Introduction: Cardiac output is the amount of blood pumped out from left ventricle into systemic ... more Introduction: Cardiac output is the amount of blood pumped out from left ventricle into systemic circulation within one minute, i.e. product of stroke volume and heart rate. Coronary artery disease occurs as a consequence of reduced blood flow to heart muscle due to partial or total coronary artery obstruction by atherosclerosis or coronary thrombosis. Surgical revascularization of myocardium is performed with or without the use of cardiopulmonary bypass. Goal: to find the values of cardiac output, cardiac index, stroke volume, and heart rate before and after surgical revascularization of myocardium. Patients and methods: research was conducted as a retrospective study in Cardiovascular Clinic of University Clinical Centre in Tuzla on a sample of 60 patients subjected to surgical revascularization of myocardium. The first group consisted of 30 patients in which the revascularization was performed without the use of cardiopulmonary bypass, and the second group consisted of 30 patient...
Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can b... more Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can be different forms and degrees of complications, e.g. left ventricular dysfunction. Fibrinolythic therapy is the only non-invasive treatment that directly influences the infarction outcome. The purpose of the study was to compare systolic function of the left ventricle measured by ejection fraction in circumstances in which an acute myocardial infarction was treated by primary stent implantation, by administration of fibrinolytic agent streptokinase, and medical treatment when none of the above mentioned methods has been used. Material and methods: A retrospective-prospective study was conducted with a sample of 90 patients, that were hospitalized in 2005 and 2006 for acute myocardial infarction, mean age being of 56±7. Patients were divided into three groups, with 30 patients in each: a group of patients refered to primary stenting, a group that received streptokinase, and a group of pat...
The role of exercise test in risk stratifying of asymptomatic patients with moderate and severe a... more The role of exercise test in risk stratifying of asymptomatic patients with moderate and severe aortic stenosis (AS) in recent literature is still controversial. The aim of this study was to evaluate the role of exercise test in stratifying the risk of patients with moderate to severe aortic stenosis. At the Internal Medicine Clinic, Department of Cardiology in Tuzla, in the period from January 2008 until January 2010 was followed 33 patients with clinical and echocardiographic parameters of moderate to severe asymptomatic aortic stenosis (mean effective orifice area EOA 0.9 +/- 0.34 cm2). In statistical analysis we used descriptive statistics, t-test, chi-square test and Kaplan-Meier life table for predictive values, sensitivity and specificity. A significance level of 0.05 was used. Two patients were excluded due to exclusion criteria, so 31 patient was followed up during 12 months period. Eighteen patients (58%) with EOA pounds sterling 0.8 cm2 had limiting symptoms during the te...
ABSTRACT Objectives: The aim of this article is to investigate the relationship between the degre... more ABSTRACT Objectives: The aim of this article is to investigate the relationship between the degree of the common carotid artery (CCA) atherosclerosis and the degree of complexity of the coronary artery disease (CAD) expressed with SYNTAX score. It is known that the existence of the CCA disease indicates with high probability the existence of CAD, but few studies have examined the relationship between CCA ultrasound findings and complexity, not just the presence of CAD. Patients and Methods: We included a total of 106 consecutive patients referred to the BH Heart Center for elective coronary angiography. In order to measure and calculate the mean intima-media thickness (IMT) we performed three measurements in predefined segments of CAA for both carotid arteries, the values are converged, and divided by the number of measurements. Plaque score (PS) was measured on the basis of maximum thickness of plaque in four clearly defined segments of both CCA. The final value of PS score is obtained by adding the thickness of plaques found in all segments of CCA. The complexity of coronary artery lesions is evaluated by using the SYNTAX score. The middle and high SYNTAX scores are associated with an increased risk of cardiac death and major cardiac events. Results: Data collection and statistical analysis is in progress and preliminary results indicate that IMT values and PS score significantly correlate with SYNTAX score >18 (r=.0,64, p<0,05), as well as SYNTAX score >27 (r=.0,79, p<0,01). It is expected that final results will show that there is a significant correlation between the degree of CCA atherosclerosis measured by two methods — IMT and PS, and the degree of complexity of coronary artery lesions. Conclusion: Preliminary results show that carotid ultrasound examination has sufficient sensitivity and specificity in the detection of patients with high risk of significant CAD and it is an argument for broader use of CCA ultrasound for the evaluation of patients who are considered for coronary angiography. Besides, we are going to improve algorithm of patients selection for coronary angiography, so, our limited material and human resources and efforts will be directed towards the treatment of patients i.e. net clinical benefit will be improved. KEYWORDS: common carotid arteries, intima-media thickness, plaque score, SYNTAX score. CITATION: Cardiol. Croat. 2013;8(9):285. Proπireni saæetak / Extended abstract Predictive value and relationship between intima-media thickness/carotid artery plaque score and severity of coronary artery disease
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2009
: The purpose of this randomized study was to evaluate the effect on graft patency by adding clop... more : The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. : Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. : Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2015
It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal ... more It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Non-thyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or 'beating-heart surgery.' The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS. Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery. The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values. NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.
Sinus of Valsalva (SV) aneurysm is rare cardiac lesion with variable clinical presentation. We pr... more Sinus of Valsalva (SV) aneurysm is rare cardiac lesion with variable clinical presentation. We presented a case of a 41-year-old female who was admitted to our Center because of severe heart failure and a signs of ruptured aneurysm of the SV into the right atrium. Transthoracic echocardiography confirmed communication between noncoronary SV and right atrium measuring 12 mm in diameter, tricuspid insufficiency, biatrial dilatation and preserved left ventricular function. Urgent heart catheterization showed normal coronary arteries. Surgical repair with patch repair of the ruptured aneurysm was performed. Control echocardiography showed no communication with regression in tricuspid insufficiency. Eight days after surgery the patient was discharged home in good condition with no symptoms. Rupture of SV aneurysm may produce serious hemodynamic instability with heart failure or sudden death. Our experience supports the concept that early diagnosis and surgical treatment can save lives fo...
Introduction: Cardiac output is the amount of blood pumped out from left ventricle into systemic ... more Introduction: Cardiac output is the amount of blood pumped out from left ventricle into systemic circulation within one minute, i.e. product of stroke volume and heart rate. Coronary artery disease occurs as a consequence of reduced blood flow to heart muscle due to partial or total coronary artery obstruction by atherosclerosis or coronary thrombosis. Surgical revascularization of myocardium is performed with or without the use of cardiopulmonary bypass. Goal: to find the values of cardiac output, cardiac index, stroke volume, and heart rate before and after surgical revascularization of myocardium. Patients and methods: research was conducted as a retrospective study in Cardiovascular Clinic of University Clinical Centre in Tuzla on a sample of 60 patients subjected to surgical revascularization of myocardium. The first group consisted of 30 patients in which the revascularization was performed without the use of cardiopulmonary bypass, and the second group consisted of 30 patient...
Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can b... more Introduction: Myocardial infarction is fatal one-third of patients. In others, concequences can be different forms and degrees of complications, e.g. left ventricular dysfunction. Fibrinolythic therapy is the only non-invasive treatment that directly influences the infarction outcome. The purpose of the study was to compare systolic function of the left ventricle measured by ejection fraction in circumstances in which an acute myocardial infarction was treated by primary stent implantation, by administration of fibrinolytic agent streptokinase, and medical treatment when none of the above mentioned methods has been used. Material and methods: A retrospective-prospective study was conducted with a sample of 90 patients, that were hospitalized in 2005 and 2006 for acute myocardial infarction, mean age being of 56±7. Patients were divided into three groups, with 30 patients in each: a group of patients refered to primary stenting, a group that received streptokinase, and a group of pat...
The role of exercise test in risk stratifying of asymptomatic patients with moderate and severe a... more The role of exercise test in risk stratifying of asymptomatic patients with moderate and severe aortic stenosis (AS) in recent literature is still controversial. The aim of this study was to evaluate the role of exercise test in stratifying the risk of patients with moderate to severe aortic stenosis. At the Internal Medicine Clinic, Department of Cardiology in Tuzla, in the period from January 2008 until January 2010 was followed 33 patients with clinical and echocardiographic parameters of moderate to severe asymptomatic aortic stenosis (mean effective orifice area EOA 0.9 +/- 0.34 cm2). In statistical analysis we used descriptive statistics, t-test, chi-square test and Kaplan-Meier life table for predictive values, sensitivity and specificity. A significance level of 0.05 was used. Two patients were excluded due to exclusion criteria, so 31 patient was followed up during 12 months period. Eighteen patients (58%) with EOA pounds sterling 0.8 cm2 had limiting symptoms during the te...
ABSTRACT Objectives: The aim of this article is to investigate the relationship between the degre... more ABSTRACT Objectives: The aim of this article is to investigate the relationship between the degree of the common carotid artery (CCA) atherosclerosis and the degree of complexity of the coronary artery disease (CAD) expressed with SYNTAX score. It is known that the existence of the CCA disease indicates with high probability the existence of CAD, but few studies have examined the relationship between CCA ultrasound findings and complexity, not just the presence of CAD. Patients and Methods: We included a total of 106 consecutive patients referred to the BH Heart Center for elective coronary angiography. In order to measure and calculate the mean intima-media thickness (IMT) we performed three measurements in predefined segments of CAA for both carotid arteries, the values are converged, and divided by the number of measurements. Plaque score (PS) was measured on the basis of maximum thickness of plaque in four clearly defined segments of both CCA. The final value of PS score is obtained by adding the thickness of plaques found in all segments of CCA. The complexity of coronary artery lesions is evaluated by using the SYNTAX score. The middle and high SYNTAX scores are associated with an increased risk of cardiac death and major cardiac events. Results: Data collection and statistical analysis is in progress and preliminary results indicate that IMT values and PS score significantly correlate with SYNTAX score >18 (r=.0,64, p<0,05), as well as SYNTAX score >27 (r=.0,79, p<0,01). It is expected that final results will show that there is a significant correlation between the degree of CCA atherosclerosis measured by two methods — IMT and PS, and the degree of complexity of coronary artery lesions. Conclusion: Preliminary results show that carotid ultrasound examination has sufficient sensitivity and specificity in the detection of patients with high risk of significant CAD and it is an argument for broader use of CCA ultrasound for the evaluation of patients who are considered for coronary angiography. Besides, we are going to improve algorithm of patients selection for coronary angiography, so, our limited material and human resources and efforts will be directed towards the treatment of patients i.e. net clinical benefit will be improved. KEYWORDS: common carotid arteries, intima-media thickness, plaque score, SYNTAX score. CITATION: Cardiol. Croat. 2013;8(9):285. Proπireni saæetak / Extended abstract Predictive value and relationship between intima-media thickness/carotid artery plaque score and severity of coronary artery disease
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery, 2009
: The purpose of this randomized study was to evaluate the effect on graft patency by adding clop... more : The purpose of this randomized study was to evaluate the effect on graft patency by adding clopidogrel to aspirin in off-pump coronary artery bypass (OPCAB) grafting and the possible side effects of such therapy. : Twenty patients who underwent standard OPCAB through median sternotomy were randomized immediately after surgery in two groups. Patients in group A (n = 10) received 100 mg of aspirin starting preoperatively, continuing indefinitely. Patients in group B received 100 mg of aspirin and, in addition, 75 mg of clopidogrel starting immediately after the operation and for 3 months. Postoperative bleeding and other perioperative parameters were compared. Angiography was repeated 3 months after surgery to determine the patency and quality of grafts. : Preoperative risk factors were similar in the two groups. There was no significant difference in average number of distal anastomosis (P = 0.572), operation time (P = 0.686), postoperative bleeding (P = 0.256), ventilation time (P = 0.635), and intensive care unit stay (P = 0.065). Length of stay was shorter in group B (P = 0.024). There was no postoperative complication in either groups. Eight of 27 grafts in group A and 2 of 29 grafts in group B (P = 0.037) were occluded at the time of control angiography. : Early administration of a combined regimen of clopidogrel and aspirin after OPCAB grafting is not associated with increased postoperative bleeding or other major complications. Despite the small number of patients in this study and small number of examined grafts, the results suggest that the addition of clopidogrel may increase graft patency after OPCAB grafting.
Anadolu Kardiyoloji Dergisi/The Anatolian Journal of Cardiology, 2015
It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal ... more It is well known that coronary artery bypass grafting (CABG) is often the cause of non-thyroidal illness syndrome (NTIS). Non-thyroidal illness syndrome (NTIS) is a state characterized by low levels of tri-iodo-thyronine (T3) and high levels of reverse T3 (rT3), with normal or low levels of thyroxin (T4) and normal, low-normal, or low levels of thyroid-stimulating hormone (TSH). Today, there are two main techniques of CABG: CABG with the use of cardiopulmonary bypass (on-pump coronary artery bypass - ONCAB) and CABG without the use of cardiopulmonary bypass (off-pump coronary artery bypass OPCAB), or 'beating-heart surgery.' The OPCAB technique is considered to be less invasive. We prospectively investigated the influence of these surgical techniques on the occurrence of NTIS. Serum levels of free fractions of thyroid hormones (FT3 and FT4) and TSH were analyzed in 70 consecutive patients subjected to CABG surgery, using the ONCAB technique in 36 patients and OPCAB technique in 34 patients. The measurements of hormone levels were performed prior to surgery and 12 hours and 14 days after surgery. The basic, the early, and the late postoperative serum levels of FT3 (p=0.458, p=0.632, p=0.869, respectively), FT4 (p=0.664, p=0.301, p=0.417, respectively), and TSH (p=0.249, p=0.058, p=0.324, respectively) were similar in both groups. The levels of FT3 and TSH were significantly lower 12 hours after surgery (p<0.0001, p<0.0001, respectively), and the FT4 levels rose at the same time (p<0.0001). The third measurement showed the return of all investigated parameters back to physiological levels, although they were still not precisely within the initial values. NTIS occurs significantly in patients subjected to CABG. Although the OPCAB technique is considered to be less invasive, its impact on the occurrence of NTIS does not differ significantly from the ONCAB technique.
Sinus of Valsalva (SV) aneurysm is rare cardiac lesion with variable clinical presentation. We pr... more Sinus of Valsalva (SV) aneurysm is rare cardiac lesion with variable clinical presentation. We presented a case of a 41-year-old female who was admitted to our Center because of severe heart failure and a signs of ruptured aneurysm of the SV into the right atrium. Transthoracic echocardiography confirmed communication between noncoronary SV and right atrium measuring 12 mm in diameter, tricuspid insufficiency, biatrial dilatation and preserved left ventricular function. Urgent heart catheterization showed normal coronary arteries. Surgical repair with patch repair of the ruptured aneurysm was performed. Control echocardiography showed no communication with regression in tricuspid insufficiency. Eight days after surgery the patient was discharged home in good condition with no symptoms. Rupture of SV aneurysm may produce serious hemodynamic instability with heart failure or sudden death. Our experience supports the concept that early diagnosis and surgical treatment can save lives fo...
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