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Cardiac practice involves the application of a range of pharmacological therapies. An anesthesiologist needs to keep pace with the rampant drug developments in the field of cardiovascular medicine for appropriate management in both perioperative and intensive care set-up, to strengthen his/her role as a perioperative physician in practice. The article reviews the changing trends and the future perspectives in major classes of cardiovascular medicine. [ABSTRACT FROM AUTHOR]

Background: Levosimendan a calcium ion sensitizer improves both systolic and diastolic functions. This novel lusitropic drug has predictable antiischemic properties which are mediated via the opening of mitochondrial adenosine triphosphate-sensitive potassium channels. This action of levosimendan is beneficial in cardiac surgical patients as it improves myocardial contractility, decreases systemic vascular resistance (SVR), and increases cardiac index (CI) and is thought to be cardioprotective. We decided to study whether levosimendan has any impact on the outcomes such as the duration of ventilation, the length of Intensive Care Unit (ICU) stay, and the hospital stay when compared with the nitroglycerine (NTG), which is the current standard of care at our center.Materials and Methods: Forty-seven patients undergoing elective coronary artery bypass surgery were randomly assigned to two groups receiving either levosimendan or NTG. The medications were started before starting surgery and continued until 24 h in the postoperative period. Baseline hemodynamic parameters were evaluated before beginning of the operation and then postoperatively at 3 different time intervals. N-terminal fragment of pro-brain natriuretic peptide (NT-proBNP) levels were also measured in both groups.Results: In comparison to the NTG group, the duration of ventilation and length of ICU stay were significantly less in levosimendan group (P < 0.05, P = 0.02). NT-proBNP level analysis showed a slow rising pattern in both groups and a statistically significant rise in the levels was observed in NTG group (P = 0.03, P = 0.02) in postoperative period when compared to levosimendan group of patients.Conclusion: Levosimendan treatment in patients undergoing surgical revascularization resulted in improved CI, decreased SVR and lower heart rate. And, thereby the duration of ventilation and length of ICU stay were significantly less in this group of patients when compared with NTG group. [ABSTRACT FROM AUTHOR]

Background Endothelin, a pro-inflammatory molecule, had been extensively studied in patients with cardiovascular illness. Impact on the perioperative outcome of patients with cyanotic congenital heart defects is still unknown. In the present study, we report perioperative changes in endothelin levels and their correlation with preoperative factors and clinical outcomes in a group of patients with tetralogy of Fallot (TOF) undergoing definitive repair. Methodology 167 patients with TOF undergoing intracardiac repair under cardiopumonary bypass were studied. Endothelin levels were taken at three different points of time and correlated with different clinical variables. Results The baseline endothelin level correlated with patients' nutritional status and degree of cyanosis. The magnitude of inflammatory response in the post-cardiopulmonary bypass (post-CPB) period as measured by endothelin level was much higher and correlated more consistently with adverse clinical outcomes in the younger age group. On multivariable analysis, age at operation, preoperative degree of hypoxemia, and endothelin levels were found to be independent predictors of clinical outcomes. Conclusions A rise in serum endothelin levels in patients with TOF undergoing definitive repair on CPB, with preoperative severity of cyanosis, nutritional status, and adverse clinical outcomes. The endothelin levels may be monitored to identify patients with cyanosis at an increased risk of exhibiting augmented inflammatory response to CPB. doi: 10.1111/jocs.12394 (J Card Surg 2014;29:670-677) [ABSTRACT FROM AUTHOR]

Indications for extra corporeal membrane oxygenation (ECMO) after pediatric cardiac surgery have been increasing despite the absence of encouraging survival statistics. Modification of ECMO circuit led to the development of integrated ECMO cardiopulmonary bypass (CPB) circuit at the author's institute, for children undergoing repair of transposition of great arteries among other congenital heart diseases (CHD). In this report, they analyzed the outcome of children with CHD, undergoing surgical repair and administered ECMO support in the last 10 years. The outcome was analyzed with reference to the timing of intervention, use of integrated ECMO--CPB circuit, indication for ECMO support, duration of ECMO run and the underlying CHD. The results reveal a significantly improved survival rate with the use of integrated ECMO--CPB circuit and early time of intervention rather than using ECMO as a last resort in the management. The patients with reactive pulmonary artery hypertension respond favorably to ECMO support. In all scenarios, early intervention is the key to survival. [ABSTRACT FROM AUTHOR]

We report a rare case of sinus of Valsalva aneurysm of both right and left coronary sinus (LCS), with perforation of the LCS opening into the left ventricle. The LCS aneurysm with its perforation was undiagnosed on transthoracic echocardiography emphasizing the role of transesophageal echocardiography in delineating the anatomy. [ABSTRACT FROM AUTHOR]