Pub Date : 2020-11-27DOI: 10.4236/WJCS.2020.1012028
S. B. Allah, E. Mangieri, J. Fedacko, P. Lohana, M. Elmahal, Amena Elsaady, Madian Abdelrahman, Jaipaul Singh, M. Khorshid, Ram B. Singh, G. Elkilany
Paradoxical valvular aortic stenosis (VAS) is a challenging area of clinical cardiology for the practitioners. It involves a small aortic valve area, low flow rate and mean pressure gradient although there is normal left ventricular ejection fraction. The aim of this study was to assess left ventricular (LV) dysfunction in a symptomatic severe aortic valve stenosis which is of crucial importance in identifying patients at risk of heart failure, postoperative complications and increased mortality. There are new insights which are involved in assessment of LV myocardial function including global longitudinal strain (GLS) by two-dimensional speckle tracking echocardiography (2D STE), myocardial performance index (MPI) and maximum rate of LV pressure rise (+dP/dt) during isovolumetric contraction time of the LV. This information can provide both diagnostic and prognostic information in addition to standard echocardiographic and clinical parameters. However, a profound understanding of the complex interaction between loading conditions, chamber geometry and contractility is necessary for the correct interpretation of myocardial deformation in order to draw appropriate conclusions in patients with aortic valve disease. This mini review is related to new and novel insights into the assessment of left ventricular function (LVF) in paradoxical low flow aortic stenosis patients with normal left ventricular ejection fraction (LVEF).
{"title":"New Insight in the Assessment of Left Ventricular Function in Paradoxical Low Flow Aortic Stenosis Patients with Normal Left Ventricular Ejection Fraction: A Mini-Review","authors":"S. B. Allah, E. Mangieri, J. Fedacko, P. Lohana, M. Elmahal, Amena Elsaady, Madian Abdelrahman, Jaipaul Singh, M. Khorshid, Ram B. Singh, G. Elkilany","doi":"10.4236/WJCS.2020.1012028","DOIUrl":"https://doi.org/10.4236/WJCS.2020.1012028","url":null,"abstract":"Paradoxical valvular aortic stenosis (VAS) \u0000is a challenging area of clinical cardiology for the practitioners. It involves \u0000a small aortic valve area, low flow rate and mean pressure gradient although \u0000there is normal left ventricular ejection fraction. The aim of this study was \u0000to assess left ventricular (LV) dysfunction in a symptomatic severe aortic \u0000valve stenosis which is of crucial importance in identifying patients at risk \u0000of heart failure, postoperative complications and increased mortality. There \u0000are new insights which are involved in assessment of LV myocardial function \u0000including global longitudinal strain (GLS) by two-dimensional speckle tracking \u0000echocardiography (2D STE), myocardial performance index (MPI) and maximum rate \u0000of LV pressure rise (+dP/dt) during isovolumetric contraction time of the LV. \u0000This information can provide both diagnostic and prognostic information in \u0000addition to standard echocardiographic and clinical parameters. However, a profound \u0000understanding of the complex interaction between loading conditions, chamber \u0000geometry and contractility is necessary for the correct interpretation of \u0000myocardial deformation in order to draw appropriate conclusions in patients \u0000with aortic valve disease. This mini review is related to new and novel \u0000insights into the assessment of left ventricular function (LVF) in paradoxical \u0000low flow aortic stenosis patients with normal left ventricular ejection \u0000fraction (LVEF).","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"31 1","pages":"264-270"},"PeriodicalIF":0.0,"publicationDate":"2020-11-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87119279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-17DOI: 10.4236/wjcs.2020.1011025
P. Uduagbamen, M. Sanusi, O. Udom, O. Salami, A. Adebajo, O. J. Alao
Background: Metabolic acidosis (MA) is a common finding on the surgical ward, more so in the intensive care unit. Diseases affecting the major organ systems of the body and higher grades of surgery are common risk factors for MA. It is associated with poor treatment outcome. Aim: To determine the risk factors and clinical correlates of metabolic acidosis and assess its relationship with treatment outcome. Methodology: A retrospective study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west Nigeria, on patients that had cardiac and vascular surgeries from January 2015 to December 2019. Three hundred and forty two participants took part in the study. The demographic, clinical and laboratory findings were entered. Statistical analysis was with Student’s t-test and Chi square. Results: Two hundred and six males and 136 females were studied. The incidences of metabolic acidosis prior to induction, on post-operative day one (POD1) and on POD28 were 20.7%, 39.8% and 14.1% respectively. Nine (2.6%) participants died during admission, of this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD1. The Risk factors for MA were advanced age, comorbidities, open heart surgery, elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk factor for prolonged hospital stay, perioperative death and declining kidney function which was commoner among participants with preexisting kidney dysfunction. Conclusion: The incidence of metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD1 and by POD28, it has significantly reduced to 14.1%. While advancing age and comorbidities were risk factors for MA, the occurrence of MA increased the risk of declining kidney function, prolonged hospital stay and death.
{"title":"Metabolic Acidosis in the Surgical Intensive Care Unit: Risk Factors, Clinical Correlates and Outcome. Findings from a High Dependency Heart and Vascular Surgical Center in Nigeria","authors":"P. Uduagbamen, M. Sanusi, O. Udom, O. Salami, A. Adebajo, O. J. Alao","doi":"10.4236/wjcs.2020.1011025","DOIUrl":"https://doi.org/10.4236/wjcs.2020.1011025","url":null,"abstract":"Background: Metabolic acidosis \u0000(MA) is a common finding on the surgical ward, more so in the intensive care \u0000unit. Diseases affecting the major organ systems of the body and higher grades \u0000of surgery are common risk factors for MA. It is associated with poor treatment \u0000outcome. Aim: To determine the risk \u0000factors and clinical correlates of metabolic acidosis and assess its \u0000relationship with treatment outcome. Methodology: A retrospective \u0000study at the “Tristate Heart and vascular Center” in Ilishan-Remo South west \u0000Nigeria, on patients that had cardiac and vascular surgeries from January 2015 to December 2019. Three hundred and forty two participants took part in the study. \u0000The demographic, clinical and laboratory findings were entered. Statistical \u0000analysis was with Student’s t-test and Chi square. Results: Two hundred and six \u0000males and 136 females were studied. The incidences of metabolic acidosis prior to induction, on \u0000post-operative day one (POD1) and on POD28 were 20.7%, 39.8% and 14.1% respectively. Nine (2.6%) participants died during admission, of \u0000this, 6 (66.7%) had MA at presentation but all (100%) had MA on POD1. \u0000The Risk factors for MA were advanced age, comorbidities, open heart surgery, \u0000elevated systolic blood pressure and low eGFR. Metabolic acidosis was a risk \u0000factor for prolonged hospital stay, perioperative death and declining kidney \u0000function which was commoner among participants with preexisting kidney \u0000dysfunction. Conclusion: The incidence of \u0000metabolic acidosis was 20.7% at induction of anesthesia, rose to 39.8% on POD1 and by POD28, it has significantly reduced to 14.1%. While advancing \u0000age and comorbidities were risk factors for MA, the occurrence of MA increased \u0000the risk of declining kidney function, prolonged hospital stay and death.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"52 1","pages":"226-241"},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85181790","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-11-17DOI: 10.4236/wjcs.2020.1011024
A. Elassal, Osman O. Al-Radi, H. Jabbad, Z. Zaher, Mohamed H. Abdelsalam, Ahmed M. Dohain, G. Abdelmohsen, K. Al_ebrahim
Background: The knowledge on pericardial disease has increased but the European Society of Cardiology in the last guidelines 2015 stated a section of perspective and unmet needs referring to the surgical management as one of these needs. Here, we present an institutional experience to contribute with other studies in explanation of questionable aspects about their surgical management. Methods: Among 127 cases (93 adults and 34 children) that were diagnosed as pericardial syndrome, we retrospectively analyzed 45 cases (40 adults and 5 children) operated for pericardial syndrome from May 2012 to June 2019. Echocardiogram was the main preoperative diagnostic tool. Surgical approach was selected according to each diagnosis. Postoperative clinical assessment, recurrence and mortality rate were the main determinants of outcome. Results: Regarding pericardial effusions, the mean preoperative medical treatment period was 17.7 ± 21.9 days and pericardial window through thoracotomy was the common approach (54.5%). In constrictive pericarditis, infection was the main etiology (40%), mean preoperative medical treatment period was 16 ± 8.8 days and complete pericardiectomy was the surgical procedure for most cases. Trans-sternal drainage was the standard approach for cardiac tamponade. No postoperative same admission recurrences were reported and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them were diagnosed as malignant effusions. Conclusion: Decision making and surgical approach affect the outcome of surgery for pericardial syndromes. Children are more responsive to medical treatment than adults are. Primary etiology and patient’s condition are still the leading determinants of morbidity and mortality.
{"title":"Surgery for Pericardial Syndromes in Adults and Children: Clarification of Questionable Aspects","authors":"A. Elassal, Osman O. Al-Radi, H. Jabbad, Z. Zaher, Mohamed H. Abdelsalam, Ahmed M. Dohain, G. Abdelmohsen, K. Al_ebrahim","doi":"10.4236/wjcs.2020.1011024","DOIUrl":"https://doi.org/10.4236/wjcs.2020.1011024","url":null,"abstract":"Background: The knowledge on \u0000pericardial disease has increased but the European Society of Cardiology in the \u0000last guidelines 2015 stated a section of perspective and unmet needs referring \u0000to the surgical management as one of these needs. Here, we present an institutional \u0000experience to contribute with other studies \u0000in explanation of questionable aspects about their surgical management. Methods: \u0000Among 127 cases (93 adults and 34 children) that were diagnosed as pericardial \u0000syndrome, we retrospectively analyzed 45 cases (40 adults and 5 children) \u0000operated for pericardial syndrome from May 2012 to June 2019. Echocardiogram \u0000was the main preoperative diagnostic tool. Surgical approach was selected \u0000according to each diagnosis. Postoperative clinical assessment, recurrence and \u0000mortality rate were the main determinants of outcome. Results: Regarding pericardial effusions, the mean preoperative medical treatment period was 17.7 ± 21.9 days and pericardial window \u0000through thoracotomy was the common approach (54.5%). In constrictive \u0000pericarditis, infection was the main etiology (40%), mean preoperative medical \u0000treatment period was 16 ± 8.8 days and complete pericardiectomy was the \u0000surgical procedure for most cases. Trans-sternal drainage was the standard \u0000approach for cardiac tamponade. No postoperative same admission recurrences \u0000were reported and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them were diagnosed as malignant effusions. Conclusion: Decision making and surgical approach \u0000affect the outcome of surgery for pericardial syndromes. Children are \u0000more responsive to medical treatment than adults are. Primary etiology and \u0000patient’s condition are still the leading determinants of morbidity and \u0000mortality.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"10 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-11-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84336758","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-26DOI: 10.4236/wjcs.2020.1010023
S. Munshi, A. Halder, Pares Bandyopadhyay
Background: Coronary artery bypass grafting (CABG) is an important modality of treatment for ischemic heart disease. Both off-pump and on-pump CABG have direct effect on the level cardiac biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) and aortic cross-clamping may cause additive myocardial damage leading to further elevation of blood markers. The present study is aimed at measuring and comparing the cardiac biomarker levels in immediate post-operative period after on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who underwent CABG from January 2015 to June 2016 on elective or emergency basis at Nilratan Sircar Medical College & Hospital have been included in the study. Total 106 patients were operated for CABG of which 75 patients were operated for OPCAB and 31 patients were operated for ONCAB. For the comparison of data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are measured during anesthesia before surgery, post-operatively after 1 hour, post-operatively after 4 hours and post-operatively after 20 hours. All recorded data are analyzed using standard statistical methods. Results: We found the markers are elevated immediately after surgery and gradually come down within 24 hours after surgery in both OPCAB and ONCAB groups. The elevation is more after ONCAB than OPCAB group in immediate post-operative period but the difference is not significant after 20 hours of surgery. Conclusion: Elevated levels of cardiac biomarkers in the immediate post-operative period indicate myocardial damage during surgery, especially after ONCAB in comparison to OPCAB. This may attribute to the better hemodynamic stability in the immediate post-operative period after OPCAB than ONCAB assuming comparable and adequate revascularization in patients of both groups. The avoidance of CPB and cross-clamp may explain better myocardial functioning immediately after OPCAB. But after 20 hours, the level of cardiac markers is comparable in both groups indicating little difference in post-operative recovery and long-term prognosis.
背景:冠状动脉旁路移植术(CABG)是治疗缺血性心脏病的重要方式。无泵和有泵冠脉搭桥对围手术期心脏生物标志物水平均有直接影响。体外循环(CPB)和主动脉交叉夹持术的使用可能导致心肌损伤，导致血液标志物进一步升高。本研究旨在测量和比较有泵搭桥(ONCAB)和无泵搭桥(OPCAB)术后即刻心脏生物标志物水平。方法:选取2015年1月至2016年6月在Nilratan Sircar医学院及医院择期或急诊行CABG的患者作为研究对象。本组共106例患者行CABG手术，其中OPCAB手术75例，ONCAB手术31例。术前麻醉、术后1小时、术后4小时、术后20小时分别测定肌钙蛋白- t (Trop-T)、肌酸激酶- mb (CK-MB)血液标志物。所有记录的数据使用标准统计方法进行分析。结果:OPCAB组和ONCAB组术后标志物均即刻升高，术后24小时内逐渐下降。ONCAB组术后即刻升高高于OPCAB组，但术后20小时差异不显著。结论:术后即刻心脏生物标志物水平升高表明手术期间心肌损伤，特别是与OPCAB相比，ONCAB后心肌损伤更明显。这可能归因于OPCAB术后立即的血流动力学稳定性优于ONCAB，假设两组患者的血运重建相当且足够。避免CPB和交叉夹持可能是OPCAB术后心肌功能改善的原因。但20小时后，两组心脏标志物水平相当，表明术后恢复和长期预后差异不大。
{"title":"Level of Cardiac Biomarkers in Immediate Post-Operative Period after Off-Pump CABG and Its Comparison with On-Pump CABG: A Prospective Analytical Study","authors":"S. Munshi, A. Halder, Pares Bandyopadhyay","doi":"10.4236/wjcs.2020.1010023","DOIUrl":"https://doi.org/10.4236/wjcs.2020.1010023","url":null,"abstract":"Background: Coronary artery \u0000bypass grafting (CABG) is an important modality of treatment for ischemic heart \u0000disease. Both off-pump and on-pump CABG have direct effect on the level cardiac \u0000biomarkers in the perioperative period. The use of cardiopulmonary bypass (CPB) \u0000and aortic cross-clamping may cause additive myocardial damage leading to \u0000further elevation of blood markers. The present study is aimed at measuring and \u0000comparing the cardiac biomarker levels in immediate post-operative period after \u0000on-pump CABG (ONCAB) and off-pump CABG (OPCAB). Methods: All the patients who \u0000underwent CABG from January 2015 to June 2016 on elective or emergency basis at \u0000Nilratan Sircar Medical College & Hospital have been included in the study. \u0000Total 106 patients were operated for CABG of which 75 patients were operated \u0000for OPCAB and 31 patients were operated for ONCAB. For the comparison of \u0000data the blood markers Troponin-T (Trop-T) and Creatine Kinase-MB (CK-MB) are \u0000measured during anesthesia before surgery, post-operatively \u0000after 1 hour, post-operatively after 4 hours and post-operatively after 20 hours. All recorded data are analyzed using standard statistical methods. Results: We found the markers are elevated immediately \u0000after surgery and gradually come down within 24 hours after surgery in both OPCAB and ONCAB groups. The elevation is more after ONCAB than \u0000OPCAB group in immediate post-operative period but the difference is not \u0000significant after 20 hours of surgery. Conclusion: Elevated levels of \u0000cardiac biomarkers in the immediate post-operative period indicate myocardial \u0000damage during surgery, especially after ONCAB in comparison to OPCAB. This may \u0000attribute to the better hemodynamic stability in the immediate post-operative \u0000period after OPCAB than ONCAB assuming comparable and adequate \u0000revascularization in patients of both groups. The avoidance of CPB and \u0000cross-clamp may explain better myocardial functioning immediately after OPCAB. But after 20 \u0000hours, the level of cardiac markers is comparable in both groups indicating \u0000little difference in post-operative recovery and long-term prognosis.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90754316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-26DOI: 10.4236/wjcs.2020.1010021
J. Blidgen, C. McGaw
Essential thrombocytosis (ET) is a rare myeloproliferative disorder, which is a major risk factor for thrombosis and bleeding, which complicates cardiovascular surgery. ET is a risk factor for coronary artery disease that should be treated. We present a case of a male with ET who underwent coronary artery bypass grafting (CABG) at the University Hospital of the West Indies, and died post-surgery. Post mortem revealed early graft thrombosis. We believe that post-operative aspirin therapy maybe would have prevented this fatal outcome.
{"title":"Essential Thrombocytosis and Fatal Coronary Graft Occlusion: A Case Report","authors":"J. Blidgen, C. McGaw","doi":"10.4236/wjcs.2020.1010021","DOIUrl":"https://doi.org/10.4236/wjcs.2020.1010021","url":null,"abstract":"Essential thrombocytosis (ET) is a rare myeloproliferative disorder, \u0000which is a major risk factor for thrombosis and bleeding, which complicates \u0000cardiovascular surgery. ET is a risk factor for coronary artery disease that \u0000should be treated. We present a case of a male with ET who underwent coronary \u0000artery bypass grafting (CABG) at the University Hospital of the West Indies, \u0000and died post-surgery. Post mortem revealed early graft thrombosis. We believe \u0000that post-operative aspirin therapy maybe would have prevented this fatal outcome.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86475686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-10-26DOI: 10.4236/wjcs.2020.1010022
P. Khakural, R. Baral, A. Bhattarai, B. Koirala
Background: Atrial Septal Defect (ASD) closure is a common cardiac surgical procedure performed worldwide. Due to favourable clinical outcome, minimal invasive approach is becoming popular. Hence this study was conducted to compare the outcome of two surgical approaches, median sternotomy and mini thoracotomy with total peripheral cannulation, in a developing country Nepal. Methods: A prospective study of 62 ASD patients, randomized to undergo surgical closure either via right anterior mini thoracotomy or median sternotomy was conducted and followed up over three years. The clinical outcome parameters like intensive care unit stay, hospital stay, post-operative duration of ventilation, cardiopulmonary bypass time, aortic cross clamp time, mediastinal drainage, size of scar and complication were compared between two groups. Results: Cardiopulmonary bypass time and aortic cross clamp time were significantly longer in right anterior mini thoracotomy group as compared to median sternotomy group (43.97 min ± 12.70 min vs 34.42 min ± 10.42 min and 25.13 min ± 7.82 min vs 19.48 min ± 6.93 min respectively, p-value 0.05). There was no significant difference in duration of surgery (2.75 hrs ± 0.43 hrs vs 2.56 hrs ± 0.41 hrs, p-value = 0.09), post-operative ventilation (2.90 hrs ± 1.22 hrs and 2.88 hrs ± 1.07 hrs, p-value = 0.96) between two groups. Post-operative mediastinal drainage was significantly less in right anterior mini thoracotomy group (214.52 ml ± 91.79 ml vs 284.03 ml ± 158.91 ml, p-value = 0.04). There was no significant difference in ICU stay and hospital stay. Conclusion: Atrial septal defect can be safely closed by right anterior mini thoracotomy with a small, cosmetically acceptable submammary scar with less pain and bleeding.
背景:房间隔缺损(ASD)关闭是世界范围内常见的心脏外科手术。由于良好的临床效果，微创入路越来越受欢迎。因此，本研究在发展中国家尼泊尔进行了比较两种手术入路的结果，胸骨正中切开术和全外周插管的小开胸术。方法:对62例ASD患者进行前瞻性研究，随机选择右前方小胸切开术或胸骨正中切开术进行手术封闭，随访3年以上。比较两组患者重症监护病房时间、住院时间、术后通气时间、体外循环时间、主动脉交叉夹持时间、纵隔引流、瘢痕大小及并发症等临床结局参数。结果:右前方小开胸组体外循环时间和主动脉交叉夹持时间(43.97 min±12.70 min vs 34.42 min±10.42 min)明显长于胸骨正中开胸组(25.13 min±7.82 min vs 19.48 min±6.93 min)， p值均为0.05。两组患者手术时间(2.75 h±0.43 h vs 2.56 h±0.41 h, p值= 0.09)、术后通气时间(2.90 h±1.22 h vs 2.88 h±1.07 h, p值= 0.96)差异无统计学意义。右侧前路小开胸组术后纵隔引流明显减少(214.52 ml±91.79 ml vs 284.03 ml±158.91 ml, p值= 0.04)。ICU住院时间与住院时间差异无统计学意义。结论:房间隔缺损可通过右前小开胸术安全封闭，乳下瘢痕面积小，美观，疼痛少，出血少。
{"title":"Atrial Septal Defect Closure by Anterior Mini Thoracotomy with Total Peripheral Cannulation: A Step towards Establishing Mini Invasive Cardiac Surgery in a Developing Nation","authors":"P. Khakural, R. Baral, A. Bhattarai, B. Koirala","doi":"10.4236/wjcs.2020.1010022","DOIUrl":"https://doi.org/10.4236/wjcs.2020.1010022","url":null,"abstract":"Background: Atrial Septal Defect \u0000(ASD) closure is a common cardiac surgical procedure performed worldwide. Due \u0000to favourable clinical outcome, minimal invasive approach is becoming popular. \u0000Hence this study was conducted to compare the outcome of two surgical \u0000approaches, median sternotomy and mini thoracotomy with total peripheral \u0000cannulation, in a developing country Nepal. Methods: A prospective study \u0000of 62 ASD patients, randomized to undergo surgical closure either via right \u0000anterior mini thoracotomy or median sternotomy was conducted and followed up \u0000over three years. The clinical outcome parameters like intensive care unit \u0000stay, hospital stay, post-operative duration of ventilation, cardiopulmonary \u0000bypass time, aortic cross clamp time, mediastinal drainage, size of scar and \u0000complication were compared between two groups. Results: Cardiopulmonary \u0000bypass time and aortic cross clamp time were significantly longer in right \u0000anterior mini thoracotomy group as compared to median sternotomy group (43.97 min ± 12.70 min vs 34.42 min ± 10.42 min and 25.13 min ± 7.82 min vs 19.48 min ± 6.93 min respectively, p-value 0.05). There was no significant difference in duration of surgery (2.75 hrs ± 0.43 hrs vs 2.56 hrs ± 0.41 hrs, p-value = 0.09), post-operative ventilation (2.90 hrs ± 1.22 hrs and 2.88 hrs ± 1.07 hrs, p-value = 0.96) between two groups. Post-operative mediastinal drainage was \u0000significantly less in right anterior mini thoracotomy group (214.52 ml ± 91.79 ml vs 284.03 ml ± 158.91 ml, p-value = 0.04). There was no significant difference in ICU stay and hospital stay. Conclusion: Atrial septal defect can be safely closed by right anterior \u0000mini thoracotomy with a small, cosmetically acceptable submammary scar with \u0000less pain and bleeding.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87843930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-09-21DOI: 10.4236/WJCS.2020.109020
V. Nzesseu, C. Kouam, J. Tamokou, J. Kuiaté
Objective: The aim of this work was to study the effects of antihypertensive therapies on certain metabolic parameters in hypertensive patients. Methods: A cross-sectional and analytical study conducted within the Bafoussam Re-gional Hospital on 343 patients including 99 normotensives and 244 hyperten-sives distributed in 71 patients naive to treatment and 173 patients under treatment (84 under monotherapy, 67 under bitherapy and 21 under trithera-py). The antihypertensive medications were recorded from the medical records. A questionnaire survey was administered to study participants and potential risk factors for hypertension sought. Blood and urine samples were collected for lipid, renal and hepatic disorder analysis. Two blood pressure measure-ments enabled us to diagnose hypertensive patients. Measurements of bio-chemical parameters such as total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, creatinine, glucose, aspartate aminotransferase (ASAT), alanine aminotransferase (ALT), potassium, chloride and calcium were done in serum by methods resulting from commercial kits. Results: Cal-cium Channel Blockers were significantly associated with increases in blood potassium (odd-ratios (OR) = 8.63, p = 0.036) and sodium (OR = 0.20, p = 0.037). Angiotensin-converting enzyme/Angiotensin II receptor blockers were significantly associated with an increase in plasma activity of ASAT (OR = 0.12, p = 0.03) whereas Diuretics were significantly associated with an increase in ALAT plasma activity (OR = 0.003, p = 0.012). Dual therapies were associ-ated with highest frequencies of hypercreatininemia (41.8%) and hyperglyce-mia (44.8%) whereas hypocholesterolemia HDL (38.1%) was most observed in hypertensive patients on triple therapy. The different therapies resulted in very low frequencies of abnormal liver profiles (in general almost all below 10%). Tritherapy had the most beneficial effects on the different profiles, with no cases of hyperkalemia, glycosuria, hypochloremia, hematuria, hyponatremia, total hypercholesterolemia, ALAT and ASAT hyperactivity. Conclusion: Triple therapy should be recommended as it has the most beneficial effects on met-abolic parameters in the study population.
目的:探讨降压治疗对高血压患者某些代谢参数的影响。方法:在巴富萨姆地区医院对343例患者进行了横断面分析研究，其中包括99例常压患者和244例高血压患者，分布在71例首次接受治疗的患者和173例正在接受治疗的患者中(84例接受单一治疗，67例接受双药治疗，21例接受三药治疗)。从医疗记录中记录降压药物。采用问卷调查的方式对参与者进行研究，并寻找高血压的潜在危险因素。采集血液和尿液进行血脂、肾脏和肝脏疾病分析。两次血压测量使我们能够诊断高血压患者。血清生化参数，如总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇、甘油三酯、肌酐、葡萄糖、天冬氨酸转氨酶(ASAT)、丙氨酸转氨酶(ALT)、钾、氯和钙的测定，采用商业试剂盒方法完成。结果:钙通道阻滞剂与血钾(奇比(OR) = 8.63, p = 0.036)和钠(OR = 0.20, p = 0.037)升高显著相关。血管紧张素转换酶/血管紧张素II受体阻滞剂与血浆ASAT活性增加显著相关(OR = 0.12, p = 0.03)，而利尿剂与血浆ALAT活性增加显著相关(OR = 0.003, p = 0.012)。双重治疗与高肌酐血症(41.8%)和高血糖血症(44.8%)的发生率最高相关，而低胆固醇血症(38.1%)在三联治疗的高血压患者中观察到最多。不同的治疗方法导致肝脏异常的频率非常低(一般几乎都低于10%)。三联疗法对不同类型的患者效果最好，没有出现高钾血症、糖尿症、低氯血症、血尿、低钠血症、总高胆固醇血症、ALAT和ASAT亢进。结论:应推荐三联疗法，因为它对研究人群的代谢参数有最有益的影响。
{"title":"Follow Up of Hypertensive Patients at Regional Hospital of Bafoussam, West Cameroon: Biochemical Profiles in Naive and Hypotensive Drug Treated Patients","authors":"V. Nzesseu, C. Kouam, J. Tamokou, J. Kuiaté","doi":"10.4236/WJCS.2020.109020","DOIUrl":"https://doi.org/10.4236/WJCS.2020.109020","url":null,"abstract":"Objective: The aim of this work was to study the effects of antihypertensive therapies on \u0000certain metabolic parameters in hypertensive patients. Methods: A \u0000cross-sectional and analytical study conducted within the Bafoussam Re-gional \u0000Hospital on 343 patients including 99 normotensives and 244 hyperten-sives \u0000distributed in 71 patients naive to treatment and 173 patients under treatment \u0000(84 under monotherapy, 67 under bitherapy and 21 under trithera-py). The \u0000antihypertensive medications were recorded from the medical records. A \u0000questionnaire survey was administered to study participants and potential risk \u0000factors for hypertension sought. Blood and urine samples were collected for \u0000lipid, renal and hepatic disorder analysis. Two blood pressure measure-ments enabled \u0000us to diagnose hypertensive patients. Measurements of bio-chemical parameters \u0000such as total cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides, \u0000creatinine, glucose, aspartate aminotransferase (ASAT), alanine \u0000aminotransferase (ALT), potassium, chloride and calcium were done in serum by \u0000methods resulting from commercial kits. Results: Cal-cium Channel Blockers were \u0000significantly associated with increases in blood potassium (odd-ratios (OR) = \u00008.63, p = 0.036) and sodium (OR = 0.20, p = 0.037). Angiotensin-converting \u0000enzyme/Angiotensin II receptor blockers were significantly associated with an \u0000increase in plasma activity of ASAT (OR = 0.12, p = 0.03) whereas Diuretics \u0000were significantly associated with an increase in ALAT plasma activity (OR = 0.003, \u0000p = 0.012). Dual therapies were associ-ated with highest frequencies of \u0000hypercreatininemia (41.8%) and hyperglyce-mia (44.8%) whereas \u0000hypocholesterolemia HDL (38.1%) was most observed in hypertensive patients on \u0000triple therapy. The different therapies resulted in very low frequencies of \u0000abnormal liver profiles (in general almost all below 10%). Tritherapy had the \u0000most beneficial effects on the different profiles, with no cases of \u0000hyperkalemia, glycosuria, hypochloremia, hematuria, hyponatremia, total hypercholesterolemia, \u0000ALAT and ASAT hyperactivity. Conclusion: Triple therapy should be recommended \u0000as it has the most beneficial effects on met-abolic parameters in the study population.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"79 1","pages":"167-185"},"PeriodicalIF":0.0,"publicationDate":"2020-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88167124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-11DOI: 10.4236/wjcs.2020.108019
C. Blazoski, Qiong Yang, H. Hirose
INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is commonly used for refractory cardiac or respiratory failure. There are reported cases of successful use of ECMO in patients with septic shock; however, there is a lack of evidence to prove its overall efficacy. Thus, we conducted this study to analyze the relationship between sepsis and ECMO in our own patients. METHODS: 305 patients who were placed on ECMO between 2010 and 2020 were identified within an IRB-approved database. Their clinical outcomes were analyzed with a specific focus on patients who were septic before or during ECMO, defined as a positive blood culture. Group S was composed of patients with a positive blood culture before or during ECMO, while Group N was composed of all patients without a positive blood culture before or during ECMO. The primary outcome compared between groups was ECMO survival rate. RESULTS: Among the 305 patients on ECMO, 58 (19%) were in Group S and 247 (81%) were in Group N. ECMO survival rates were 45% in Group S and 62% in Group N (p = 0.017). CONCLUSION: Of our 305 patients, patients who were septic upon ECMO placement or those who developed sepsis during ECMO had worse ECMO survival rates than non-septic patients. Ultimately, patients who are septic or have a high probability of becoming septic may not be indicated for ECMO placement, and cautious administration of ECMO to these patients may be necessary.
{"title":"Outcomes of Extracorporeal Membrane Oxygenation in Blood Culture Positive Septic Patients","authors":"C. Blazoski, Qiong Yang, H. Hirose","doi":"10.4236/wjcs.2020.108019","DOIUrl":"https://doi.org/10.4236/wjcs.2020.108019","url":null,"abstract":"INTRODUCTION: Extracorporeal membrane oxygenation (ECMO) is commonly used for \u0000refractory cardiac or respiratory failure. There are reported cases of \u0000successful use of ECMO in patients with septic shock; however, there is a lack \u0000of evidence to prove its overall efficacy. Thus, we conducted this study to \u0000analyze the relationship between sepsis and ECMO in our own patients. METHODS: 305 patients who were placed on ECMO between 2010 and 2020 were identified \u0000within an IRB-approved database. Their clinical outcomes were analyzed with a specific focus on patients who were \u0000septic before or during ECMO, defined as a positive blood culture. Group S was \u0000composed of patients with a positive blood culture before or during ECMO, while \u0000Group N was composed of all patients without a positive blood culture before or \u0000during ECMO. The primary outcome compared between groups was ECMO survival rate. RESULTS: Among the \u0000305 patients on ECMO, 58 (19%) were in Group S and 247 (81%) were in Group N. \u0000ECMO survival rates were 45% in Group S and 62% in Group N (p = 0.017). CONCLUSION: Of our 305 patients, patients who were septic upon \u0000ECMO placement or those who \u0000developed sepsis during ECMO had worse ECMO survival rates than non-septic \u0000patients. Ultimately, patients who are septic or have a high probability of \u0000becoming septic may not be indicated for ECMO placement, and cautious \u0000administration of ECMO to these patients may be necessary.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"243 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91422088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-11DOI: 10.4236/wjcs.2020.108017
P. S. Ba, Yacouba Tamboura, M. Diop, Papa Amath Diagne, N. F. Sow, P. A. Dieng, A. G. Ciss
In atrioventricular septal defect (AVSD), anatomical lesions usually are an ostium primum atrio-septal defect; a common atrioventricular valve, an inlet ventricular septal defect (VSD). It is most often associated with major chromosomal abnormalities. It is the most common congenital disease in Down syndrome. Our case was an infant with a Down syndrome who was admitted for a dyspnea (stage 3 in New York Heart Association classification) and tachycardia. The diagnosis was made by a transthoracic echocardiography. It showed a rare variety of atrioventricular septal defect without an atrial septal defect. The child was treated successfully with one patch technic and no recurrence was noted.
{"title":"Atrioventricular Septal Defect with Intact Interatrial Septum. Case Report","authors":"P. S. Ba, Yacouba Tamboura, M. Diop, Papa Amath Diagne, N. F. Sow, P. A. Dieng, A. G. Ciss","doi":"10.4236/wjcs.2020.108017","DOIUrl":"https://doi.org/10.4236/wjcs.2020.108017","url":null,"abstract":"In atrioventricular septal defect (AVSD), anatomical \u0000lesions usually are an ostium primum atrio-septal defect; a common \u0000atrioventricular valve, an inlet ventricular septal defect (VSD). It is most \u0000often associated with major chromosomal abnormalities. It is the most common \u0000congenital disease in Down syndrome. Our case was an infant with a Down \u0000syndrome who was admitted for a dyspnea (stage 3 in New York Heart Association classification) \u0000and tachycardia. The diagnosis was made by a transthoracic echocardiography. It \u0000showed a rare variety of atrioventricular septal defect without an atrial \u0000septal defect. The child was treated successfully with one patch technic and no \u0000recurrence was noted.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"86 1","pages":"143-149"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83218907","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2020-08-11DOI: 10.4236/wjcs.2020.108018
A. Satsangi, Biswajit Singh
Patients with D-TGA with atrial level mixing of systemic and pulmonary blood, the morphological left ventricle supports the low pressure pulmonary circulation and regresses in mass and volume as time passes. The LV once regressed is unable to support the high pressure systemic circulation after ASO. These patients are candidates for early ASO, preferably within 3 weeks of life. As age progresses, the scope of these surgical procedures skews and an atrial switch remains the only option to improve quality of life. In Atrial switch, the pulmonary and systemic circulation is returned into an “in series” circulation and cyanosis is obliterated.
{"title":"Palliative Senning Procedure: Management of dTGA with VSD and PVOD in an Adolescent","authors":"A. Satsangi, Biswajit Singh","doi":"10.4236/wjcs.2020.108018","DOIUrl":"https://doi.org/10.4236/wjcs.2020.108018","url":null,"abstract":"Patients with D-TGA with atrial level mixing of \u0000systemic and pulmonary blood, the morphological left ventricle supports the low \u0000pressure pulmonary circulation and regresses in mass and volume as time passes. \u0000The LV once regressed is unable to support the high pressure systemic \u0000circulation after ASO. These patients are candidates for early ASO, preferably \u0000within 3 weeks of life. As age progresses, the scope of these surgical \u0000procedures skews and an atrial switch remains the only option to improve \u0000quality of life. In Atrial switch, the pulmonary and systemic circulation is returned \u0000into an “in series” circulation and cyanosis is obliterated.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"32 1","pages":"150-157"},"PeriodicalIF":0.0,"publicationDate":"2020-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77656787","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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