European Journal of Cardiovascular Medicine

Introduction; aortic valve replacement is a common wide spread surgical procedure performed worldwide. One of the main problems in such procedure is facing a small aortic ring to which the surgeon may not have a suitable size valve. So all efforts are made to try to measure the aortic ring preoperatively by different methods like transthoracic echocardiography, transesophageal echocardiography, CT scan and others Objectives; the main objective of this study is to assess the ability of transthoracic echocardiography in successfully measuring the aortic ring in Mosul Center for Cardiology and Cardiac Surgery and comparing it with other measurement methods. Methods; this is a retrospective clinical case series study conducted in Mosul Center for Cardiology and Cardiac Surgery over the period from June 2012 to February 2014. 54 patients were included in the study and were studied according to their sex and age distribution, type and cause of aortic valve disease, aortic valve morphology, echocardiographic and intraoperative aortic ring sizing. Results; 48.1% of our patients had an echocardiographic and intraoperative aortic valve measurement within 1 mm difference while 28.8% had an echocardiographic aortic ring being 1-2.5 mm larger than the intraoperative aortic ring measurement and 23.1% had the echocardiographic measurements being more than 2.5 mm larger than the actual intraoperative size. Discussion: these results were found to be comparable to other international results and also comparable to other studies that used other preoperative measurement methods Conclusion; transthoracic echocardiographic measurement of the aortic ring is a safe, non-invasive and reliable method for measuring the aortic ring without the need for other invasive and expensive procedures however the surgeon should prepare at least one valve size smaller than the echocardiographic measured aortic ring for safety.

The leading cause of death worldwide is not communicable diseases or infectious diseases, rather it is non-communicable diseases and life style related disorders. Among non-communicable diseases, cardiovascular diseases is attributable as the leading cause of mortality worldwide. Cardiovascular disease is a multifactorial disorder and thus it is more important to prevent it beforehand rather than finding a cure. It is known fact that cardiovascular diseases are more prevalent in elderly/upper age group individuals, but owing to increasing work stress and sedentary life style, younger age group under fifty years are also suffering from early cardiac diseases. This can be due to accelerated biological aging. Therefore in this study we have tried to find possible links between lifestyle disorders and cardiovascular diseases so that we can prevent the outcome of the disease at the earliest.

Statins exert beneficial effects on the endothelium, inflammation and the coagulation cascade that are independent of cholesterol lowering. The main mechanism underlying these effects is inhibi- tion of isoprenoid synthesis, modulating the inflammatory cascade and the endothelial activation reliable of atherosclerosis. Different studies demonstrated that statins improve endothelial function in patients with stable atherosclerotic plaque and that this effect is dose-dependent. Statins may modulate endothelial expression of adhesion molecules, as demonstrated in the ARMYDA-CAMS, and may enhance mobilisation of endothelial progenitor cells. Elevated C-reactive protein levels, an inflammatory marker that also plays a direct pathogenetic role in the atherosclerotic process, have been correlated with worse outcome in patients with cardio- vascular disease. Multiple studies demonstrated that statin attenuates the rise of inflammatory markers and improves clinical outcome in patients with stable angina, unstable angina and non-Q wave acute myocardial infarction. During percutaneous coronary intervention randomised trials showed a benefical effect of statin pre-treatment in reducing peri-procedural myocardial damage probably by plaque stabilisation and inhibition of microembolisation phenomena during stent implantation. The ARMYDA study and the NAPLES II trial demonstrated this beneficial effect in patients undergoing coronary revascularisation for stable angina. Also in patients with ACS, receiving invasive strategy, the role of statins in preventing peri-procedural damage was demonstrated in the ARMYDA-ACS study by the administration of an acute high loading-dose with atorvastatin. In patients already on chronic statin therapy at the time of the procedure, an acute drug reload before stenting would have cardio- protective effects, like demonstrated in the ARMYDA RECAPTURE study.