Q. A. Azad, A. I. Khan, A. Mamun, N. Dey, Sajia Sajmin Siddiqua, Mohammad Awlad Hossain
In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37
{"title":"Management of Vascular Injury in a Vascular Center of a Developing Country","authors":"Q. A. Azad, A. I. Khan, A. Mamun, N. Dey, Sajia Sajmin Siddiqua, Mohammad Awlad Hossain","doi":"10.3329/bhj.v36i1.55515","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55515","url":null,"abstract":"In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas.\u0000Bangladesh Heart Journal 2021; 36(1) : 32-37","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132093541","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}
M. Siddiqui, P. Karmakar, N. Alam, Mizanur Rahman, P. Karmaker, M. Ahsan, Anup Kumar Howlader, Fahdia Afroz, Chowdhury Md Kudrat EKhuda, Abhijit Roy
Background: The “obesity paradox”, a counterintuitive decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients when acute cardiovascular decompensation occurs. However, whether this phenomenon exists in patients undergoing percutaneous coronary intervention (PCI) is not well known. The existence of obesity paradox and its impact on short-term clinical outcomes after PCI have not been thoroughly investigated, especially in Bangladesh. Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, Dhaka, in 100 patients who underwent PCI. They were divided in two groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI <23.0 kg/m2). Short-term in-hospital outcomes after PCI were observed and recorded. Results: Acute left ventricular failure (LVF) was found to be statistically significant between groups (p < 0.01) being higher in Group-I. The difference of mean duration of hospital stay (LOS) after PCI was higher in the same group which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with in-hospital outcomes after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007). Conclusion: The results of the study uphold the phenomenon of the “obesity paradox” following PCI. The underweight and normal weight people are at greater risk to experience short-term in-hospital adverse clinical outcomes than overweight and obese people after PCI. Bangladesh Heart Journal 2021; 36(1): 1-8
{"title":"Obesity Paradox in Short-Term Clinical Outcomes After Percutaneous Coronary Interventions","authors":"M. Siddiqui, P. Karmakar, N. Alam, Mizanur Rahman, P. Karmaker, M. Ahsan, Anup Kumar Howlader, Fahdia Afroz, Chowdhury Md Kudrat EKhuda, Abhijit Roy","doi":"10.3329/bhj.v36i1.55511","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55511","url":null,"abstract":"Background: The “obesity paradox”, a counterintuitive decrease in morbidity and mortality with increasing body mass index (BMI), has been shown in patients when acute cardiovascular decompensation occurs. However, whether this phenomenon exists in patients undergoing percutaneous coronary intervention (PCI) is not well known. The existence of obesity paradox and its impact on short-term clinical outcomes after PCI have not been thoroughly investigated, especially in Bangladesh.\u0000Methods: This cross-sectional observational study was conducted at National Institute of Cardiovascular Diseases, Dhaka, in 100 patients who underwent PCI. They were divided in two groups on the basis of BMI of Asian ethnicity: Group I (BMI < 23 kg/m2) and Group II (BMI <23.0 kg/m2). Short-term in-hospital outcomes after PCI were observed and recorded.\u0000Results: Acute left ventricular failure (LVF) was found to be statistically significant between groups (p < 0.01) being higher in Group-I. The difference of mean duration of hospital stay (LOS) after PCI was higher in the same group which was statistically significant (p < 0.01). Diabetes mellitus and dyslipidemia were found to be the independent predictors for developing adverse in hospital outcome (OR= 1.68 and 1.46; 95% CI = 1.25 – 2.24 and 1.16 – 1.83; p = 0.018 and 0.040, respectively). BMI was inversely associated with in-hospital outcomes after PCI (OR = 0.95; 95% CI = 0.91 – 0.98; p = 0.007).\u0000Conclusion: The results of the study uphold the phenomenon of the “obesity paradox” following PCI. The underweight and normal weight people are at greater risk to experience short-term in-hospital adverse clinical outcomes than overweight and obese people after PCI.\u0000Bangladesh Heart Journal 2021; 36(1): 1-8","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130434380","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}
Md Sorower Hossain, Istiaq Ahmed, S. Raha, S. Biswas, Md. Kamrul Hasan
Introduction: Warfarin is recommended following mechanical valve replacement to prevent thromboembolic complications. A combination of warfarin and aspirin may further reduce thromboembolic events in these patients. This study was designed to evaluate safety and efficacy of combined low dose aspirin and warfarin therapy following mechanical mitral valve replacement. Materials and Methods: Purposively selected 99 patients who underwent mechanical mitral valve replacement were divided into two groups. Patients of Group A (n=50) received combined low dose aspirin (75mg) and warfarin. Patients of Group B (n=49) received conventional dose of warfarin alone. International normalized ratio (INR) was targeted 1.8-2.4 for group A Patients and 2.5-3.5 for group B Patients. Post-operatively INR, thromboembolic events, anti-coagulation related haemorrhage and other morbidity and mortality were registered in both groups. Result: Patients were followed up postoperatively for 9 months. The mean dose of warfarin in group A and group B was 4.36 ± 0.31 mg and 5.57±0.52 mg respectively (p<0.001). The overall mean INR of two groups of patients were statistically different (P<0.001) with low INR in group A (2.19±0.13) patients compared to group B (3.03±0.31). The thromboembolic events in group A (0.02/patient year) were lower than those in group B (0.08/Patient year). There was no statistically significant (p=0.362) difference in bleeding episodes between two groups but data indicate proportion of minor bleeding manifestations were higher in patients treated with warfarin plus aspirin group. Conclusion: Following mechanical mitral valve replacement, a combination of aspirin (75mg) and low dose warfarin with an aim to maintain INR between 1.8 and 2.4 (lower than recommended 2.5-3.5) may provide satisfactory outcomes in term of thrombosis, embolism and bleeding without increase in mortality. Bangladesh Heart Journal 2021; 36(1): 24-31
{"title":"Evaluation of Safety and Efficacy of Combined Low Dose Aspirin and Warfarin Following Mechanical Heart Valve Replacement for Mitral Valve Disease","authors":"Md Sorower Hossain, Istiaq Ahmed, S. Raha, S. Biswas, Md. Kamrul Hasan","doi":"10.3329/bhj.v36i1.55514","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55514","url":null,"abstract":"Introduction: Warfarin is recommended following mechanical valve replacement to prevent thromboembolic complications. A combination of warfarin and aspirin may further reduce thromboembolic events in these patients. This study was designed to evaluate safety and efficacy of combined low dose aspirin and warfarin therapy following mechanical mitral valve replacement.\u0000Materials and Methods: Purposively selected 99 patients who underwent mechanical mitral valve replacement were divided into two groups. Patients of Group A (n=50) received combined low dose aspirin (75mg) and warfarin. Patients of Group B (n=49) received conventional dose of warfarin alone. International normalized ratio (INR) was targeted 1.8-2.4 for group A Patients and 2.5-3.5 for group B Patients. Post-operatively INR, thromboembolic events, anti-coagulation related haemorrhage and other morbidity and mortality were registered in both groups.\u0000Result: Patients were followed up postoperatively for 9 months. The mean dose of warfarin in group A and group B was 4.36 ± 0.31 mg and 5.57±0.52 mg respectively (p<0.001). The overall mean INR of two groups of patients were statistically different (P<0.001) with low INR in group A (2.19±0.13) patients compared to group B (3.03±0.31). The thromboembolic events in group A (0.02/patient year) were lower than those in group B (0.08/Patient year). There was no statistically significant (p=0.362) difference in bleeding episodes between two groups but data indicate proportion of minor bleeding manifestations were higher in patients treated with warfarin plus aspirin group.\u0000Conclusion: Following mechanical mitral valve replacement, a combination of aspirin (75mg) and low dose warfarin with an aim to maintain INR between 1.8 and 2.4 (lower than recommended 2.5-3.5) may provide satisfactory outcomes in term of thrombosis, embolism and bleeding without increase in mortality.\u0000Bangladesh Heart Journal 2021; 36(1): 24-31","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124122080","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}
Bishnu Pada Saha, M. Uddin, S. Hashem, Priyanka Adhikary, Mohammad Arifur Rahman, C. M. K. E Khuda, S. Shahriar, M. Hasan, Mizanur Rahman Majumder, F. Sultana, Whaiduzzaman Jewel
Background: Intervention for bifurcation lesions is associated with increased risk of adverse events and includes acute side branch (SB) occlusion during main branch (MB) stenting. This acute occlusion of side branch can often be catastrophic for the patient. We here in describe our experience in National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh with a technique which can be incorporated into bifurcation stenting to reduce or almost eliminate the incidence of side branch occlusion or catastrophe. Methods: A prospective, observational, non-blinded study in patients from a single tertiary referral cardiac center National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh. Patients with an indication for percutaneous coronary intervention (PCI) of a denovo bifurcation lesion were screened. The study included 51 patients who underwent coronary angiogram in our institution and had bifurcation lesions suitable for single stent strategy between March 2017 to September 2018. Results: 51 patients with bifurcation lesion were included in the study and underwent a balloon embedded bifurcation stenting with a semi inflated balloon placed across the SB ostium. Angiographic success was achieved in all the patients but procedural success was achieved in 88.2% of the patients. TIMI 3 flow of main branch (MB) was achieved 96.08% and side branch (SB) was achieved 88.2%. Incidence of dissection was 5.9%, acute occlusion of SB was 2.0% and MACE was 3.9%. Mean fluoroscopy time and contrast volume was similar to that of conventional bifurcation stenting. The jailed SB balloon and wire could be successfully removed in all patients. Conclusion: The present study suggests that balloon embedded bifurcation stenting with a semi inflated balloon to protect the SB is feasible, with minimal procedural adverse events and successful in minimizing or almost eliminating the incidence of acute side branch occlusion or dissection as well as MACE. Bangladesh Heart Journal 2021; 36(1): 17-23
{"title":"Effect of Balloon Embedded Bifurcating Stenting with Single Stent Strategy for Side Branch Protection","authors":"Bishnu Pada Saha, M. Uddin, S. Hashem, Priyanka Adhikary, Mohammad Arifur Rahman, C. M. K. E Khuda, S. Shahriar, M. Hasan, Mizanur Rahman Majumder, F. Sultana, Whaiduzzaman Jewel","doi":"10.3329/bhj.v36i1.55513","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55513","url":null,"abstract":"Background: Intervention for bifurcation lesions is associated with increased risk of adverse events and includes acute side branch (SB) occlusion during main branch (MB) stenting. This acute occlusion of side branch can often be catastrophic for the patient. We here in describe our experience in National Institute of Cardiovascular Diseases and Hospital (NICVD), Dhaka, Bangladesh with a technique which can be incorporated into bifurcation stenting to reduce or almost eliminate the incidence of side branch occlusion or catastrophe.\u0000Methods: A prospective, observational, non-blinded study in patients from a single tertiary referral cardiac center National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka, Bangladesh. Patients with an indication for percutaneous coronary intervention (PCI) of a denovo bifurcation lesion were screened. The study included 51 patients who underwent coronary angiogram in our institution and had bifurcation lesions suitable for single stent strategy between March 2017 to September 2018.\u0000Results: 51 patients with bifurcation lesion were included in the study and underwent a balloon embedded bifurcation stenting with a semi inflated balloon placed across the SB ostium. Angiographic success was achieved in all the patients but procedural success was achieved in 88.2% of the patients. TIMI 3 flow of main branch (MB) was achieved 96.08% and side branch (SB) was achieved 88.2%. Incidence of dissection was 5.9%, acute occlusion of SB was 2.0% and MACE was 3.9%. Mean fluoroscopy time and contrast volume was similar to that of conventional bifurcation stenting. The jailed SB balloon and wire could be successfully removed in all patients.\u0000Conclusion: The present study suggests that balloon embedded bifurcation stenting with a semi inflated balloon to protect the SB is feasible, with minimal procedural adverse events and successful in minimizing or almost eliminating the incidence of acute side branch occlusion or dissection as well as MACE.\u0000Bangladesh Heart Journal 2021; 36(1): 17-23","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130794361","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}
Although a few closed heart operations were performed in the late 1960s, well organized approach to open heart surgery began in Bangladesh only after establishment of Institute of Cardiovascular Diseases (ICVD) in 1978. A Japanese team of surgeons, anesthetists, nurses and technicians provided extensive support in capacity building of the local human resources. Ultimately the first open heart surgery of Bangladesh, the direct closure of Atrial Septal Defect of an 18 year old college student, was performed on 18th September 1981. It was great news of that time. People came to know about the success story of the ICVD director then Colonel M Abdul Malik, a renowned cardiologist cum team leader and the Bangladeshi surgeon duo Dr M Nabi Alam Khan and Dr S R Khan. But somehow the anesthetists, an important part of the team were out of focus and have been forgotten over time. Led by Prof Khalilur Rahman, the anesthetist team of the day included Dr Nurul Islam, Dr Abdul Hadi, Dr Delowar Hossain, Dr A Y F Ellahi Chowdhury and Dr Monir Hossain. This article is an attempt to remind their contribution and expressing respect and gratitude to the anesthetists of that pioneering team. Bangladesh Heart Journal 2021; 36(1) : 55-60
虽然在1960年代末进行了一些心脏闭合手术，但是在1978年建立心血管疾病研究所之后，孟加拉国才开始有组织的心脏直视手术。一支由外科医生、麻醉师、护士和技术人员组成的日本团队为当地人力资源的能力建设提供了广泛支持。1981年9月18日，孟加拉国进行了第一次心脏直视手术，对一名18岁的大学生进行了房间隔缺损直接封闭手术。这是当时的大好消息。人们开始了解到当时的ICVD主任M Abdul Malik上校，著名心脏病专家兼团队负责人，以及孟加拉国的两位外科医生M Nabi Alam Khan和S R Khan的成功故事。但不知何故，麻醉师，团队的重要组成部分，失去了焦点，随着时间的推移被遗忘了。当天的麻醉师小组由Khalilur Rahman教授领导，包括Nurul Islam医生、Abdul Hadi医生、Delowar Hossain医生、A Y F Ellahi Chowdhury医生和Monir Hossain医生。这篇文章试图提醒他们的贡献，并对这支先锋团队的麻醉师表示敬意和感谢。孟加拉国心脏杂志2021;36(1): 55-60
{"title":"The Anesthesia & Anesthetists of the First Open Heart Surgery of Bangladesh","authors":"Suman Nazmul Hosain, F. Amin, S. Ferdous","doi":"10.3329/bhj.v36i1.55518","DOIUrl":"https://doi.org/10.3329/bhj.v36i1.55518","url":null,"abstract":"Although a few closed heart operations were performed in the late 1960s, well organized approach to open heart surgery began in Bangladesh only after establishment of Institute of Cardiovascular Diseases (ICVD) in 1978. A Japanese team of surgeons, anesthetists, nurses and technicians provided extensive support in capacity building of the local human resources. Ultimately the first open heart surgery of Bangladesh, the direct closure of Atrial Septal Defect of an 18 year old college student, was performed on 18th September 1981. It was great news of that time. People came to know about the success story of the ICVD director then Colonel M Abdul Malik, a renowned cardiologist cum team leader and the Bangladeshi surgeon duo Dr M Nabi Alam Khan and Dr S R Khan. But somehow the anesthetists, an important part of the team were out of focus and have been forgotten over time. Led by Prof Khalilur Rahman, the anesthetist team of the day included Dr Nurul Islam, Dr Abdul Hadi, Dr Delowar Hossain, Dr A Y F Ellahi Chowdhury and Dr Monir Hossain. This article is an attempt to remind their contribution and expressing respect and gratitude to the anesthetists of that pioneering team.\u0000Bangladesh Heart Journal 2021; 36(1) : 55-60","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127186534","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}
Mainul Islam, M. A. Ali, U. H. Ferdaushi, S. Nabi, Sayeedur Rahman Khan, Shariful Islam, H. Mahmoud
Background: Ischemic heart disease (IHD) is one of the leading cause of morbidity and mortality worldwide. Ischemic cardiomyopathy (ICM) is a delayed complication of IHD that arises as dilated cardiomyopathy with depressed ventricular function, which cannot be attributed entirely to coronary artery obstruction or ischemic injury. Objectives: To evaluate the clinical, electrocardiographic and echocardiographic profile of patients presenting with ischemic cardiomyopathy. Methods: In this cross sectional observational study 100 patients of ischemic cardiomyopathy admitted in hospital or visited OPD in NICVD, Dhaka from March’15 to Sept’15 were studied. Enrollment of the patients were done after fulfilling the inclusion and exclusion criteria. Clinical, electrocardiographic and echocardiographic data were collected then data analysis was done. Results: Data analysis of 100 patients was showed age range was 40-80 years and mean age was 61.4±7.9 years. 79% subjects were male. Most common symptoms were dyspnea (93%), chest pain(73%), palpitation (39%) and edema (23%). Most patients were in NYHA functional class lV (43%). 64% cases had history of anterior myocardial infarction (MI), 22% had inferior MI, 25% had H/O PTCA and 7% had CABG. 71% subjects had tachycardia, 65% had lungs basal rales, 56% had systolic blood pressure below 100 mmhg and 25% had edema. ECG findings was as follows sinus rhythm (85%), Sinus tachycardia 71%, AF 15%, LBBB 34%, RBBB 12%, pathological Q in anterior surface 65% and inferior surface 21%, non specific ST-T changes 41% and PVCs was found in 17%.On echocardiography ,anterior wall hypokinesia was seen in 52% and global hypokinesia in 43%. Mean left ventricular ejection fraction (LVEF) was 31±5.9% and mean left ventricular internal diastolic diameter (LVIDd) was 6.5±0.4 cm. (59%) subjects had mitral regurgitation (MR) grade-l and 20% had MR grade-ll. Conclusion: The clinical presentation of ischemic cardiomyopathy varies from patient to patient. Severity of symptoms correlates with severity of left ventricular systolic dysfunction, left ventricular diameter and mitral regurgitation grade . Anterior Myocardial infarction has more chance to develop ischemic cardiomyopathy. Bangladesh Heart Journal 2020; 35(2) : 121-127
{"title":"Clinical, Electrocardiographic and Echocardiographic Profile of Ischemic Cardiomyopathy: An analysis of 100 cases.","authors":"Mainul Islam, M. A. Ali, U. H. Ferdaushi, S. Nabi, Sayeedur Rahman Khan, Shariful Islam, H. Mahmoud","doi":"10.3329/BHJ.V35I2.52898","DOIUrl":"https://doi.org/10.3329/BHJ.V35I2.52898","url":null,"abstract":"Background: Ischemic heart disease (IHD) is one of the leading cause of morbidity and mortality worldwide. Ischemic cardiomyopathy (ICM) is a delayed complication of IHD that arises as dilated cardiomyopathy with depressed ventricular function, which cannot be attributed entirely to coronary artery obstruction or ischemic injury. \u0000Objectives: To evaluate the clinical, electrocardiographic and echocardiographic profile of patients presenting with ischemic cardiomyopathy. Methods: In this cross sectional observational study 100 patients of ischemic cardiomyopathy admitted in hospital or visited OPD in NICVD, Dhaka from March’15 to Sept’15 were studied. Enrollment of the patients were done after fulfilling the inclusion and exclusion criteria. Clinical, electrocardiographic and echocardiographic data were collected then data analysis was done. \u0000Results: Data analysis of 100 patients was showed age range was 40-80 years and mean age was 61.4±7.9 years. 79% subjects were male. Most common symptoms were dyspnea (93%), chest pain(73%), palpitation (39%) and edema (23%). Most patients were in NYHA functional class lV (43%). 64% cases had history of anterior myocardial infarction (MI), 22% had inferior MI, 25% had H/O PTCA and 7% had CABG. 71% subjects had tachycardia, 65% had lungs basal rales, 56% had systolic blood pressure below 100 mmhg and 25% had edema. ECG findings was as follows sinus rhythm (85%), Sinus tachycardia 71%, AF 15%, LBBB 34%, RBBB 12%, pathological Q in anterior surface 65% and inferior surface 21%, non specific ST-T changes 41% and PVCs was found in 17%.On echocardiography ,anterior wall hypokinesia was seen in 52% and global hypokinesia in 43%. Mean left ventricular ejection fraction (LVEF) was 31±5.9% and mean left ventricular internal diastolic diameter (LVIDd) was 6.5±0.4 cm. (59%) subjects had mitral regurgitation (MR) grade-l and 20% had MR grade-ll. \u0000Conclusion: The clinical presentation of ischemic cardiomyopathy varies from patient to patient. Severity of symptoms correlates with severity of left ventricular systolic dysfunction, left ventricular diameter and mitral regurgitation grade . Anterior Myocardial infarction has more chance to develop ischemic cardiomyopathy. \u0000Bangladesh Heart Journal 2020; 35(2) : 121-127","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"43 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2021-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122095786","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}
Muhammad Salim Mahmod, Mohammad Arifur Rahman, Nuruddin Mohammod Zahangir, R. Basak, Mohammad Maknunur Rahman Khan
Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm. myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Recently, several case reports of pseudoaneurysm formation after DES implantation have been reported in the literature. We describe the successful surgical management of giant mycotic pseudoaneurysm of RCA presenting as fever of unknown origin with AMI (inferior) three months after multivessel PCI in LAD & RCA with DES in radial route. This report illustrates the importance of early detection and prompt management of these rare coronary pseudoaneurysms, which is a highly lethal condition. At three months follow-up after surgery, the patient was asymptomatic with fair LVEF 58% Bangladesh Heart Journal 2020; 35(1) : 66-70
{"title":"Successful Management of a Giant Mycotic Coronary Artery Aneurysm Develeped after Multivessel PCI with Drug-Eluting Stent","authors":"Muhammad Salim Mahmod, Mohammad Arifur Rahman, Nuruddin Mohammod Zahangir, R. Basak, Mohammad Maknunur Rahman Khan","doi":"10.3329/bhj.v35i1.49145","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49145","url":null,"abstract":"Coronary artery stent infection has been reported with both bare metal stent and drug eluting stent and can present as mycotic coronary artery aneurysm, pseudoaneurysm. myocardial abscess, pericarditis or exudative effusion. Infection at the site of coronary stent implantation is rare and is believed to result typically from either direct stent contamination at the time of delivery or transient bacteraemia from access site. Recently, several case reports of pseudoaneurysm formation after DES implantation have been reported in the literature. We describe the successful surgical management of giant mycotic pseudoaneurysm of RCA presenting as fever of unknown origin with AMI (inferior) three months after multivessel PCI in LAD & RCA with DES in radial route. This report illustrates the importance of early detection and prompt management of these rare coronary pseudoaneurysms, which is a highly lethal condition. At three months follow-up after surgery, the patient was asymptomatic with fair LVEF 58% \u0000Bangladesh Heart Journal 2020; 35(1) : 66-70","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115385696","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}
Mohammad Arifur Rahman, Afzalur Rahman, Mohammd Mahbubur Rahman, Farhana Ahmed, Md. Kamrul Hasan, J. Farjana, Md Azizur Rahaman Majumder, Ahmed Mamunul Huq, Atikur Rahman
Background: Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients (>80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. The elderly usually has higher prevalence of co morbidities and more often experience complications during and after revascularization procedures. Our aim was to evaluate clinical outcomes of PCI in patients older than 80 years, compared to their younger counterparts. Materials and methods: From July 2017 to July 2018 we included 212 patients with IHD purposively in Cardiology department of National Institute of Cardiovascular Diseases undergone PCI who were divided into 2 groups according to age: e” 80 years (n = 74) and < 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint were Renal impairment, MI, LVF, emergency revascularization and death. Results: Very elderly patients were more frequently male (86%) and nonsmoker at present (41% vs. 63%, p=0.003), had higher prevalence of hypertension (60% vs. 50%, p<0.13), and more often presented with NSTEMI (54% vs. 23%, p<0.001). Elderly group had higher incidence of TVD and LM disease (36% vs. 26% and 9.5% vs. 2.9%, p=0.07) and more incidence of ostial (16.2% vs.5.1%,p=0.007) and calcified lesions (31.1% vs. 14.5%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%,p=0.07), whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07). Conclusion: Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group. Bangladesh Heart Journal 2020; 35(1) : 61-65
背景:心血管疾病和缺血性心脏病(IHD)是世界范围内高龄患者(>80岁)发病率和死亡率的主要原因。这些患者代表了一个快速增长的接受经皮冠状动脉介入治疗(PCI)的人群，现在在现实世界中，超过五分之一的患者接受了PCI治疗。此外，他们往往比年轻人有更大的缺血负担，这表明他们从冠状动脉血运重建治疗中获益的范围更大。老年人通常有较高的合并症患病率，并且在血运重建术期间和之后更常出现并发症。我们的目的是评估80岁以上患者PCI的临床效果，并与年轻患者进行比较。材料与方法:2017年7月至2018年7月，我们在国立心血管疾病研究所心内科接受PCI治疗的IHD患者212例，按年龄分为80岁(n = 74)和80岁以下(n = 138)两组。获得基线临床特征、冠状动脉介入治疗指征和住院结果。研究终点为肾功能损害、心肌梗死、左心室充血、急诊血运重建术和死亡。结果:高龄患者多为男性(86%)，目前不吸烟(41%比63%，p=0.003)，高血压患病率较高(60%比50%，p<0.13)，更常出现NSTEMI(54%比23%，p<0.001)。老年组TVD、LM病变发生率较高(36% vs. 26%， 9.5% vs. 2.9%， p=0.07)，口部病变发生率较高(16.2% vs.5.1%，p=0.007)、钙化病变发生率较高(31.1% vs. 14.5%， p=0.004)。两组的手术成功率(TIMI III)都很高，但与年轻组相比，老年人的手术成功率仍较低(95%对97%，p=0.65)。高龄患者PCI术后出血、CIN、MI、LVF和死亡发生率较高(9.5%比6.1%、8.2%比3.7%、6.8%比5.8%、9.5%比5.1%和5.4%比3.6%，p=0.07)，而年轻患者急诊血运重建术发生率较高(5.4%比6.5%，p=0.07)。结论:≥80岁高龄患者行PCI时血管部位并发症较多，LM、TVD多，口部及钙化病变多。虽然手术成功率与年轻组相似，但他们面临更多的PCI后CIN、LVF和MI，重复血运重建率更高。孟加拉国心脏杂志2020;35(1): 61-65
{"title":"In-hospital Outcome of Percutaneous Coronary Intervention among Very Elderly Patients with Ischemic Heart Disease in a Dedicated Cardiac Hospital","authors":"Mohammad Arifur Rahman, Afzalur Rahman, Mohammd Mahbubur Rahman, Farhana Ahmed, Md. Kamrul Hasan, J. Farjana, Md Azizur Rahaman Majumder, Ahmed Mamunul Huq, Atikur Rahman","doi":"10.3329/bhj.v35i1.49144","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49144","url":null,"abstract":"Background: Cardiovascular disease, and ischemic heart disease (IHD), is a major cause of morbidity and mortality in the very elderly patients (>80 years) worldwide. These patients represent a rapidly growing cohort presenting for percutaneous coronary intervention (PCI), now constituting more than one in five patients treated with PCI in real-world practice. Furthermore, they often have greater ischemic burden than their younger counterparts, suggesting that they have greater scope of benefit from coronary revascularization therapy. The elderly usually has higher prevalence of co morbidities and more often experience complications during and after revascularization procedures. Our aim was to evaluate clinical outcomes of PCI in patients older than 80 years, compared to their younger counterparts. \u0000Materials and methods: From July 2017 to July 2018 we included 212 patients with IHD purposively in Cardiology department of National Institute of Cardiovascular Diseases undergone PCI who were divided into 2 groups according to age: e” 80 years (n = 74) and < 80 years (n = 138). Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes were obtained. Study endpoint were Renal impairment, MI, LVF, emergency revascularization and death. \u0000Results: Very elderly patients were more frequently male (86%) and nonsmoker at present (41% vs. 63%, p=0.003), had higher prevalence of hypertension (60% vs. 50%, p<0.13), and more often presented with NSTEMI (54% vs. 23%, p<0.001). Elderly group had higher incidence of TVD and LM disease (36% vs. 26% and 9.5% vs. 2.9%, p=0.07) and more incidence of ostial (16.2% vs.5.1%,p=0.007) and calcified lesions (31.1% vs. 14.5%, p=0.004). Procedural success (TIMI III) were high in both groups, but still lower in the elderly as compared to younger group (95% vs. 97%, p=0.65). Very elderly patients had higher incidence of post PCI bleeding, CIN, MI, LVF and death (9.5% vs.6.1%, 8.2% vs.3.7%, 6.8% vs.5.8%, 9.5% vs. 5.1% and 5.4%vs.3.6%,p=0.07), whereas emergency revascularization were higher in younger group (5.4% vs. 6.5%, p=0.07). \u0000Conclusion: Very elderly patients aged ≥80 years face more vascular site complications during PCI, usually have more LM and TVD with more ostial and calcified lesions in comparison with younger group. Though procedural success is similar with younger group, they face more post PCI CIN, LVF and MI. Repeat revascularization was higher in younger group. \u0000Bangladesh Heart Journal 2020; 35(1) : 61-65","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129995845","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}
A. Shamsuddin, P. Biswas, Muhammad Ishtiaque Sayeed Al Manzoo, M. Azad, Md Nurul Akhtar Hasan, Jasmin Hosain, Mohammad Sharifuzzaman Shamsuddin
Absent left pulmonary artery with Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS), is a rare congenital cardiac anomaly. Here we present such a case of A 2 year 11 month old girl with cyanosis, exertional dyspnoea. Her diagnosis is confirmed by echocardiography and CT angiogram. There are very few cases have been reported till date with high postoperative mortality. Although per operative decision making was challenging regarding pulmonary valve and size of the RPA, we performed ICR with RPA reductionplasty and creation of monocuspid pulmonary valve with success. As it is a rare association and we have overcome the hindrance we came across per operatively, we are reporting this case. Bangladesh Heart Journal 2020; 35(1) : 74-77
{"title":"Tetralogy of Fallot with Absent Pulmonary Valve Syndrome with Absent Left Pulmonary Artery - A Rare Presentation","authors":"A. Shamsuddin, P. Biswas, Muhammad Ishtiaque Sayeed Al Manzoo, M. Azad, Md Nurul Akhtar Hasan, Jasmin Hosain, Mohammad Sharifuzzaman Shamsuddin","doi":"10.3329/bhj.v35i1.49148","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49148","url":null,"abstract":"Absent left pulmonary artery with Tetralogy of Fallot (TOF) with absent pulmonary valve syndrome (APVS), is a rare congenital cardiac anomaly. Here we present such a case of A 2 year 11 month old girl with cyanosis, exertional dyspnoea. Her diagnosis is confirmed by echocardiography and CT angiogram. There are very few cases have been reported till date with high postoperative mortality. Although per operative decision making was challenging regarding pulmonary valve and size of the RPA, we performed ICR with RPA reductionplasty and creation of monocuspid pulmonary valve with success. As it is a rare association and we have overcome the hindrance we came across per operatively, we are reporting this case. \u0000Bangladesh Heart Journal 2020; 35(1) : 74-77","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"8 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124955008","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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