Brain Natriuretic Peptide and the Severity of Aortic Regurgitation: Is There Any Correlation?

We aimed to evaluate the correlation between aortic regurgitation severity and brain natriuretic (BNP) levels as a marker for left ventricular dysfunction. Sixty consecutive male patients (mean age 22 ± 3 years) with isolated chronic aortic regurgitation were enrolled in the study together with a control group of 30 age-matched healthy volunteers (group A). Patients were classified with regard to aortic regurgitation vena contracta width as follows: group B, < 3 mm, mild ( n = 16); group C, ≥ 3 and < 6 mm, moderate ( n = 26); group D, ≥ 6 mm, severe ( n = 18). BNP measurements were performed with a fluorescence immunoassay kit. BNP levels were increased in patients with aortic regurgitation, and severity of regurgitation had a significant influence on BNP levels. This effect can be explained by the volume loading effect of aortic regurgitation.

The Significance of Elevated Brain Natriuretic Peptide Levels in Chronic Obstructive Pulmonary Disease

We investigated the clinical significance of brain natriuretic peptide (BNP), a cardiac hormone, in chronic obstructive pulmonary disease (COPD). Subjects were 38 patients with stable COPD, of whom 20 had cor pulmonale (CP), and 22 were healthy individuals. Plasma BNP levels were measured and pulmonary arterial pressure (PAP) was estimated by echocardiography. Arterial blood gas analysis, forced vital capacity (FVC) and forced expiratory volume in 1 s (FEV1) were also recorded. BNP levels of patients with COPD were higher than those of controls (48.2 ± 37.5 and 9.3 ± 3.0 pg/ml). Patients with CP had a higher mean BNP level with respect to those without CP (73.9 ± 35.8 and 21.0 ± 10.2 pg/ml, respectively). BNP levels correlated with PAP ( r = 0.68), partial arterial oxygen pressure ( r = −0.70), FEV1 ( r = −0.65) and FVC ( r = −0.52). We have concluded that BNP determination has a role in the diagnosis of CP in patients with COPD.

Importance of urinary measurement of glutathione S-transferase in renal dysfunction patients after on- and off-pump coronary artery bypass surgery

BACKGROUND

Acute renal failure (ARF) occurring after on-pump and off-pump cardiac surgery was assessed by urinary alpha glutathione S-transferase measurement (alpha-GST) in patients who already had renal dysfunction.

METHODS

Fifty-one patients with plasma creatinine levels ranging between 1.5 and 2.0 mg/dL were included in the study. On-pump coronary artery bypass was performed in 25 of them, and off-pump surgery in the other 25 patients. Urinary alpha-GST levels, plasma creatinine levels, creatinine clearance and fractional excretion of sodium were measured.

RESULTS

Urinary alpha-GST levels were found to be significantly increased at 24 hours postoperatively. A weak correlation was detected between alpha-GST levels and plasma creatinine, creatinine clearance and fractional excretion of sodium. Preoperative and postoperative 24 hour levels showed a positive predictive value for the occurrence of acute renal failure.

CONCLUSIONS

Tubular damage produced by cardiopulmonary bypass is not the only factor associated with postoperative ARF. Because factors independent of pump usage can adversely affect renal function, excluding pump usage alone is not sufficient to prevent postoperative ARF in patients who have preoperative renal dysfunction.

Comparison of ultrasonically activated scalpel and traditional technique in radial artery harvesting: clinical research

BACKGROUND

Use of the radial artery (RA) as a conduit in coronary artery bypass grafting (CABG) has become increasingly popular in recent years. The aim of this study was to compare the results of two different RA harvesting techniques. Use of the harmonic scalpel is suggested to be safe and additionally reduces spasm rates.

MATERIAL AND METHODS

From January 2000, the first 200 consecutive patients who underwent RA harvesting for CABG were enrolled in this study. Patients were divided into two groups. RA was harvested by means of electrocautery + hemoclips in Group I and by harmonic scalpel + hemoclips in Group II. 30 patients (30 %) in Group I and 25 patients (25 %) in Group II were female. Mean age was 53.9 +/- 9.3 and 53.5 +/- 8.4 years in Group I and Group II, respectively. Hand circulation and ulnar collateral flow was assured with a modified Allen test in all patients preoperatively. During the operation perfusion of the hand was monitored by oximetric plethysmography. The distal end of RA was also explored and clamped with a soft vascular clamp to evaluate the saturation values in the groups. During the clamping period, oxygen saturation values did not decrease so we harvested RAs in all patients.

RESULTS

There were no statistically significant differences between the groups with the exception of the RA harvesting times, the postoperative analgesia requirements, the rate of vasospasm and the need for hemostatic clips.

CONCLUSION

Harmonic scalpel usage in RA harvesting causes less trauma to adjacent tissues; the analgesia requirements, the rate of vasospasm, the RA harvesting time and the need of hemostatic clips decreases. We conclude that the use of a harmonic scalpel for radial artery harvesting is safer and faster than the routine technique.

Primary Chylopericardium

Primary chylopericardium is a rare entity. Here we describe a 36-year-old, asymptomatic male in whom pericardial effusion was detected by chest X-ray and echocardiography on routine health control. After pericardiocentesis that revealed the chylous nature of the fluid, partial pericardiectomy without duct ligation was carried out. In the follow-up period, there was no evidence of pericardial fluid on chest X-ray and echocardiography, at three months after the procedure.