal. in ResearchinCardiovascularMedicine. 2023, 12 (1): 8-18 regarding the prediction of adherence to heart failure (HF) therapy at the HF clinic of Shahid Rajaee Hospital, Iran. [1] The goal of this study was to determine the degree of treatment adherence while also exploring various demographic, clinical, comorbidity, and self-care behavior characteristics that may have an impact on adherence among HF patients. The findings of this study match with our perspective on enhancing medication adherence and health outcomes in practical settings. [2] To do this, it is important to implement a patient-centered strategy that considers several criteria, such as age, educational attainment, marital status, and health insurance coverage. A study from Malang-Indonesia[3] found that the majority of the respondents (61. 1%, 11 respondents) had never heard of HF therapy. Prior knowledge will help HF patients to know more about the therapy. Education and reminder book has been given to increase therapeutic adherence in patients with HF.