Introduction: The objectives of the present study are to describe the institutional experience, technical aspects and outcome of right ventricular outflow tract (RVOT) stenting in Tetralogy of Fallot type lesions as the initial palliation in a Bangladeshi centre. Methods: This is a retrospective, single-center study of nonrandomized, consecutive 32 patients over a 12-year period. Selected patients underwent cardiac catheterization for implanting a stent into an obstructed RVOT to improve pulmonary blood flow.Statistical data analysis was performed using SPSS 20. Results: Thirty cases had stenting in RVOT and two cases were postponed. Median age was 8.1 (3-40) months, median weight was 4.8 (3.3-11.4)kg, median procedure time was 65 (26-210) minutes and fluoroscopy time was 16 (10-75) minutes.Stents were implanted through 5F Judkins coronary guide catheter and 5F or 6F delivery sheath of ADOII device. Median stent diameter was 6 (4-7) mm. Stent length varies from 12-22 mm with median 14 mm. Oxygen saturation of the patients increased from median 60 (30 - 75)% to 91 (85-98)%. In one patient stent was embolized to aorta and was fixed to descending aorta. Two cases were postponed for short infundibular length. One patient died from non cardiac cause two months after palliation. No procedure related mortality recorded. Conclusion: Right ventricular outflow tract stenting is a good option of palliation for small babies with reduced pulmonary blood flow. In our setting we did most of the palliation to offer better quality of life who could not afford surgery or who was detected late. Bangladesh Heart Journal 2020; 35(1) : 1-5
{"title":"Stenting of Right Ventricular Out Flow Tract: Analysis of 32 Cases from Catheterization Laboratory of a Paediatric Cardiac Centre","authors":"N. Begum, N. I. Bhuiyan, A. Khan","doi":"10.3329/bhj.v35i1.49136","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49136","url":null,"abstract":"Introduction: The objectives of the present study are to describe the institutional experience, technical aspects and outcome of right ventricular outflow tract (RVOT) stenting in Tetralogy of Fallot type lesions as the initial palliation in a Bangladeshi centre. \u0000Methods: This is a retrospective, single-center study of nonrandomized, consecutive 32 patients over a 12-year period. Selected patients underwent cardiac catheterization for implanting a stent into an obstructed RVOT to improve pulmonary blood flow.Statistical data analysis was performed using SPSS 20. \u0000Results: Thirty cases had stenting in RVOT and two cases were postponed. Median age was 8.1 (3-40) months, median weight was 4.8 (3.3-11.4)kg, median procedure time was 65 (26-210) minutes and fluoroscopy time was 16 (10-75) minutes.Stents were implanted through 5F Judkins coronary guide catheter and 5F or 6F delivery sheath of ADOII device. Median stent diameter was 6 (4-7) mm. Stent length varies from 12-22 mm with median 14 mm. Oxygen saturation of the patients increased from median 60 (30 - 75)% to 91 (85-98)%. In one patient stent was embolized to aorta and was fixed to descending aorta. Two cases were postponed for short infundibular length. One patient died from non cardiac cause two months after palliation. No procedure related mortality recorded. \u0000Conclusion: Right ventricular outflow tract stenting is a good option of palliation for small babies with reduced pulmonary blood flow. In our setting we did most of the palliation to offer better quality of life who could not afford surgery or who was detected late. \u0000Bangladesh Heart Journal 2020; 35(1) : 1-5","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"5 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":"121303400","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. R. Chowdhury, Muhammad Abdul Quaium Chowdhury, J. D. Gupta, Subir Barua, M. Mannan, Mohammad Fazle Maruf, M. Rahman, Satyajit Dhar, N. Hosain
Background: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope provides a better real time view of the larynx, epiglottis and vocal cords. It also keeps the intubating anesthetist away from the patient as compared to conventional laryngoscopy. This may be very important in this COVID-19 era. To the best of our knowledge the Department of Cardiac Surgery and Cardiac Anesthesia of Chattogram Medical College & Hospital is the first center in Bangladesh to introduce video laryngoscope in cardiac OT. The objective of this study was aimed to compare the intubation time, hemodynamic response to laryngoscopy, success rates and operator’s comfort using the conventional Macintosh laryngoscope and video laryngoscope in adult patients undergoing cardiac surgery. Materials and Methods: A total of 60 adult patients were included in this comparative study, subjected to general anesthesia for cardiac surgery, intubated using either conventional Macintosh direct laryngoscope or video laryngoscope. Patients were intubated by 3 different consultant anesthesiologists with equal competency of our department. Results: There was not much difference between Video laryngoscopy and conventional laryngoscopy in terms of intubation time and success rate. Video laryngoscopy exhibited less hemodynamic response to laryngoscopy and intubation; however, the difference was not statistically significant in this small group of patients. Operators were much more comfortable with Video laryngoscope than conventional laryngoscope particularly with the cases of difficult intubation because of the better glottic view with the former. Conclusion: Video laryngoscope is preferred by cardiac anesthetists because of better glottic view. Bangladesh Heart Journal 2020; 35(1) : 47-53
{"title":"Video Laryngoscopic Endotracheal Intubation in Cardiac Operation Theater - Experience at a Peripheral Tertiary Healthcare Centre of Bangladesh","authors":"M. R. Chowdhury, Muhammad Abdul Quaium Chowdhury, J. D. Gupta, Subir Barua, M. Mannan, Mohammad Fazle Maruf, M. Rahman, Satyajit Dhar, N. Hosain","doi":"10.3329/bhj.v35i1.49142","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49142","url":null,"abstract":"Background: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope provides a better real time view of the larynx, epiglottis and vocal cords. It also keeps the intubating anesthetist away from the patient as compared to conventional laryngoscopy. This may be very important in this COVID-19 era. To the best of our knowledge the Department of Cardiac Surgery and Cardiac Anesthesia of Chattogram Medical College & Hospital is the first center in Bangladesh to introduce video laryngoscope in cardiac OT. \u0000The objective of this study was aimed to compare the intubation time, hemodynamic response to laryngoscopy, success rates and operator’s comfort using the conventional Macintosh laryngoscope and video laryngoscope in adult patients undergoing cardiac surgery. \u0000Materials and Methods: A total of 60 adult patients were included in this comparative study, subjected to general anesthesia for cardiac surgery, intubated using either conventional Macintosh direct laryngoscope or video laryngoscope. Patients were intubated by 3 different consultant anesthesiologists with equal competency of our department. \u0000Results: There was not much difference between Video laryngoscopy and conventional laryngoscopy in terms of intubation time and success rate. Video laryngoscopy exhibited less hemodynamic response to laryngoscopy and intubation; however, the difference was not statistically significant in this small group of patients. Operators were much more comfortable with Video laryngoscope than conventional laryngoscope particularly with the cases of difficult intubation because of the better glottic view with the former. \u0000Conclusion: Video laryngoscope is preferred by cardiac anesthetists because of better glottic view. \u0000Bangladesh Heart Journal 2020; 35(1) : 47-53","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"15 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":"131796069","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}
P. Bala, Atahar Ali, Kazi Atiqur Rahman, Nighat Islam, M. Khan
Abstract Not Available Bangladesh Heart Journal 2020; 35(1) : 71-73
孟加拉心脏杂志2020;35(1): 71-73
{"title":"A Case of Massive Metoprolol Overdose Successfully Managed","authors":"P. Bala, Atahar Ali, Kazi Atiqur Rahman, Nighat Islam, M. Khan","doi":"10.3329/bhj.v35i1.49147","DOIUrl":"https://doi.org/10.3329/bhj.v35i1.49147","url":null,"abstract":"Abstract Not Available \u0000Bangladesh Heart Journal 2020; 35(1) : 71-73","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"39 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":"131365353","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. Alam, Hossain, M. Basit, S. Hoque, A. Mohibullah
Objectives: Cardiology consultation for hospitalized patients is a common and sometimes mandatory practice in every country. This is because of increased morbidity and mortality of cardiac cases that also has other co-morbidities. We conducted this study to know the pattern of disease profile and the idea of requesting doctors about the cardiac diseases from the cases they referred to the department of Cardiology. Methods: This prospective observational study was carried out in BIRDEM General Hospital, Shahbag, Dhaka from July to December 2017. We followed every case till the final and confirmed diagnoses were made. All the relevant collected data were compiled on a master data sheet. All findings were expressed as frequency with percentage and analysis were done using SPSS for windows version 22.0. Results: This study revealed that majority of the referred cases to the department of cardiology was routine (84.4%) and non-cardiac (57%). Non-cardiac cases were referred mainly for the fitness of general anesthesia (GA) (18.4%). But among the critical cases (14.0%), mostly were cardiac (9.1%). Among all the cardiac cases, Hypertension (8.8%) got the highest referral followed by Acute Myocardial Infarction (AMI) (3.8%) and Dilated Cardiomyopathy (DCM) (3.8%). Conclusions: Hospitalized patients were referred to the department of Cardiology differs according to the requesting unit. The surgical units referred their cases to get the cardiac clearance for a major surgery and the medical units referred for typical cardiac emergencies like AMI. Bangladesh Heart Journal 2019; 34(1) : 1-4
目的:住院患者的心脏病会诊在每个国家都是一种常见的，有时是强制性的做法。这是因为心脏病病例的发病率和死亡率增加，也有其他合并症。我们进行这项研究是为了了解疾病概况的模式以及从他们转介到心脏病科的病例中要求医生了解心脏病的想法。方法:本前瞻性观察研究于2017年7月至12月在达卡Shahbag BIRDEM总医院进行。我们跟踪每一个病例，直到最后确诊。所有收集到的相关数据都汇编在一份主数据表上。所有结果以频率加百分比表示，分析使用SPSS for windows version 22.0。结果:本研究显示，大多数转介到心内科的病例是常规(84.4%)和非心脏(57%)。非心脏类病例主要参考全麻适应度(GA)(18.4%)。但危重病例中以心脏为主(9.1%)，占14.0%。在所有心脏病例中，高血压(8.8%)转诊最多，其次是急性心肌梗死(AMI)(3.8%)和扩张型心肌病(DCM)(3.8%)。结论:住院患者转诊到心内科的情况因转诊单位的不同而不同。外科单位将他们的病例转介给大手术的心脏清除，医疗单位转介给典型的心脏紧急情况，如急性心肌梗塞。孟加拉国心脏杂志2019;34(1): 1-4
{"title":"Characteristics of Disease Profile of Hospitalized Patients Referred to the Department of Cardiology in a Tertiary Care Hospital","authors":"M. Alam, Hossain, M. Basit, S. Hoque, A. Mohibullah","doi":"10.3329/BHJ.V34I1.41901","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41901","url":null,"abstract":"Objectives: Cardiology consultation for hospitalized patients is a common and sometimes mandatory practice in every country. This is because of increased morbidity and mortality of cardiac cases that also has other co-morbidities. We conducted this study to know the pattern of disease profile and the idea of requesting doctors about the cardiac diseases from the cases they referred to the department of Cardiology. \u0000Methods: This prospective observational study was carried out in BIRDEM General Hospital, Shahbag, Dhaka from July to December 2017. We followed every case till the final and confirmed diagnoses were made. All the relevant collected data were compiled on a master data sheet. All findings were expressed as frequency with percentage and analysis were done using SPSS for windows version 22.0. \u0000Results: This study revealed that majority of the referred cases to the department of cardiology was routine (84.4%) and non-cardiac (57%). Non-cardiac cases were referred mainly for the fitness of general anesthesia (GA) (18.4%). But among the critical cases (14.0%), mostly were cardiac (9.1%). Among all the cardiac cases, Hypertension (8.8%) got the highest referral followed by Acute Myocardial Infarction (AMI) (3.8%) and Dilated Cardiomyopathy (DCM) (3.8%). \u0000Conclusions: Hospitalized patients were referred to the department of Cardiology differs according to the requesting unit. The surgical units referred their cases to get the cardiac clearance for a major surgery and the medical units referred for typical cardiac emergencies like AMI. \u0000Bangladesh Heart Journal 2019; 34(1) : 1-4","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127986460","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}
Background: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass. Methods: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done. Results: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = < .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018). Conclusions: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass. Bangladesh Heart Journal 2019; 34(1) : 25-30
{"title":"Evaluation of Blood Lactate Level as Predictor of Early Adverse Outcome after Cardiac Surgery under Cardiopulmonary Bypass","authors":"M. Azad, K. Islam, M. Quasem","doi":"10.3329/BHJ.V34I1.41904","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41904","url":null,"abstract":"Background: We examined the hypothesis that high blood lactate level in intensive care unit patient after adult cardiac surgery under cardiopulmonary bypass is associated with early adverse outcome. The objective of this study was to evaluate whether high blood lactate level after cardiac surgery is a predictor of the early outcome after adult cardiac surgery under cardiopulmonary bypass. \u0000Methods: This prospective observational study was carried out in the department of Cardiac Surgery at National Institute of Cardiovascular Disease (NICVD), Dhaka from July, 2013 to April 2014. A total number of 100 patients who underwent cardiac operation with cardiopulmonary bypass were enrolled in this study as per inclusion and exclusion criteria. Patients were divided into two groups according to their blood lactate level 6 hours after transferintensive care unit. Peroperative variables and postoperative variables were observed and recorded during the hospital course of patient. Categorical variables were analyzed by Chi- Square test and Fisher’s exact test and continuous variables were analyzed by ‘t’ test. Multiple Binary Logistic Regression Analysis of predictors for each of the outcome variables was done. \u0000Results: Blood lactate levels ≥3mmol/L 6 hours after transfer to intensive care unit were present in 57(57%) patients. Multiple logistic regression analysis showed higher blood lactate level was an independent predictor for early postoperative low output syndrome (OR 9.073, 95% CI 2.819 – 29.207, p = < .0001), pulmonary complication (OR 5.734, 95% CI 1.814 – 18.122, p = .003), neurological deficits (OR 9.725, 95% CI 1.111 - 85.147, p = .040), renal dysfunction (OR 7.393, 95% CI 1.855-29.469, p = .005), arrhythmia (OR 10.512, 95% CI 1.902 – 58.108, p = .007) and wound infection (OR 7.742, 95% CI 1.418 - 42.259, p = .018). \u0000Conclusions: High blood lactate level 6 hours after transfer to intensive care unit is an independent predictor for worse outcomes in adult patients after cardiac surgery under cardiopulmonary bypass. \u0000Bangladesh Heart Journal 2019; 34(1) : 25-30","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133089406","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}
Kaisar Haroon, Tania Taher, S. Alam, N. Huq, S. S. Hossain
Objective: Carotid body tumour is a rare tumour. This is a case report of carotid body tumour of the right side involving the right hypoglossal nerve with MRI appearance and pathological features. The objective is to present a case of Hypoglossal nerve palsy due to carotid body tumour involving the right carotid artery bifurcation. Method: A 18-year old male presented with a welldefined swelling of his right neck, increasing hoarseness, and left ward tongue deviation on protrusion present for two years CT neck and MRI were done. The tumour was identified and the patient underwent surgery. His Histopathology report commented it to be carotid body tumour. Result: The patient showed significant improvement after surgery. His tongue deviation improved and his hoarseness of voice had been begun to improve. Conclusion: Carotid body tumours are benign lesion mimicking other pathology. High level of suspicision, imaging and careful resection is important for avoiding complications. Bangladesh Heart Journal 2019; 34(1) : 68-72
{"title":"Carotid body Tumour with Hypoglossal Nerve Palsy- A Case Report","authors":"Kaisar Haroon, Tania Taher, S. Alam, N. Huq, S. S. Hossain","doi":"10.3329/BHJ.V34I1.41910","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41910","url":null,"abstract":"Objective: Carotid body tumour is a rare tumour. This is a case report of carotid body tumour of the right side involving the right hypoglossal nerve with MRI appearance and pathological features. The objective is to present a case of Hypoglossal nerve palsy due to carotid body tumour involving the right carotid artery bifurcation. \u0000Method: A 18-year old male presented with a welldefined swelling of his right neck, increasing hoarseness, and left ward tongue deviation on protrusion present for two years CT neck and MRI were done. The tumour was identified and the patient underwent surgery. His Histopathology report commented it to be carotid body tumour. \u0000Result: The patient showed significant improvement after surgery. His tongue deviation improved and his hoarseness of voice had been begun to improve. \u0000Conclusion: Carotid body tumours are benign lesion mimicking other pathology. High level of suspicision, imaging and careful resection is important for avoiding complications. \u0000Bangladesh Heart Journal 2019; 34(1) : 68-72","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"51 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121545505","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}
S. Islam, Afzalur Rahman, A. Chowdhury, Mohsin Ahmed, K. K. Karmakar, M. U. Firoz, Mohammad Arifur Rahman, M. Haque, Mohammad Sadaqul Islam Sikdar, Ashrafuzzaman Tamal, A. Islam, Muhammad Ruhul Amin, Abeeda Tasnim Reza, F. Cader
Background: Limited contemporary data exist regarding the impact of SYNTAX score on procedural outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients. Objectives: To evaluate the significance of the SYNTAX score for predicting procedural outcome after primary PCI in patient with acute STEMI. Methods: This perspective observational study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low Syntax score d”22) and Group II (high Syntax score > 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. Procedural outcome was observed in between two groups. Results: Among study patients 57.5% were in SYNTAX score d”22 (Group I) and 42.5% were in SYNTAX score >22 (Group II). Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P<0.05). The high SYNTAX score group had lower ejection fraction (47.8±5.1 vs. 54.4±4.3, p= 0.04), lower TIMI flow 3 rate (76.47% vs 91.3%, p= 0.03 ) greater rate of MACE (29.4% vs. 4.3%, p=0.041), lower procedural success rate ( 76.47 vs. 91.3%, p= 0.046) compared to the low SYNTAX score group. ROC curve showed 77% sensitivity and 32% specificity for SYNTAX score when cut off value was 22 Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%. Conclusions: SYNTAX score was an independent variable that can predict procedural outcomes Bangladesh Heart Journal 2019; 34(1) : 5-10
背景:目前关于SYNTAX评分对急性STEMI患者行初级经皮冠状动脉介入治疗(PCI)预后影响的数据有限。目的:评价SYNTAX评分对急性STEMI患者首次PCI术后预后的预测意义。方法:本前瞻性观察研究于2015年9月至2016年9月在孟加拉国达卡国立心血管疾病研究所心内科进行。42例接受首次PCI治疗的急性STEMI患者被纳入研究。但2例患者因首次PCI失败而被排除在研究之外。将患者分为两组:1组(低语法评分d " 22)和2组(高语法评分> 22)。所有患者的句法评分是根据首次PCI前的初始冠状动脉造影计算的。观察两组患者的手术结局。结果:57.5%的患者SYNTAX评分为d”22分(I组)，42.5%的患者SYNTAX评分>22分(II组)。在传统心血管危险因素中，II组糖尿病患病率明显高于I组(82.4% vs 34.8%， p  0.003)。血管造影显示，ⅰ组LAD动脉罪魁祸首病变最大(69.6% vs 17.6%)，ⅱ组RCA罪魁祸首病变最大(64.7% vs 21.7%)，两组间差异有统计学意义(P<0.05)。SYNTAX评分高组射血分数较低(47.8±5.1比54.4±4.3,p=0.04)， TIMI flow 3率较低(76.47%比91.3%，p= 0.03)， MACE较高(29.4%比4.3%，p=0.041)，手术成功率较低(76.47比91.3%，p= 0.046)。当截断值为22时，ROC曲线显示SYNTAX评分的敏感性为77%，特异性为32%。Primary PCI转归设置时，SYNTEX评分的性能测试阳性预测值为83%。结论:SYNTAX评分是一个可以预测手术结果的独立变量;34(1): 5-10
{"title":"SYNTAX Score on Procedural Outcome among Patient Undergoing Primary Percutaneous Coronary Intervention","authors":"S. Islam, Afzalur Rahman, A. Chowdhury, Mohsin Ahmed, K. K. Karmakar, M. U. Firoz, Mohammad Arifur Rahman, M. Haque, Mohammad Sadaqul Islam Sikdar, Ashrafuzzaman Tamal, A. Islam, Muhammad Ruhul Amin, Abeeda Tasnim Reza, F. Cader","doi":"10.3329/BHJ.V34I1.41902","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41902","url":null,"abstract":"Background: Limited contemporary data exist regarding the impact of SYNTAX score on procedural outcomes undergoing primary percutaneous coronary intervention(PCI) in acute STEMI patients. \u0000Objectives: To evaluate the significance of the SYNTAX score for predicting procedural outcome after primary PCI in patient with acute STEMI. \u0000Methods: This perspective observational study was conducted in the department of cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from September, 2015 to September, 2016. 42 patients with acute STEMI who underwent primary PCI were considered for the study. But 2 patients were excluded from the study due to failure of primary PCI. The patients were divided into two groups: Group I (low Syntax score d”22) and Group II (high Syntax score > 22). The Syntax score of all patients were calculated from an initial coronary angiogram before primary PCI. Procedural outcome was observed in between two groups. \u0000Results: Among study patients 57.5% were in SYNTAX score d”22 (Group I) and 42.5% were in SYNTAX score >22 (Group II). Among traditional cardiovascular risk factors diabetes was significantly more prevalent in the Group II than Group I ( 82.4% vs 34.8%, p  0.003). Angiographic profile revealed maximum (69.6% vs 17.6%) culprit lesion in LAD artery in Group I and maximum culprit lesion (64.7% vs 21.7%) in RCA in Group II, these were the statistically significant between Group I and Group II (P<0.05). The high SYNTAX score group had lower ejection fraction (47.8±5.1 vs. 54.4±4.3, p= 0.04), lower TIMI flow 3 rate (76.47% vs 91.3%, p= 0.03 ) greater rate of MACE (29.4% vs. 4.3%, p=0.041), lower procedural success rate ( 76.47 vs. 91.3%, p= 0.046) compared to the low SYNTAX score group. ROC curve showed 77% sensitivity and 32% specificity for SYNTAX score when cut off value was 22 Performance test of SYNTEX score in the setting of Primary PCI outcome showed positive predictive value 83%. \u0000Conclusions: SYNTAX score was an independent variable that can predict procedural outcomes \u0000Bangladesh Heart Journal 2019; 34(1) : 5-10","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"41 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133303002","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}
D. Parvin, Sunil Krishna Baul, S. Hossain, S. Munshi, M. Hadiuzzaman, K. Fatema
Background: The leading cause of mortality in men and women worldwide is coronary artery disease (CAD). For hospitalization in our country, acute coronary syndrome (ACS) is a major reason. Dyslipidemia is found one of the most important modifiable risk factors for CAD. Aim: The aim of the study was to determine the pattern and prevalence of dyslipidemia among patients with ACS admitted in National Institute of Cardiovascular Diseases (NICVD), Dhaka. Subjects and methods: One thousand (1000) patients with ACS were included and classified according to clinical presentation, the findings on the admission electrocardiogram (ECG) and the results of serial cardiac troponin levels, into myocardial infarction(MI), either STelevation or non ST- elevation MI, and unstable angina(UA) subgroups. In the other group 500 healthy subjects were included as controls. All subjects were subjected determination lipid profile. ECG and Troponin- I were done for diagnosis and follow up of the patients. Results: In patients with ACS, high levels of TC (>200 mg/dl) were found in 60.67%,high levels of LDL (> 130 mg/dl) were found in 58%, high levels of TG (>150 mg/ dl) were found in 63.33%, however, low levels of HDL (< 40 mg/dl) were found in 66%. There was a statistically significant elevation in TC, LDL, TG serum levels in patients with ACS compared to control subjects (p<0.05) while the HDL was significantly low in ACS patient compared to control subjects (p <0.05). TC/HDL > 5 and TG/HDL> 4 were significantly higher in patients with ACS than controls. There was no significant difference between MI and UA patients regarding all lipid profile parameters. TC, LDL, TG were significantly higher in males than in females while HDL was significantly higher in females compared to males. Also TC/HDL and TG/HDL ratios were significantly higher in males compared to females. All lipid components were significantly more prevalent in males than in females except TG where there was no significant difference between males and females. Stepwise regression analysis of lipid parameters revealed that TC/HDL and TG/HDL ratios were independent risk factors for ACS. Conclusion: Dyslipidemia is one the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS and more studies about them as risk factors of atherosclerosis and its impact on other systems is advised. Bangladesh Heart Journal 2019; 34(1) : 31-36
{"title":"Pattern and Prevalence of Dyslipidemia among Patients with Acute Coronary Syndrome Admitted in a Tertiary Level Hospital","authors":"D. Parvin, Sunil Krishna Baul, S. Hossain, S. Munshi, M. Hadiuzzaman, K. Fatema","doi":"10.3329/BHJ.V34I1.41905","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41905","url":null,"abstract":"Background: The leading cause of mortality in men and women worldwide is coronary artery disease (CAD). For hospitalization in our country, acute coronary syndrome (ACS) is a major reason. Dyslipidemia is found one of the most important modifiable risk factors for CAD. \u0000Aim: The aim of the study was to determine the pattern and prevalence of dyslipidemia among patients with ACS admitted in National Institute of Cardiovascular Diseases (NICVD), Dhaka. \u0000Subjects and methods: One thousand (1000) patients with ACS were included and classified according to clinical presentation, the findings on the admission electrocardiogram (ECG) and the results of serial cardiac troponin levels, into myocardial infarction(MI), either STelevation or non ST- elevation MI, and unstable angina(UA) subgroups. In the other group 500 healthy subjects were included as controls. All subjects were subjected determination lipid profile. ECG and Troponin- I were done for diagnosis and follow up of the patients. \u0000Results: In patients with ACS, high levels of TC (>200 mg/dl) were found in 60.67%,high levels of LDL (> 130 mg/dl) were found in 58%, high levels of TG (>150 mg/ dl) were found in 63.33%, however, low levels of HDL (< 40 mg/dl) were found in 66%. There was a statistically significant elevation in TC, LDL, TG serum levels in patients with ACS compared to control subjects (p<0.05) while the HDL was significantly low in ACS patient compared to control subjects (p <0.05). TC/HDL > 5 and TG/HDL> 4 were significantly higher in patients with ACS than controls. There was no significant difference between MI and UA patients regarding all lipid profile parameters. TC, LDL, TG were significantly higher in males than in females while HDL was significantly higher in females compared to males. Also TC/HDL and TG/HDL ratios were significantly higher in males compared to females. All lipid components were significantly more prevalent in males than in females except TG where there was no significant difference between males and females. Stepwise regression analysis of lipid parameters revealed that TC/HDL and TG/HDL ratios were independent risk factors for ACS. \u0000Conclusion: Dyslipidemia is one the major risk factors which is widely prevalent in patients with ACS and is more prevalent in males than in females. We recommend paying more attention to serum lipids and other modifiable risk factors for prevention of ACS and more studies about them as risk factors of atherosclerosis and its impact on other systems is advised. \u0000Bangladesh Heart Journal 2019; 34(1) : 31-36","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"117039158","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}
The prevalence of peripheral artery disease (PAD) continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance.Lower extremity PAD affects approximately 10% of population, with 30% to 40% of these patients presenting with claudication symptoms. Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include duplex scanning, computed tomography angiogram, magnetic resonance angiography and invasive modalities peripheral angiogram is the gold standard. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Intermittent claudication may be improved by risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. By contrast, critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. The management of CLI should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk. Most of the cases, revascularization is indicated to save limbs; an “endovascular first” approach and lastly surgical approach, if all measures were failed. The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion; percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularisation to achieve acceptable long-term outcome. Bangladesh Heart Journal 2019; 34(1) : 58-67
{"title":"Peripheral Vascular Intervention: A Review","authors":"Mohsin Ahmed, A. Bashar, Abdullah Al Gaddafi","doi":"10.3329/BHJ.V34I1.41909","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41909","url":null,"abstract":"The prevalence of peripheral artery disease (PAD) continues to increase worldwide. It is important to identify patients with PAD because of the increased risk of myocardial infarction, stroke, and cardiovascular death and impaired quality of life because of a profound limitation in exercise performance.Lower extremity PAD affects approximately 10% of population, with 30% to 40% of these patients presenting with claudication symptoms. Peripheral arterial disease is common, but the diagnosis frequently is overlooked because of subtle physical findings and lack of classic symptoms. Screening based on the ankle brachial index using doppler ultrasonography may be more useful than physical examination alone. Noninvasive modalities to locate lesions include duplex scanning, computed tomography angiogram, magnetic resonance angiography and invasive modalities peripheral angiogram is the gold standard. Major risk factors for peripheral arterial disease are cigarette smoking, diabetes mellitus, older age (older than 40 years), hypertension, hyperlipidemia, and hyperhomocystinemia. Intermittent claudication may be improved by risk-factor modification, exercise, and pharmacologic therapy. Based on available evidence, a supervised exercise program is the most effective treatment. Effective drug therapies for peripheral arterial disease include aspirin (with or without dipyridamole), clopidogrel, cilostazol, and pentoxifylline. By contrast, critical limb ischemia (CLI) is considered the most severe pattern of peripheral artery disease. It is defined by the presence of chronic ischemic rest pain, ulceration or gangrene attributable to the occlusion of peripheral arterial vessels. It is associated with a high risk of major amputation, cardiovascular events and death. The management of CLI should include an exercise program, guideline-based medical therapy to lower the cardiovascular risk. Most of the cases, revascularization is indicated to save limbs; an “endovascular first” approach and lastly surgical approach, if all measures were failed. The choice of the intervention is dependent on the anatomy of the stenotic or occlusive lesion; percutaneous interventions are appropriate when the lesion is focal and short but longer lesions must be treated with surgical revascularisation to achieve acceptable long-term outcome. \u0000Bangladesh Heart Journal 2019; 34(1) : 58-67","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114991375","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}
Al Gaddafi, D. Das, G. Faruque, Z. Islam, Mahboob Rahman, Fn Jui, K. Walid, A. Biswas
A descriptive type of cross sectional study among 210 diabetic patients with foot ulcer was carried out in Diabetic Association Medical College during the period of May 2016 to April 2017 and were categorized based on Meggitt-Wagner system to find out the complications, management, below knee amputation rate and mortality rate. The aim of this study was to practise a profile of diabetic foot ulcer (DFU), complications and its management to assess the outcome of the surgical interventions. Majority of the patients were male 112(53%), and most of them 116 patients (55.23%) presented within Wegner grade - 2 and grade-3 diabetic foot ulcers. The duration of diabetes more than 10 years was 116 (55%). 99 (47%) patients out of 210 patients developed diabetic neuropathy. 76 (36%) patients presented with CKD. Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center, associated habit of smoking are all factors which lead to incidence of DFU at an earlier age than that seen in other studies. After admission of diabetic foot ulcer patients, diabetic foot ulcer is classified according to Wagner grading and treated the diabetic foot ulcer patients as the using protocol ’!1.Assesment whether it was conservative or surgical. 2. Optimal blood sugar control. 3. Systemic antibiotic. 4. Moist wound environment. 5. Offloading such as total contact casting. 6. Improves peripheral arterial circulation due to lack of vascularity. 7. Surgical debridement or minor amputation or major amputation. In case of G-4 or G-5 patients, ischemia was treated before debridement or amputation so that vascular circulation improved in the ulcer area and then healing potential was fastened. Bangladesh Heart Journal 2019; 34(1) : 52-57
{"title":"Management of Diabetic Foot Ulcer in a Tertiary Level Hospital-Faridpur","authors":"Al Gaddafi, D. Das, G. Faruque, Z. Islam, Mahboob Rahman, Fn Jui, K. Walid, A. Biswas","doi":"10.3329/BHJ.V34I1.41908","DOIUrl":"https://doi.org/10.3329/BHJ.V34I1.41908","url":null,"abstract":"A descriptive type of cross sectional study among 210 diabetic patients with foot ulcer was carried out in Diabetic Association Medical College during the period of May 2016 to April 2017 and were categorized based on Meggitt-Wagner system to find out the complications, management, below knee amputation rate and mortality rate. The aim of this study was to practise a profile of diabetic foot ulcer (DFU), complications and its management to assess the outcome of the surgical interventions. Majority of the patients were male 112(53%), and most of them 116 patients (55.23%) presented within Wegner grade - 2 and grade-3 diabetic foot ulcers. The duration of diabetes more than 10 years was 116 (55%). 99 (47%) patients out of 210 patients developed diabetic neuropathy. 76 (36%) patients presented with CKD. Lack of awareness about diabetes mellitus and its lower limb complications, poor compliance to the treatment, poorly controlled blood sugar levels, delay in diagnosis, and late presentation to the tertiary care center, associated habit of smoking are all factors which lead to incidence of DFU at an earlier age than that seen in other studies. After admission of diabetic foot ulcer patients, diabetic foot ulcer is classified according to Wagner grading and treated the diabetic foot ulcer patients as the using protocol ’!1.Assesment whether it was conservative or surgical. 2. Optimal blood sugar control. 3. Systemic antibiotic. 4. Moist wound environment. 5. Offloading such as total contact casting. 6. Improves peripheral arterial circulation due to lack of vascularity. 7. Surgical debridement or minor amputation or major amputation. In case of G-4 or G-5 patients, ischemia was treated before debridement or amputation so that vascular circulation improved in the ulcer area and then healing potential was fastened. \u0000Bangladesh Heart Journal 2019; 34(1) : 52-57","PeriodicalId":247590,"journal":{"name":"Bangladesh Heart Journal","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129436406","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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