Heart and vessels
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Common carotid artery (CCA) injury is a serious complication of internal jugular vein (IJV) cannulation. To minimize unintentional CCA puncture, the anatomic relationship between the IJV and the CCA and the size of IJV were compared under different head positions. Ultrasound analyses of the IJV and the CCA were performed in 103 consecutive patients. ⋯ RPA positively correlated with age, and D IJV positively correlated with body mass index. In conclusion, excessive left rotation should be avoided to minimize the probability of unintentional CCA puncture during IJV cannulation. When 30° left rotation is not feasible, the head-flexion position should be utilized.
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Prolonged P-wave duration, indicating atrial conduction delay, is a marker of left atrial abnormality and is reported as a potent precursor of atrial fibrillation (AF). Several studies have shown that obstructive sleep apnea (OSA) is associated with AF. We evaluated the relationship between OSA and prolonged P-wave duration. ⋯ Multivariate regression analysis showed that age, BMI, male gender, and AHI (partial correlation coefficient, 0.47; P < 0.001) were significantly independently correlated to P-wave duration. Severity of OSA is significantly associated with delayed atrial conduction time. Obstructive sleep apnea may lead to progression of atrial remodeling as an AF substrate.
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Serum troponin T levels using a highly sensitive assay (hsTnT) in patients with chronic kidney disease (CKD) not on dialysis have not been examined. The aim of this prospective cohort study was to investigate the association of hsTnT with cardiac events in ambulatory CKD patients not on dialysis. The serum hsTnT level was measured in 442 ambulatory CKD patients not on dialysis whose estimated glomerular filtration rate was <60 ml/min/1.73 m(2). ⋯ After adjusting for other confounders, elevated hsTnT level was an independent predictor for cardiac events (hazard ratio 6.18, 95 % confidence interval 1.38-27.7, P = 0.0080 for highest quartile vs lowest quartile). In addition, C-index for receiver-operating characteristic curves for cardiac events was greater in an established risks plus hsTnT model than in the established risk alone model (0.857 vs 0.844, P = 0.026). Using a highly sensitive assay, serum hsTnT level was shown to be an independent predictor of cardiac events and a promising risk stratification tool in patients with CKD not on dialysis.
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A 68-year-old woman was admitted to our hospital because of back pain and syncope. Transthoracic echocardiography revealed pericardial effusion, a collapsed right ventricle, a giant aneurysm connected to the coronary sinus, a dilated left main trunk coronary artery, and a dilated left circumflex artery (LCx). ⋯ Rupture of coronary artery aneurysm or coronary artery fistula is very rare. Transthoracic two-dimensional echocardiography was very useful in our case for the diagnosis of cardiac tamponade, giant coronary aneurysm, and coronary artery fistula.
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It is important to establish effective treatment for postoperative atrial fibrillation (AF), the most common complication after cardiac surgery. We evaluated the efficacy and safety of landiolol hydrochloride for rhythm conversion in patients with postoperative AF. Among 134 patients who developed new-onset AF after open heart surgery between 2007 and 2009, 69 patients who received landiolol hydrochloride for treatment of postoperative AF were enrolled. ⋯ The heart rate was reduced from 130 ± 26 to 81 ± 12 (p < 0.05) after landiolol administration, while blood pressure did not decrease significantly. Landiolol hydrochloride was effective for conversion of postoperative AF. This ultra-short-acting β-blocker is a safe first-line treatment for postoperative AF after open heart surgery, and is most effective in patients who have undergone off-pump coronary artery bypass grafting.