Pub Date : 2020-07-06DOI: 10.4236/wjcs.2020.107013
M. Vakamudi, Rajeshkumar Kodali, R. Karthekeyan, P. Thangavel, Kamalakannan Sambandham
Introduction:Regional anaesthesia combined with general anaesthesia reduces stress response to surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are limited hence we aimed to compare efficacy and safety of caudal, thoracic epidural and intravenous analgesia in paediatric cardiac surgery. Methodology: This study was conducted in the Department of Anaesthesiology in a tertiary care teaching hospital in southern India from February 2019 to December 2019. 90 children were randomised into group A, group B, group C. Children in group A received caudal analgesia along with GA. Group B children received thoracic epidural along with GA. Group C patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg fentanyl given in all 3 groups if pain score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain scores were significantly lower in thoracic epidural group compared to other two grou ps. Duration of ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia groups (436.37 ± 705.51) minutes. Duration of ICU stay was significantly low in thoracic epidural group (2.73 ± 0.69) days compared to caudal (3.7 ± 2.8) and intravenous analgesia groups (4.33 ± 0.920). We didn’t have any complications like hematoma, transient or permanent neurological sequelae in regional anesthesia groups. Conclusion: Regional anaesthesia along with general anaesthesia was more effective in pain relief than intravenous analgesia with general anaesthesia in paediatric cardiac surgery.
{"title":"A Comparative Study on Safety and Efficacy of Caudal, Thoracic Epidural and Intra Venous Analgesia in Paediatric Cardiac Surgery: A Double Blind Randomised Trial","authors":"M. Vakamudi, Rajeshkumar Kodali, R. Karthekeyan, P. Thangavel, Kamalakannan Sambandham","doi":"10.4236/wjcs.2020.107013","DOIUrl":"https://doi.org/10.4236/wjcs.2020.107013","url":null,"abstract":"Introduction:Regional anaesthesia combined \u0000with general anaesthesia reduces stress response to \u0000surgery, duration of ventilation, intensive care unit (ICU) stay and promotes early recovery. Studies on \u0000thoracic epidural, caudal analgesia along with general anaesthesia (GA) in paediatric cardiac surgery are \u0000limited hence we aimed to compare efficacy \u0000and safety of caudal, thoracic epidural and intravenous analgesia in \u0000paediatric cardiac surgery. Methodology: This study was conducted in the \u0000Department of Anaesthesiology in a tertiary care teaching hospital in southern \u0000India from February 2019 to December 2019. 90 children were randomised into \u0000group A, group B, group C. Children in group A received caudal analgesia along \u0000with GA. Group B children received thoracic epidural along with GA. Group C \u0000patients received intravenous analgesia along with GA. Rescue analgesia 1 mcg/kg \u0000fentanyl given in all 3 groups if pain \u0000score is more than 4. Primary outcome assessed was post-op pain scores. Secondary outcome assessed \u0000was duration of ventilation, duration of intensive care unit stay. Results: All patients were comparable in terms of age, sex, weight, mean RACHS score, baseline heart rate and blood pressure. Pain \u0000scores were significantly lower in \u0000thoracic epidural group compared to other two grou ps. Duration of \u0000ventilation was lower in thoracic epidural group (91.17± 43.85) minutes and caudal (199.6 ± 723.59) minutes compared to intravenous analgesia \u0000groups (436.37 ± 705.51) \u0000minutes. Duration of ICU stay was significantly low in thoracic epidural group \u0000(2.73 ± 0.69) days compared to \u0000caudal (3.7 ± 2.8) and \u0000intravenous analgesia groups (4.33 ± 0.920). We didn’t have any \u0000complications like hematoma, transient or permanent neurological sequelae in \u0000regional anesthesia groups. Conclusion: Regional anaesthesia along with general \u0000anaesthesia was more effective in pain relief than intravenous analgesia with \u0000general anaesthesia in paediatric cardiac surgery.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"44 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84799560","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 : 2020-07-06DOI: 10.4236/wjcs.2020.107014
Amine Majdoub, Anas Elhafidi, Cedric Mutuale, S. Boulmakoul, M. Messouak
Background: Left ventricular to right atrial communications (LV-RA) or the Gerbode defects are rare and complex types of ventricular septal defect. Their clinical diagnosis is not specific. However, the main clue to identifying Gerbode defect comes from Doppler-coupled echocardiography (TTE), and the treatment is mainly surgical. Aim: We hereby report our experience in surgical management of Gerbode defect through two exceptional congenital cases (type 1 and type 2 of Gerbode defect). Case Presentation: The diagnosis was established in adult patients, the first case is a 27-year-old woman who had dyspnea, and in whom the TTE revealed LV-RA communication, with repercussions on the right cavities. The second case is a 23-year-old man, with the concept of statutory weight delay, consulted for progressive dyspnea; the TTE initially revealed a very large perimembranous ventricular defect associated with significant pulmonary hypertension. Cardiopulmonary bypass surgery was done for a successful and complete correction. Conclusion: Gerbode defect is so rare; the diagnosis is made by TTE. And surgery must not be delayed until repercussion on right cavities and pulmonary hypertension.
{"title":"The Gerbode Defect: About 2 Cases","authors":"Amine Majdoub, Anas Elhafidi, Cedric Mutuale, S. Boulmakoul, M. Messouak","doi":"10.4236/wjcs.2020.107014","DOIUrl":"https://doi.org/10.4236/wjcs.2020.107014","url":null,"abstract":"Background: Left ventricular to right \u0000atrial communications (LV-RA) or the Gerbode defects are rare and complex types \u0000of ventricular septal defect. Their clinical diagnosis is not specific. \u0000However, the main clue to identifying Gerbode defect comes \u0000from Doppler-coupled echocardiography (TTE), and the treatment is mainly surgical. Aim: We hereby \u0000report our experience in surgical management of Gerbode defect through two exceptional congenital cases \u0000(type 1 and type 2 of Gerbode defect). Case Presentation: The diagnosis was established in adult patients, the first case is a 27-year-old woman who \u0000had dyspnea, and in whom the TTE \u0000revealed LV-RA communication, with repercussions on the right cavities. \u0000The second case is a 23-year-old man, with the concept of \u0000statutory weight delay, consulted for progressive dyspnea; the TTE initially revealed a very large perimembranous \u0000ventricular defect associated with \u0000significant pulmonary hypertension. Cardiopulmonary bypass surgery was done for a successful and complete correction. Conclusion: Gerbode defect is so rare; the diagnosis is made by TTE. And surgery \u0000must not be delayed until repercussion on right cavities and pulmonary \u0000hypertension.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"40 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78923438","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 : 2020-06-15DOI: 10.4236/wjcs.2020.106010
Debmalya Saha, Pawan K Singh, R. Sharma, S. Naqvi, Saket Aggarwal, M. Geelani
Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few cases reported till date. This case study presents a 45-year male with rare type of thymoma. On the contrast-enhanced CT images, there was a large mass lesion of predominantly fat attenuation in the pre-vascular compartment of the mediastinum insinuating on both sides of the visceral compartment of the mediastinum, and extending upto the bilateral cardio phrenic and anterior costophrenic angles, anterior to the right ventricle with loss of fat plane with the pericardium, with few sub-centimetric lymph nodes in the right paratracheal and AP window and a calcified right hilar lymph node, suggestive of well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut tissue biopsy was inconclusive, and the repeat biopsy revealed as fibro-collagenous tissue with area of necrosis, focal myxoid changes in the background with presence of cells which are spindle to oval in shape with mild nuclear pleomorphism and negative for S100, Cytokeratin, CD34, desmin. The entire tumor was resected en masse after meticulous dissection without the support of cardiopulmonary bypass (CPB) with an intact pericardium. Final histopathology report of the surgical biopsy specimens is consistent with dedifferentiated thymoliposarcoma with focal ganglionic cell differentiation. Postoperative follow-up CECT of thorax revealed no evidence of residual mass in the pre-vascular compartment. The patient is disease-free and asymptomatic after 6-month and he is under routine follow-up under Radiotherapy department since he received 30 Gy of postoperative radiotherapy (PORT).
{"title":"A Case of Giant Mediastinal Liposarcoma of Thymic Origin: A Rare Clinical Entity","authors":"Debmalya Saha, Pawan K Singh, R. Sharma, S. Naqvi, Saket Aggarwal, M. Geelani","doi":"10.4236/wjcs.2020.106010","DOIUrl":"https://doi.org/10.4236/wjcs.2020.106010","url":null,"abstract":"Thymoliposarcoma is an exceedingly rare tumor of thymus with a very few \u0000cases reported till date. This case study presents a 45-year male with rare \u0000type of thymoma. On the contrast-enhanced CT images, \u0000there was a large mass lesion of predominantly fat attenuation in the \u0000pre-vascular compartment of the mediastinum insinuating on both sides of the \u0000visceral compartment of the mediastinum, and extending upto the bilateral \u0000cardio phrenic and anterior costophrenic angles, anterior to the right \u0000ventricle with loss of fat plane with the pericardium, with few sub-centimetric \u0000lymph nodes in the right paratracheal and AP window and a calcified right hilar \u0000lymph node, suggestive of well-differentiated liposarcoma/thymoliposarcoma. Initial CT guided tru-cut tissue biopsy was inconclusive, \u0000and the repeat biopsy revealed as fibro-collagenous tissue with area of \u0000necrosis, focal myxoid changes in the background with presence of cells which \u0000are spindle to oval in shape with mild nuclear pleomorphism and negative for \u0000S100, Cytokeratin, CD34, desmin. The entire tumor was resected en masse \u0000after meticulous dissection without the support of cardiopulmonary bypass (CPB) \u0000with an intact pericardium. Final histopathology report of the surgical biopsy \u0000specimens is consistent with dedifferentiated thymoliposarcoma with focal \u0000ganglionic cell differentiation. Postoperative follow-up \u0000CECT of thorax revealed no evidence of residual mass in the pre-vascular \u0000compartment. The patient is disease-free and asymptomatic after 6-month and he is under routine \u0000follow-up under Radiotherapy department since he received 30 Gy of postoperative radiotherapy \u0000(PORT).","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"116 1","pages":"75-82"},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79260263","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 : 2020-06-15DOI: 10.4236/wjcs.2020.106012
E. Çelik, A. Çora, Kadir Burhan Karadem, Dinçer Uysal
Background: We aimed to investigate the effect of seasons on atrial fibrillation that occurred after coronary bypass surgery operation. Method: 187 patients underwent coronary artery bypass operation in our clinic between July 2018 - July 2019. Isolated coronary artery bypass graft operation was performed with cardiopulmonary bypass to179 of these patients. Forty three patients that developed atrial fibrillation after coronary bypass operation, demographic, laboratory findings and date of atrial fibrillation data investigated retrospectively. Results: Forty three patients developed atrial fibrillation after coronary artery bypass surgery. Forty one patients operated in winter, 48 in spring, 47 in summer, 43 in autumn and 13 patients developed atrial fibrillation in winter, 11 (25.6%) in spring, 8 (20.9%) in summer and 11 (23.3%) in autumn respectively. There is no statistical significance found by Z test that performed for all seasons for atrial fibrillation. Conclusion: There are many reasons that could play role on developing atrial fibrillation after coronary artery bypass surgery. There are many publications that report vitamin D deficiency as a reason for developing atrial fibrillation after coronary bypass surgery. In our study, we did not evaluate a relationship between the development of post operative atrial fibrillation and seasons.
{"title":"Role of the Seasonal Cycle in Atrial Fibrillation Seen after Coronary Artery Bypass Surgery","authors":"E. Çelik, A. Çora, Kadir Burhan Karadem, Dinçer Uysal","doi":"10.4236/wjcs.2020.106012","DOIUrl":"https://doi.org/10.4236/wjcs.2020.106012","url":null,"abstract":"Background: We aimed to investigate the effect of seasons on atrial fibrillation \u0000that occurred after coronary bypass surgery operation. Method: 187 \u0000patients underwent coronary artery bypass operation in our clinic between July 2018 - July 2019. Isolated coronary artery bypass graft \u0000operation was performed with cardiopulmonary bypass to179 of these patients. Forty three patients that \u0000developed atrial fibrillation after coronary bypass operation, demographic, \u0000laboratory findings and date of atrial fibrillation data investigated retrospectively. Results: Forty three patients developed atrial fibrillation after \u0000coronary artery bypass surgery. Forty one patients operated in winter, 48 in \u0000spring, 47 in summer, 43 in autumn and 13 patients developed atrial \u0000fibrillation in winter, 11 (25.6%) in spring, 8 (20.9%) in summer and 11 \u0000(23.3%) in autumn respectively. There is no statistical significance found by Z \u0000test that performed for all seasons for atrial fibrillation. Conclusion: There \u0000are many reasons that could play role on developing atrial fibrillation after coronary artery \u0000bypass surgery. There are many publications that report vitamin D deficiency as \u0000a reason for developing atrial fibrillation after coronary bypass surgery. In \u0000our study, we did not evaluate a relationship between the development of post \u0000operative atrial fibrillation and seasons.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"192 1","pages":"91-99"},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74424228","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 : 2020-06-15DOI: 10.4236/wjcs.2020.106011
A. Fall, A. Sow, I. Basse, A. M. Coundoul, Fondjo P. S. Monoue, A. Thiongane, D. Boiro, I. Ly, B. Niang, I. Ba, G. Diagne, P. Faye, O. Ndiaye
Congenital cyanogenic heart disease (CCHD) is a malformation of the heart and large vessels characterized by an oxygen desaturation in the arterial blood, responsible for cyanosis. The general objective was to study the profile of CCHD in Senegalese hospitals. This is a retrospective study carried out over a period of 8 years (January 1, 2010 - December 31, 2017) and including all children aged 0 to 16 years followed for a CCHD. The hospital prevalence was 0.87% for 420 cases collected. The sex ratio was 1.44 and the average age at diagnosis was 16 months. First degree parental consanguinity was noted in 36 cases (30.78%). The main reasons for consultation were breathing difficulty in 242 cases (57.62%) and fever in 136 patients (32.36%). Apart from cyanosis, the clinical signs were dominated by the heart murmur in 313 cases (74.7%), tachycardia in 283 cases (67.38%) and digital hippocratism in 162 cases (38.57%). Cardiomegaly was found in 239 patients (83.36%). The main types of CCHD were tetralogy of Fallot and transposition of the large vessels. In biology, 206 patients (49.05%) presented polyglobulia. A complete surgical cure was carried out in 22 patients (5.24%). Complications were anoxic crisis (52 cases) and hemorrhagic syndrome (17 cases). There were 97 deaths (28.28%) during hospitalization. The diagnosis of CCHD is late in our country and surgical management is poor explaining the high mortality.
{"title":"Congenital Cyanogenic Heart Disease in Children: About 420 Cases in Africa","authors":"A. Fall, A. Sow, I. Basse, A. M. Coundoul, Fondjo P. S. Monoue, A. Thiongane, D. Boiro, I. Ly, B. Niang, I. Ba, G. Diagne, P. Faye, O. Ndiaye","doi":"10.4236/wjcs.2020.106011","DOIUrl":"https://doi.org/10.4236/wjcs.2020.106011","url":null,"abstract":"Congenital cyanogenic heart disease (CCHD) is a malformation of the heart \u0000and large vessels characterized by an oxygen desaturation in the arterial \u0000blood, responsible for cyanosis. The general objective was to study the profile \u0000of CCHD in Senegalese hospitals. This is a retrospective study carried out over \u0000a period of 8 years (January 1, 2010 - December 31, 2017) and including all children \u0000aged 0 to 16 years followed for a CCHD. The hospital prevalence was 0.87% for \u0000420 cases collected. The sex ratio was 1.44 and the average age at diagnosis \u0000was 16 months. First degree parental consanguinity was noted in 36 cases (30.78%). The main reasons for \u0000consultation were breathing difficulty in 242 cases (57.62%) and fever \u0000in 136 patients (32.36%). Apart from cyanosis, the clinical signs were \u0000dominated by the heart murmur in 313 cases (74.7%), tachycardia in 283 cases \u0000(67.38%) and digital hippocratism in 162 cases (38.57%). Cardiomegaly was found \u0000in 239 patients (83.36%). The main types of CCHD were tetralogy of Fallot and \u0000transposition of the large vessels. In biology, 206 patients (49.05%) presented \u0000polyglobulia. A complete surgical cure was carried out in 22 patients (5.24%). \u0000Complications were anoxic crisis (52 cases) and hemorrhagic syndrome (17 \u0000cases). There were 97 deaths (28.28%) during hospitalization. The diagnosis of \u0000CCHD is late in our country and surgical management is poor explaining the high \u0000mortality.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84457470","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 : 2020-05-18DOI: 10.22541/au.158981360.05697032
Dharmendra Joshi, M. Acharya, Niraj Bhattarai, Md. Abir Tazim Chowdhury, M. Alauddin, Md. Rezwanul Hoque
AbstractBackground: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources.Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated.Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery.Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.Keywords:Cardiac Surgery, Morbidity, Mortality, Evaluation
{"title":"Evaluation of 100 Cases of Mortality after Cardiac Surgery: A Single-Center Experience in Bangladesh ","authors":"Dharmendra Joshi, M. Acharya, Niraj Bhattarai, Md. Abir Tazim Chowdhury, M. Alauddin, Md. Rezwanul Hoque","doi":"10.22541/au.158981360.05697032","DOIUrl":"https://doi.org/10.22541/au.158981360.05697032","url":null,"abstract":"AbstractBackground: Vigilance ensures safety in cardiac surgery. Performance in cardiac surgery is often measured by short-term mortality. Several risk factors like advanced age, female gender, higher body mass index, decreased left ventricular function, emergent, and redo operations have appeared recurrently as poor prognostic variables. Evaluation of postoperative mortality is crucial to find loopholes to provide proper care and reduce preventable mortality after cardiac surgery in developing countries with limited infrastructures and resources.Methods: This is a retrospective study conducted in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University. Perioperative data of 100 cases of mortality after cardiac surgery performed from 1 January 2014 to 30 May 2018 were collected from the university medical record. The data on age, gender, body mass index, preoperative investigations, diagnoses, types of operations, details of cardiopulmonary bypass, and postoperative period of the study populations were evaluated.Results: During the study period, about 1627 cases of cardiac surgery were done with an overall mortality rate of 6.15%. The mean age was 41.05 ± 20.19 (0 - 68) years, and 66% of patients were male. Preoperative ejection fraction (EF) of the study population was an average 56.63% ± 11.85%; 9% of the patients had EF < 40%. Off-pump coronary artery bypass (32.27%) was the most commonly performed surgery followed by mitral valve replacement (24.28%). On-pump cardiac surgery was done among 65% of the study population with a mean cross-clamp time and bypass time of 32.56 ± 11.55 minutes and 80.57 ± 18.09 minutes, respectively. Most of the mortality was found in the first two weeks after surgery.Conclusion: Mortality after cardiac surgery is multifactorial. A large-scale prospective study with comparative groups is required to find out preventable measures of mortality after cardiac surgery which will improve the quality of services provided to the patients in developing countries.Keywords:Cardiac Surgery, Morbidity, Mortality, Evaluation","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"15 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78218435","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 : 2020-05-11DOI: 10.4236/wjcs.2020.105007
M. Diop, Papa Amath Diagne, N. F. Sow, P. S. Ba, M. Gaye, P. O. Ba, S. Diatta, M. S. Diop, Marème Soda Mbaye, P. A. Dieng, A. G. Ciss, A. Ndiaye
In Africa, acute rheumatic fever is endemic. Cardiac involvement is one of the most common complications in the form of valvular heart disease representing all damages to the heart valves. It is in this perspective that we realized this study whose general objective was to evaluate the results of mitral repair surgery in children in Senegal and the specific objective was to state the indications for mitral repair surgery and assess the results in terms of morbidity and mortality. This is a retrospective and analytical monocentric study, in the thoracic and cardiovascular surgery department of FANN National University Hospital Center in Dakar. It took place over a period of 30 months. All the patients who underwent mitral surgery, aged less than 18 years were included. The total number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. The average age at the time of the surgery was 12 years old [5 - 17]. The functional symptomatology was dominated by the dyspnea found in all the patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all patients. For all surgical procedures, the approach was a vertical midline sternotomy. The mitral valve was approached by left atriotomy in 40 patients (63.5%) and by transseptal way in 23 patients. All patients had undergone mitral valve repair associated or not with either aortic valve repair in 9 patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one tricuspid valve repair in 31 patients (49%). The average duration of intubation was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. Postoperative complications have been observed. Surgery was performed in 10 patients with 3 mitral valve replacements, 2 aortic valve replacements, a double mitral and an aortic valve replacement associated with a tricuspid repair and in 4 cases a perfection of their mitral repair. Early and late surgical mortality was zero. The average follow-up time for our patients was 9 months [1 - 26]. During their follow-up, the evolution was favorable in 89% of patients who no longer had any functional symptoms.
{"title":"Indications and Results of Repair of the Rhumatismal Valve in Children in Senegal concerning 63 Cases","authors":"M. Diop, Papa Amath Diagne, N. F. Sow, P. S. Ba, M. Gaye, P. O. Ba, S. Diatta, M. S. Diop, Marème Soda Mbaye, P. A. Dieng, A. G. Ciss, A. Ndiaye","doi":"10.4236/wjcs.2020.105007","DOIUrl":"https://doi.org/10.4236/wjcs.2020.105007","url":null,"abstract":"In Africa, acute rheumatic fever is endemic. Cardiac involvement is one \u0000of the most common complications in the form \u0000of valvular heart disease representing all damages to the heart valves. \u0000It is in this perspective that we realized this study whose general objective \u0000was to evaluate the results of mitral repair surgery in children in Senegal and \u0000the specific objective was to state the indications for mitral repair surgery \u0000and assess the results in terms of morbidity and mortality. This is a \u0000retrospective and analytical monocentric study, in the thoracic and \u0000cardiovascular surgery department of FANN National University Hospital Center \u0000in Dakar. It took place over a period of 30 months. All the patients who \u0000underwent mitral surgery, aged less than 18 years were included. The total \u0000number of patients was 63, including 39 girls and 24 boys, a sex ratio of 0.62. \u0000The average age at the time of the surgery was 12 years old [5 - 17]. The \u0000functional symptomatology was dominated by the dyspnea found in all the \u0000patients. Cardiac ultrasound was diagnosed with mitral regurgitation in all \u0000patients. For all surgical procedures, the approach was a vertical midline \u0000sternotomy. The mitral valve was approached by left atriotomy in 40 patients \u0000(63.5%) and by transseptal way in 23 patients. All patients had undergone \u0000mitral valve repair associated or not with either aortic valve repair in 9 \u0000patients (14.2%), aortic valve replacement in 3 patients (4.8%), or one \u0000tricuspid valve repair in 31 patients (49%). The average duration of intubation \u0000was 6 hours [2 - 52]. The average length of stay in intensive care was 2 days. \u0000Postoperative complications have been observed. Surgery was performed in 10 \u0000patients with 3 mitral valve replacements, 2 aortic valve replacements, a \u0000double mitral and an aortic valve replacement associated with a tricuspid \u0000repair and in 4 cases a perfection of their mitral repair. Early and late \u0000surgical mortality was zero. The average follow-up time for our patients was 9 \u0000months [1 - 26]. During their follow-up, the evolution was favorable in 89% of \u0000patients who no longer had any functional symptoms.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73290291","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 : 2020-05-11DOI: 10.4236/wjcs.2020.105008
V. Hajiyev, T. Erkenov, A. Smechowski, S. Just, O. Grimmig, D. Fritzsche
Background: Patients with left ventricular ejection fraction (LVEF) ≤ 35% are at a high risk of sudden cardiac death (SCD) and benefit from implantable cardioverter-defibrillator (ICD) therapy. ICD implantation is not indicated during the first 40 days after acute myocardial infarction and Methods: This is a retrospective study conducted in the Heart Center in Cottbus. From 02.2015 through 02.2018 26 WCD patients were retrospectively analyzed and followed-up. Patient demographics, defibrillation treatments, and daily wear times were retrospectively obtained from our clinical database and LifeVest network. The patients were questioned about actual NYHA grade and implanted ICD at the end of follow-up. Results: Twenty-five patients (mean age 65, 22 men, 3 women) were treated with a WCD in response to heart failure (mean EF = 24%) after cardiac surgery (21 CABG, 1 AVR, 1 AVR + CABG, 1 AVR + MVR, MVR + CABG). Average daily use of a WCD was 22.1 (SD ± 2.7) hours which were worn for 85 days (SD ± 35). At that time 11.96 (SD ± 15) events were detected but not treated, 1 defibrillation performed and no asystole seen. At the end of follow-up (12 months, SD ± 9) 20 patients were questioned. All of the patients were alive and 5 (25%) of them were with implanted ICD. 10 (50%) patients were in NYHA grade I, 3 (12%) in NYHA grade II, 3 (12%) between grade II-III, 2 (8%) in grade III and 2 (8%) patients in NYHA grade IV. Conclusions: A WCD is an effective therapy for prevention of sudden cardiac death during the recovery period of heart function after cardiac surgery. This is treatment with high patient compliance.
{"title":"Analysis of Patients with LifeVest after Cardiac Surgery","authors":"V. Hajiyev, T. Erkenov, A. Smechowski, S. Just, O. Grimmig, D. Fritzsche","doi":"10.4236/wjcs.2020.105008","DOIUrl":"https://doi.org/10.4236/wjcs.2020.105008","url":null,"abstract":"Background: Patients with left ventricular ejection fraction (LVEF) ≤ 35% are \u0000at a high risk of sudden cardiac death (SCD) and benefit from implantable \u0000cardioverter-defibrillator (ICD) therapy. ICD implantation is not indicated \u0000during the first 40 days after acute myocardial infarction and Methods: This is a retrospective \u0000study conducted in the Heart Center in Cottbus. From 02.2015 through 02.2018 26 \u0000WCD patients were retrospectively analyzed and followed-up. Patient demographics, \u0000defibrillation treatments, and daily wear times were retrospectively obtained \u0000from our clinical database and LifeVest network. The patients were questioned \u0000about actual NYHA grade and implanted ICD at the end of follow-up. Results: Twenty-five \u0000patients (mean age 65, 22 men, 3 women) were treated with a WCD in response to \u0000heart failure (mean EF = 24%) after cardiac surgery (21 CABG, 1 AVR, 1 AVR + \u0000CABG, 1 AVR + MVR, MVR + CABG). Average daily use of a WCD was 22.1 (SD ± 2.7) hours \u0000which were worn for 85 days (SD ± 35). At that time 11.96 (SD ± 15) events were \u0000detected but not treated, 1 defibrillation performed and no asystole seen. At \u0000the end of follow-up (12 months, SD ± 9) 20 patients were questioned. All of \u0000the patients were alive and 5 (25%) of them were with implanted ICD. 10 (50%) \u0000patients were in NYHA grade I, 3 (12%) in NYHA grade II, 3 (12%) \u0000between grade II-III, 2 (8%) in grade III and 2 (8%) patients in NYHA grade IV. Conclusions: A WCD is an effective therapy for prevention of sudden \u0000cardiac death during the recovery period of heart function after cardiac \u0000surgery. This is treatment with high patient compliance.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82566089","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 : 2020-04-10DOI: 10.4236/wjcs.2020.104006
R. W. Sudjud, A. Catriona, R. Kadarsah
Inotropic agents are indicated to treat ventricular dysfunction that frequently found post-CABG surgery. However, the use of inotropic isn’t free from disadvantageous side effects and is related to higher morbidity and mortality in post-CABG surgery patients. Several risk factors are known to affect higher need for inotropic agents’ post-CABG surgery. This study aims to discover the inotropic requirement in patients undergoing CABG surgery based on age, sex, preoperative left ventricular ejection fraction (LVEF), comorbidities, cross clamping time (CCT), and cardiopulmonary bypass (CPB) duration in Hasan Sadikin General Hospital Bandung in 2014-2016. This study is a descriptive cross-sectional study done retrospectively through medical records. This study found the inotropic requirement post-CABG surgery was 130 patients (74.3%). The inotropic requirement based on age was 28 patients (80.0%) > 65 years old, 112 patients (75.7%) were male, 18 patients (66.7%) were female, 19 patients (100%) with LVEF, 41 patients (85.4%) with DM, 20 patients (90.9%) with CKD, 44 patients (93.6%) with >90 minute CCT, 37 patients (90.2%) with >120 minute duration CPB. In conclusion, there was a higher inotropic requirement in patients with age > 65 years old, preoperative LVEF comorbidities, CPB duration > 120 minutes and CCT > 90 minutes.
{"title":"Inotropic Requirement in Patients Undergoing Coronary Artery Bypass Grafting (CABG) in RSUP Dr. Hasan Sadikin Bandung in 2014-2016","authors":"R. W. Sudjud, A. Catriona, R. Kadarsah","doi":"10.4236/wjcs.2020.104006","DOIUrl":"https://doi.org/10.4236/wjcs.2020.104006","url":null,"abstract":"Inotropic agents are indicated to treat ventricular dysfunction that frequently found post-CABG surgery. However, the use of inotropic isn’t free from disadvantageous side effects and is related to higher morbidity and mortality in post-CABG surgery patients. Several risk factors are known to affect higher need for inotropic agents’ post-CABG surgery. This study aims to discover the inotropic requirement in patients undergoing CABG surgery based on age, sex, preoperative left ventricular ejection fraction (LVEF), comorbidities, cross clamping time (CCT), and cardiopulmonary bypass (CPB) duration in Hasan Sadikin General Hospital Bandung in 2014-2016. This study is a descriptive cross-sectional study done retrospectively through medical records. This study found the inotropic requirement post-CABG surgery was 130 patients (74.3%). The inotropic requirement based on age was 28 patients (80.0%) > 65 years old, 112 patients (75.7%) were male, 18 patients (66.7%) were female, 19 patients (100%) with LVEF, 41 patients (85.4%) with DM, 20 patients (90.9%) with CKD, 44 patients (93.6%) with >90 minute CCT, 37 patients (90.2%) with >120 minute duration CPB. In conclusion, there was a higher inotropic requirement in patients with age > 65 years old, preoperative LVEF comorbidities, CPB duration > 120 minutes and CCT > 90 minutes.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74398355","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 : 2020-03-26DOI: 10.4236/wjcs.2020.103005
I. Okyere, S. G. Brenu, P. Okyere
Introduction: Patients presenting with cardiac injuries from gunshot wounds and blunt chest trauma have high mortality, without any observed survival benefit when presenting with cardiac tamponade. Cardiac tamponade is a life-threatening hemodynamically significant compression of the heart by a sudden or gradual accumulation of collections in the pericardial space that incites and overrides the body’s compensatory mechanism. Clinical Case: We present and discuss the successful management and survival of two patients with traumatic cardiac tamponade from gunshot wounds to the precordium who underwent successful lifesaving median sternotomy at a Teaching Hospital in Ghana with a new Cardiovascular and Thoracic Surgery Unit. Discussion: Usually the diagnosis of cardiac tamponade from traumatic haemopericardium is made by clinical findings which though may not always be present especially after blunt chest trauma. EFAST is a reliable tool for diagnosing and following cardiac tamponade. Median sternotomy is the standard procedure in these patients to access and repair cardiac injury either with or without cardiopulmonary bypass. Conclusion: Emergency median sternotomy in patients with cardiac tamponade from chest trauma especially after EFAST diagnosis can be lifesaving even in less resourced centres.
{"title":"Lifesaving Emergency Sternotomy in Traumatic Cardiac Tamponade in a Teaching Hospital in Ghana: Survival of Two Rare Cases","authors":"I. Okyere, S. G. Brenu, P. Okyere","doi":"10.4236/wjcs.2020.103005","DOIUrl":"https://doi.org/10.4236/wjcs.2020.103005","url":null,"abstract":"Introduction: Patients presenting with cardiac injuries from gunshot wounds and blunt chest trauma have high mortality, without any observed survival benefit when presenting with cardiac tamponade. Cardiac tamponade is a life-threatening hemodynamically significant compression of the heart by a sudden or gradual accumulation of collections in the pericardial space that incites and overrides the body’s compensatory mechanism. Clinical Case: We present and discuss the successful management and survival of two patients with traumatic cardiac tamponade from gunshot wounds to the precordium who underwent successful lifesaving median sternotomy at a Teaching Hospital in Ghana with a new Cardiovascular and Thoracic Surgery Unit. Discussion: Usually the diagnosis of cardiac tamponade from traumatic haemopericardium is made by clinical findings which though may not always be present especially after blunt chest trauma. EFAST is a reliable tool for diagnosing and following cardiac tamponade. Median sternotomy is the standard procedure in these patients to access and repair cardiac injury either with or without cardiopulmonary bypass. Conclusion: Emergency median sternotomy in patients with cardiac tamponade from chest trauma especially after EFAST diagnosis can be lifesaving even in less resourced centres.","PeriodicalId":23646,"journal":{"name":"World Journal of Cardiovascular Surgery","volume":"96 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-03-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82772527","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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