allopurinol and Heart-Valve-Diseases

To assess the effects of preoperative administration of allopurinol in patients undergoing open-heart surgery (OHS) for valvular heart diseases.. In this prospective randomised double-blind study, 50 consecutive patients undergoing OHS for valvular heart disease were randomised into two groups of 25 patients each: (a) control group received placebo and (b) test group received allopurinol prior to surgery. Serum troponin T and creatine phosphokinase-MB (CPK-MB) isoenzymes were measured prior to the induction of anaesthesia, at the time of aortic cross-clamp release and 24h following termination of cardiopulmonary bypass. Postoperatively assessed parameters were inotropic score, rhythm, and duration of mechanical ventilation and occurrence of a low cardiac output state.. Significant differences were observed with respect to inotropic score: median 5 ((0-25) vs 0 (0-25) p=0.027) and mean 6.44+/-6.145 versus 3.4+/-5.54, mean duration of mechanical ventilation (11.1+/-4.9 vs 7.5+/-2.5 h, p=0.002, hospital stay (6.35+/-1.43 vs 5.04+/-0.611, p=0.001) and maintenance of normal sinus rhythm (NSR) (18 vs 25, p=0.004) between the control groups versus the test group, respectively. There were no significant differences in the levels and trends of troponin T and CPK-MB between the two groups.. The administration of allopurinol prior to OHS for valvular heart diseases is associated with increased conversion and maintenance to normal sinus rhythm, reduced inotropic score and a reduction in the duration of mechanical ventilation and hospital stay. There was, however, no significant difference in the blood levels of CPK-MB and troponin T and a large sample size is required to assess this further.

Topics: Adult; Allopurinol; Biomarkers; Cardiopulmonary Bypass; Creatine Kinase, MB Form; Epidemiologic Methods; Female; Free Radical Scavengers; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Length of Stay; Male; Middle Aged; Postoperative Care; Postoperative Complications; Preanesthetic Medication; Respiration, Artificial; Troponin T; Young Adult

Infusion of L-arginine (a precursor of nitric oxide, NO) in cardioplegia was examined to test its effect on metabolism of myocardium after myocardial ischemia and reperfusion (IR). Twenty-eight patients undergoing valve replacement were involved and randomly divided into two groups: the control group (crystalloid cardioplegia) and the experimental group (crystalloid cardioplegia + L-arginine). Blood samples were taken both before aortic clamping and after aortic unclamping from right radial artery to measure the concentrations of NO2-/NO3-, lactic acid (LA), malondialdehyde (MDA), superoxide dismutase (SOD), and xanthine oxidase (XOD). In the control group, the NO2-/NO3- level decreased at aortic unclamping, and 30 min later, it decreased significantly as compared with that before aortic clamping (p < .05). In the experimental group, it increased at aortic unclamping (p < .05), and 60 min later, increased to the peak. Five, fifteen, and thirty min after aortic unclamping, the concentrations of LA and MDA in the experimental group were lower than those in the control group (p < .05). Thirty and sixty min after aortic unclamping, the concentrations of SOD remained higher in the experimental group than those in the control group (p < .05). There was no difference between groups in the concentrations of XOD. The addition of L-arginine to the cardioplegia can protect the myocardium from injury by releasing nitric oxide.

Topics: Aged; Arginine; Cardiac Surgical Procedures; Cardioplegic Solutions; Female; Heart Arrest, Induced; Heart Valve Diseases; Humans; Lactic Acid; Male; Malondialdehyde; Middle Aged; Myocardium; Superoxide Dismutase; Xanthine Oxidase

The aim of this study was to evaluate factors of digoxin use and its relation to mortality in ED patients with atrial fibrillation (AF).. The Chinese AF registry enrolled 2016 AF patients from 20 representative EDs, and the period of study was one year. Predictors of digoxin use and its relation to mortality were assessed by logistic and Cox regression analyses.. Digoxin was assigned in 609 patients (30.6%), and younger age, lower body mass index values, and existence of permanent AF, heart failure (HF), chronic obstructive pulmonary disease, and valvular heart disease were identified to be factors associated with digoxin use. During the follow-up, compared to patients without digoxin therapy, digoxin-treated patients had significantly higher risk of all-cause death (17.2% vs. 13.0%, P=0.012) and cardiovascular death (15.1% vs. 6.7%, P<0.001), but similar risk of sudden cardiac death (1.1% vs. 0.7%, P=0.341). However, after adjustment for related covariates, digoxin use was no longer notably associated with increased all-cause mortality (hazards ratio [HR] 0.973, 95% confidence interval [CI] 0.718-1.318) and cardiovascular death (HR 1.313, 95% CI 0.905-1.906). Besides, neutral associations of digoxin treatment to mortality were obtained in relevant subgroups, with no interactions observed between digoxin and gender, HF, valvular heart disease, or concomitant warfarin treatment in mortality risk.. In ED patients with AF, digoxin was more frequently assigned to vulnerable patients with concomitant HF or valvular heart disease, and digoxin use was not related to a significantly increased risk of mortality.

Topics: Age Factors; Aged; Aged, 80 and over; Allopurinol; Anti-Arrhythmia Agents; Atrial Fibrillation; Body Mass Index; Cardiovascular Diseases; Cause of Death; China; Comorbidity; Death, Sudden, Cardiac; Digoxin; Emergency Service, Hospital; Female; Heart Failure; Heart Valve Diseases; Humans; Male; Middle Aged; Mortality; Proportional Hazards Models; Prospective Studies; Pulmonary Disease, Chronic Obstructive; Registries; Risk Factors

We observed previously that allopurinol, which was used for the treatment of gout, had a life saving effect after experiment on traumatic shock rats and hemorrhagic shock rabbits. To evaluate the effect of allopurinol fifteen patients undergoing open heart surgery who were considered to have similar metabolic derangement in shock patient were examined. Allopurinol was given orally 2 mg per kg body weight twice before the start of nitrous oxide, oxygen and halothane anesthesia. In the control group of ten patients who were not treated with allopurinol, serum uric acid increased, the lactate/pyruvate ratio rose and beta-glucuronidase activity increased respectively after open heart surgery as in shock. But the metabolic changes of the fifteen patients pretreated with allopurinol were less significant, although same tendency was observed. The heart beat of all patients except one case in the allopurinol group, started spontaneously after extracorporeal circulation without using DC counter shock. In the control group all patients needed DC counter shock. We concluded that allopurinol was effective in preventing damage of cellular structures and derangements of metabolism of patients undergoing open heart surgery.

Topics: Allopurinol; Cardiac Surgical Procedures; Glucuronidase; Heart Septal Defects; Heart Valve Diseases; Humans; Lactates; Myocardial Contraction; Postoperative Period; Preoperative Care; Pyruvates; Uric Acid