Pub Date : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10662
Khurrum Akhtar, Sana Imtiaz, S. Rafique, D. Kamal, Kaleem Ahmad, Andaleeb Ara, Nadeem Sadiq, Mujeeb Ur Rehman
We report a case of successful hybrid device closure of large mid muscular Ventricular Septal Defect (VSD) in an infant for the very first time in Pakistan. Increasing collaboration between pediatric cardiac interventionalists and congenital cardiac surgeons has resulted in introduction of various hybrid procedures in the management of Congenital Heart Diseases (CHD). Advantages of hybrid procedures include complex interventions by using minimally invasive methods, avoidance of cardiopulmonary bypass, shorter procedure and recovery time leading to subsequent decrease in complications. A large VSD in an infant carries an increased risk of morbidity including failure to thrive, congestive cardiac failure, and recurrentrespiratory tract infections. Timely and safely the successful perventricular closure of large VSD using hybrid approach is a milestone in the management of VSDs in infants.
{"title":"Hybrid Perventricular Ventricular Septal Defect Device Closure in a 3-Months Old Infant with Severe Failure to Thrive","authors":"Khurrum Akhtar, Sana Imtiaz, S. Rafique, D. Kamal, Kaleem Ahmad, Andaleeb Ara, Nadeem Sadiq, Mujeeb Ur Rehman","doi":"10.51253/pafmj.v73isuppl-3.10662","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10662","url":null,"abstract":"We report a case of successful hybrid device closure of large mid muscular Ventricular Septal Defect (VSD) in an infant for the very first time in Pakistan. Increasing collaboration between pediatric cardiac interventionalists and congenital cardiac surgeons has resulted in introduction of various hybrid procedures in the management of Congenital Heart Diseases (CHD). Advantages of hybrid procedures include complex interventions by using minimally invasive methods, avoidance of cardiopulmonary bypass, shorter procedure and recovery time leading to subsequent decrease in complications. A large VSD in an infant carries an increased risk of morbidity including failure to thrive, congestive cardiac failure, and recurrentrespiratory tract infections. Timely and safely the successful perventricular closure of large VSD using hybrid approach is a milestone in the management of VSDs in infants.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"48 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138952366","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10643
Azizullah, Nadeem Sadiq, Muhammad Asad Farhan, Abubakar Umar Sadiq, Sana Imtiaz
Despite improvements in the design of mechanical prosthetic heart valves and regular use of anticoagulation, prosthetic heart valve thrombosis remain the most dreadful complication associated with high mortality. Surgical thrombectomy or valvereplacement is used as a conventional therapy. Medical thrombolysis, on the other hand, is a therapy choice. Present case is of a 26-year old female with Ebstein's irregularity who effectively endured tricuspid prosthetic valve thrombolysis usingintravenous Streptokinase (SK). The outcome of our patient supports that SK can be an adequate therapeutic option for thrombolysis of tricuspid Prosthetic Valve Thrombosis (PVT) in children and adolescents.
{"title":"Management of Prosthetic Tricuspid Valve Thrombosis with Streptokinase","authors":"Azizullah, Nadeem Sadiq, Muhammad Asad Farhan, Abubakar Umar Sadiq, Sana Imtiaz","doi":"10.51253/pafmj.v73isuppl-3.10643","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10643","url":null,"abstract":"Despite improvements in the design of mechanical prosthetic heart valves and regular use of anticoagulation, prosthetic heart valve thrombosis remain the most dreadful complication associated with high mortality. Surgical thrombectomy or valvereplacement is used as a conventional therapy. Medical thrombolysis, on the other hand, is a therapy choice. Present case is of a 26-year old female with Ebstein's irregularity who effectively endured tricuspid prosthetic valve thrombolysis usingintravenous Streptokinase (SK). The outcome of our patient supports that SK can be an adequate therapeutic option for thrombolysis of tricuspid Prosthetic Valve Thrombosis (PVT) in children and adolescents.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"35 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950750","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10935
Nasir Ali, Atif Nawaz, Imtiaz Ahmed Chaudhry, Muhammad Imran Asghar, Syed Aqeel Hussain, Rehan Masroor, Muhammad Ahmad Khan
Objective: To assess outcome of Left Atrial reduction plasty and sinus rhythm restoration in patients undergoing Mitral valve surgery with chronic Atrial Fibrillation. Study Design: Longitudinal study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2017-Jun 2022. Methodology: Thirty three (n=33) patients with mitral valve disease were recruited via convenience sampling, all of whom exhibited an enlarged left atrium and pre-operative Atrial Fibrillation (AF). Pre-operative cardiac evaluations were performed using Transthoracic Echocardiography (TTE). Pre- and post-surgery trans-esophageal echocardiography studies were conducted as a routine procedure. Follow-up echocardiographic assessments were carried out at intervals of 1 month, 3 months, and 6 months, alongside Electrocardiograms (ECGs). During surgery, median sternotomy was done. Cardiopulmonary Bypass (CPB) time was established followed by cardiac arrest. After Mitral valve Repair/Replacement (MVR), Left Atrial (LA) plication was done by a double needle. Results: Out of thirty three (n=33) patients, 25(75.7%) females and 8(24.2%) male patients, with mean age of 44.3±15.5 years, underwent mitral valve surgery(repair/replacement) followed by LA reduction & sinus rhythm restoration procedure. Complete restoration of sinus rhythm with re-appearance of “a” wave on echocardiography, signifying LA transport function through mitral valve was observed in 31(93.9%) patients on 3rd month and only 1(3.0%) individual continued to have persistent AF after 6 months. (83.70±2.50 mm vs. 47.50±1.08 mm) (p<0.001).................. Conclusion: Left atrial reduction by “Plication technique” followed by “Diathermy Fulguration” as a part of mitral valve surgery has yielded ...............
研究目的评估接受二尖瓣手术的慢性心房颤动患者接受左心房缩小成形术和恢复窦性心律的效果：纵向研究：研究地点和时间：巴基斯坦拉瓦尔品第武装部队心脏病研究所/国家心脏病研究所成人心脏外科，2017年1月-2022年6月：通过便利抽样招募了33名（n=33）二尖瓣疾病患者，他们均表现为左心房扩大和术前房颤（AF）。术前使用经胸超声心动图（TTE）进行心脏评估。手术前后的经食道超声心动图检查是常规程序。每隔 1 个月、3 个月和 6 个月进行一次超声心动图随访评估，同时进行心电图检查。手术期间，进行了胸骨正中切开术。心肺旁路（CPB）时间确定后进行心脏停搏。二尖瓣修复/置换术（MVR）后，用双针植入左心房（LA）：在 33 名（n=33）患者中，25 名（75.7%）女性和 8 名（24.2%）男性患者接受了二尖瓣手术（修复/置换），随后进行了 LA 缩窄和窦性心律恢复手术。第 3 个月，31 例（93.9%）患者观察到窦性心律完全恢复，超声心动图上重新出现 "a "波，表明 LA 通过二尖瓣的转运功能，只有 1 例（3.0%）患者在 6 个月后仍有持续性房颤。(83.70±2.50 mm vs. 47.50±1.08 mm) (p<0.001)..................Conclusion：作为二尖瓣手术的一部分，通过 "折叠技术 "和 "热疗 "缩窄左心房可获得 ...............。
{"title":"Left Atrial Reduction Plasty and Sinus Rhythm Restoration in patients undergoing Mitral Valve Surgery with Chronic Atrial Fibrillation","authors":"Nasir Ali, Atif Nawaz, Imtiaz Ahmed Chaudhry, Muhammad Imran Asghar, Syed Aqeel Hussain, Rehan Masroor, Muhammad Ahmad Khan","doi":"10.51253/pafmj.v73isuppl-3.10935","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10935","url":null,"abstract":"Objective: To assess outcome of Left Atrial reduction plasty and sinus rhythm restoration in patients undergoing Mitral valve surgery with chronic Atrial Fibrillation.\u0000Study Design: Longitudinal study.\u0000Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from Jan 2017-Jun 2022.\u0000Methodology: Thirty three (n=33) patients with mitral valve disease were recruited via convenience sampling, all of whom exhibited an enlarged left atrium and pre-operative Atrial Fibrillation (AF). Pre-operative cardiac evaluations were performed using Transthoracic Echocardiography (TTE). Pre- and post-surgery trans-esophageal echocardiography studies were conducted as a routine procedure. Follow-up echocardiographic assessments were carried out at intervals of 1 month, 3 months, and 6 months, alongside Electrocardiograms (ECGs). During surgery, median sternotomy was done. Cardiopulmonary Bypass (CPB) time was established followed by cardiac arrest. After Mitral valve Repair/Replacement (MVR), Left Atrial (LA) plication was done by a double needle.\u0000Results: Out of thirty three (n=33) patients, 25(75.7%) females and 8(24.2%) male patients, with mean age of 44.3±15.5 years, underwent mitral valve surgery(repair/replacement) followed by LA reduction & sinus rhythm restoration procedure. Complete restoration of sinus rhythm with re-appearance of “a” wave on echocardiography, signifying LA transport function through mitral valve was observed in 31(93.9%) patients on 3rd month and only 1(3.0%) individual continued to have persistent AF after 6 months. (83.70±2.50 mm vs. 47.50±1.08 mm) (p<0.001)..................\u0000Conclusion: Left atrial reduction by “Plication technique” followed by “Diathermy Fulguration” as a part of mitral valve surgery has yielded ...............","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"57 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138951887","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10687
Muhammad Usama Akhtar, I. A. Chaudhry, Syed Muzaffar Hasan Kirmani
Intra-Aortic Balloon Pump (IABP) rupture is relatively rare but significant complication of IABP and can lead to serious problems such as the cerebral ischemia and air embolism. The IABP insertion complication rate is reported as approximately 30%, with 2.6% experiencing major complications. Notably, balloon rupture accounts for a portion of these complications, with reported incidence ranging from <1-2%. Patients with diabetes, peripheral vascular disease, and advanced age are at higher risk. It emphasizes the need for continuous monitoring of balloon function, particularly in patients with pre-existing vascular disease. Healthcare providers should remain vigilant to monitor early signs of balloon rupture owing to the chance of development of potentially severe neurological complications. This case emphasizes the importance of early detection and management, including the precise choice of balloon size and length, and potentially the use of ultrasound to evaluate for anatomical abnormalities that could contribute to IABP rupture.
{"title":"Intra-Aortic Balloon Pump Rupture leading to Cerebral Air Embolism: A Case Report","authors":"Muhammad Usama Akhtar, I. A. Chaudhry, Syed Muzaffar Hasan Kirmani","doi":"10.51253/pafmj.v73isuppl-3.10687","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10687","url":null,"abstract":"Intra-Aortic Balloon Pump (IABP) rupture is relatively rare but significant complication of IABP and can lead to serious problems such as the cerebral ischemia and air embolism. The IABP insertion complication rate is reported as approximately 30%, with 2.6% experiencing major complications. Notably, balloon rupture accounts for a portion of these complications, with reported incidence ranging from <1-2%. Patients with diabetes, peripheral vascular disease, and advanced age are at higher risk. It emphasizes the need for continuous monitoring of balloon function, particularly in patients with pre-existing vascular disease. Healthcare providers should remain vigilant to monitor early signs of balloon rupture owing to the chance of development of potentially severe neurological complications. This case emphasizes the importance of early detection and management, including the precise choice of balloon size and length, and potentially the use of ultrasound to evaluate for anatomical abnormalities that could contribute to IABP rupture.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"33 12","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138949634","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10661
Sana Imtiaz, S. Rafique, Khurrum Akhtar, Amjad Mehmood, Hajira Akbar, Andaleeb Ara, Ayesha Sana
Objective: To determine post procedural immediate and short-term outcomes of transcatheter Ventricular Septal Defect (VSD) device closure. Study Design: Longitudinal Cross-sectional study. Place and Duration of Study: Pediatric Cardiology Unit at Tertiary Cardiac Care Centre, Rawalpindi, Pakistan, from Feb to Oct 2022. Methodology: Total of 62 patients fulfilling inclusion and exclusion criteria who underwent transcatheter VSD device closure were retrospectively identified from our institutional database by non-probability consecutive sampling technique. Preprocedural evaluation [Transthoracic Echocardiography (TTE) & Electrocardiography(ECG)], procedural details and immediate post procedure outcomes were documented. Follow-up evaluations were done at 6 and 12 months. It included clinical examination, TTE and 12 lead ECG. New onset and status of old complications were documented in each visit. SPSS version 24.00 was used to analyze data. Chi-square test was used to find association between study variables. p-<0.05 wasconsidered significant. Results: Sixty-two patients were followed up for upto 1 year after VSD device closure. Mean VSD size on Echo was 4.612.52mm. Successful closure was obtained in 54(87.0%) of cases out of 62. Complications documented during and immediately after procedure were transient arrythmias in 22(35.5%), residual leaks in 9(14.6%) which reduced to 3(4.8%) on 12 months follow up, device redeployment in 3(4.8%), complete heart block (cAVB) in 1(1.6%), device embolization in 1(1.6%), hemolysis in 2(3.2%), contrast related complications in 1(1.6%), aortic regurgitation (AR) in 4(6.4%). Death occurred in 1(1.6%) patient secondary to contrast related complications. Conclusion: Transcatheter VSD closure is a promising and safe treatment modality with high success rate. Complications ..
{"title":"Short Term Outcomes of Transcatheter Ventricular Septal Defect Device Closure at Tertiary Cardiac Care Center","authors":"Sana Imtiaz, S. Rafique, Khurrum Akhtar, Amjad Mehmood, Hajira Akbar, Andaleeb Ara, Ayesha Sana","doi":"10.51253/pafmj.v73isuppl-3.10661","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10661","url":null,"abstract":"Objective: To determine post procedural immediate and short-term outcomes of transcatheter Ventricular Septal Defect (VSD) device closure.\u0000Study Design: Longitudinal Cross-sectional study.\u0000Place and Duration of Study: Pediatric Cardiology Unit at Tertiary Cardiac Care Centre, Rawalpindi, Pakistan, from Feb to Oct 2022.\u0000Methodology: Total of 62 patients fulfilling inclusion and exclusion criteria who underwent transcatheter VSD device closure were retrospectively identified from our institutional database by non-probability consecutive sampling technique. Preprocedural evaluation [Transthoracic Echocardiography (TTE) & Electrocardiography(ECG)], procedural details and immediate post procedure outcomes were documented. Follow-up evaluations were done at 6 and 12 months. It included clinical examination, TTE and 12 lead ECG. New onset and status of old complications were documented in each visit. SPSS version 24.00 was used to analyze data. Chi-square test was used to find association between study variables. p-<0.05 wasconsidered significant. \u0000Results: Sixty-two patients were followed up for upto 1 year after VSD device closure. Mean VSD size on Echo was 4.612.52mm. Successful closure was obtained in 54(87.0%) of cases out of 62. Complications documented during and immediately after procedure were transient arrythmias in 22(35.5%), residual leaks in 9(14.6%) which reduced to 3(4.8%) on 12 months follow up, device redeployment in 3(4.8%), complete heart block (cAVB) in 1(1.6%), device embolization in 1(1.6%), hemolysis in 2(3.2%), contrast related complications in 1(1.6%), aortic regurgitation (AR) in 4(6.4%). Death occurred in 1(1.6%) patient secondary to contrast related complications.\u0000Conclusion: Transcatheter VSD closure is a promising and safe treatment modality with high success rate. Complications ..","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"43 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950912","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10659
Sarwat Paiker Malik, Muhammad Nadir Khan, S. Kiani, Masood Khan, Fahad Khan Toru, Maida Anwar, Javeria Kamran, Naseem Azad
Objective: To determine the pattern of Coronary Artery Disease in patients presenting with Non ST-Elevation Acute Coronary Syndrome(NSTE-ACS) with a normal Electrocardiogram (ECG) and to assess the frequency of left circumflex artery as a culprit artery. Study Design: Analytical Cross-sectional Study. Place and Duration of Study: In Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi,Pakistan, from Aug 2022 to Jan 2023. Methodology: A total of n=118 patients with NSTE-ACS, presenting within 24-hours of symptoms onset, with a normal ECG reports, were recruited using non-probability consecutive sampling. Demographics, Ejection fraction, and Coronary angiography findings were noted. Coronary Angiography was done as per standard protocol. The number of diseased vessels was recorded. Data management and analysis were done on SPSS version-26;00. Mean±SD along with frequencies & percentages were used to express quantitative and qualitative variables respectively. Chi square and Student t-test were applied and p-value <0.05 was taken as statistically significant. Results: Out of the 118 patients, 86(72.0%) were males. Mean age of the patients was 60.269.67 years. The coronary angiography showed Triple Vessel Coronary Artery Disease (TVCAD) in 50(42.4%) patients, double and single vessel coronary artery disease in 22(18.6%) and 43(36.4%) patients, respectively. The culprit artery was found to be Left circumflex artery in 77(65.3%), left anterior descending in 69(58.5%) and Right coronary artery in 49(39.0%) of the patients. Conclusion: Majority of the patients with normal ECG and NSTE-ACS had TVCAD and the Left Circumflex artery was the most common Culprit in such patients.
{"title":"Pattern of Coronary Artery Disease and Frequency of Left Circumflex Artery as a Culprit in Patients of Non-ST Elevation Acute Coronary Syndrome with a Normal Electrocardiogram","authors":"Sarwat Paiker Malik, Muhammad Nadir Khan, S. Kiani, Masood Khan, Fahad Khan Toru, Maida Anwar, Javeria Kamran, Naseem Azad","doi":"10.51253/pafmj.v73isuppl-3.10659","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10659","url":null,"abstract":"Objective: To determine the pattern of Coronary Artery Disease in patients presenting with Non ST-Elevation Acute Coronary Syndrome(NSTE-ACS) with a normal Electrocardiogram (ECG) and to assess the frequency of left circumflex artery as a culprit artery.\u0000Study Design: Analytical Cross-sectional Study.\u0000Place and Duration of Study: In Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi,Pakistan, from Aug 2022 to Jan 2023.\u0000Methodology: A total of n=118 patients with NSTE-ACS, presenting within 24-hours of symptoms onset, with a normal ECG reports, were recruited using non-probability consecutive sampling. Demographics, Ejection fraction, and Coronary angiography findings were noted. Coronary Angiography was done as per standard protocol. The number of diseased vessels was recorded. Data management and analysis were done on SPSS version-26;00. Mean±SD along with frequencies & percentages were used to express quantitative and qualitative variables respectively. Chi square and Student t-test were applied and p-value <0.05 was taken as statistically significant.\u0000Results: Out of the 118 patients, 86(72.0%) were males. Mean age of the patients was 60.269.67 years. The coronary angiography showed Triple Vessel Coronary Artery Disease (TVCAD) in 50(42.4%) patients, double and single vessel coronary artery disease in 22(18.6%) and 43(36.4%) patients, respectively. The culprit artery was found to be Left circumflex artery in 77(65.3%), left anterior descending in 69(58.5%) and Right coronary artery in 49(39.0%) of the patients.\u0000Conclusion: Majority of the patients with normal ECG and NSTE-ACS had TVCAD and the Left Circumflex artery was the most common Culprit in such patients.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"58 16","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138950935","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10590
S. Kiani, A. Chaudhry, Faheem Ul Hassan
Coronary artery perforation is an infrequent yet serious complication of Percutaneous Coronary Intervention (PCI). Management includes conservative methods like prolonged balloon tamponade, emergency pericardiocentesis, in addition to implantation of covered stents, coil embolization of small vessels, as well as, Coronary Artery Bypass Graft (CABG) Surgery. Here we describe a unique case of coronary perforation management by using a man-made covered stent and an un-inflated semi-compliant balloon over a standard Drug Eluting Stent (DES).
{"title":"Cover to Make a Covered Stent: An Unusual Method of treating a Coronary Perforation","authors":"S. Kiani, A. Chaudhry, Faheem Ul Hassan","doi":"10.51253/pafmj.v73isuppl-3.10590","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10590","url":null,"abstract":"Coronary artery perforation is an infrequent yet serious complication of Percutaneous Coronary Intervention (PCI). Management includes conservative methods like prolonged balloon tamponade, emergency pericardiocentesis, in addition to implantation of covered stents, coil embolization of small vessels, as well as, Coronary Artery Bypass Graft (CABG) Surgery. Here we describe a unique case of coronary perforation management by using a man-made covered stent and an un-inflated semi-compliant balloon over a standard Drug Eluting Stent (DES).","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"133 20","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953641","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10517
Muhammad Umar Farooq, Imran Bashir, F. Younis, Syed Muzaffar Hasan Kirmani, Waqas Alam, Syed Ali Raza Ali Shah, Ayesha Sana, Javeria Kamran
Objective: To compare the effectiveness of combining Magnesium Sulphate with Amiodarone vs Magnesium Sulphate to prevent cardiac arrhythmias in Coronary Artery Bypass Grafting (CABG) patients. Study Design: Quasi-Experimental Study. Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Jul 2022 to Mar 2023. Methodology: Two hundred and sixty-two (n=262) Coronary Artery Bypass Graft patients, eligible for the study, wereenrolled through consecutive sampling and divided into group A - experiment group (3 mg/kg amiodarone+30 mg/kg magnesium sulphate was given, n1=131) and group B- control group (30 mg/kg magnesium sulphate was given, n2=131) by non-random allocation lottery method at the removal of the aortic cross-clamp. The statistical package for social science, SPSS version 26:00 was used to analyse the data. Mean±SD was calculated for continuous variables whereas for categorical variables, percentages and frequencies were calculated. Chi-square test was utilized to find the association and student t-test was applied to find the mean difference between the study groups. Results: Study participants consisted of 194(74.1%) males and 68(26.0%) females. The patients' mean age was 57.29±9.88 years and 58.30±10.69 years respectively, in group-A and group-B. The frequency of pre and post-operative cardiac dysrhythmias was considerably different in both groups. In group-A, 22(16.7%) patients developed dysrhythmias, while in control group,dysrhythmias occurred in 49 (37.4%) patients (p-value <0.001). Conclusion: Combined prophylactic therapy with amiodarone and magnesium sulphate significantly reduced the per and post-operative dysrhythmias in CABG surgeries.
目的比较硫酸镁联合胺碘酮与硫酸镁预防冠状动脉旁路移植术（CABG）患者心律失常的效果：准实验研究：研究地点和时间：巴基斯坦拉瓦尔品第武装部队心脏病研究所/国家心脏病研究所，2022 年 7 月至 2023 年 3 月：符合研究条件的262名（n=262）冠状动脉旁路移植术患者通过连续抽样的方式被纳入研究，并在移除主动脉交叉夹钳时通过非随机分配抽签法被分为A组--实验组（给予3毫克/千克胺碘酮+30毫克/千克硫酸镁，n1=131）和B组--对照组（给予30毫克/千克硫酸镁，n2=131）。数据分析采用 SPSS 26:00 版社会科学统计软件包。连续变量计算平均值±SD，分类变量计算百分比和频率。利用卡方检验（Chi-square test）找出相关性，利用学生 t 检验（student t test）找出研究组之间的平均差异：研究参与者包括 194 名男性（74.1%）和 68 名女性（26.0%）。A组和B组患者的平均年龄分别为（57.29±9.88）岁和（58.30±10.69）岁。两组患者术前和术后出现心律失常的频率差异很大。在 A 组中，22（16.7%）名患者出现了心律失常，而在对照组中，49（37.4%）名患者出现了心律失常（P 值<0.001）：结论：胺碘酮和硫酸镁联合预防治疗可显著减少 CABG 手术前后的心律失常。
{"title":"Comparing the Effect of Perioperative Amiodarone and Magnesium Sulphate Combination with Magnesium Sulphate for Prevention of Cardiac Dysrhythmias in Open Heart Surgeries: A Quasi-Experimental Study","authors":"Muhammad Umar Farooq, Imran Bashir, F. Younis, Syed Muzaffar Hasan Kirmani, Waqas Alam, Syed Ali Raza Ali Shah, Ayesha Sana, Javeria Kamran","doi":"10.51253/pafmj.v73isuppl-3.10517","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10517","url":null,"abstract":"Objective: To compare the effectiveness of combining Magnesium Sulphate with Amiodarone vs Magnesium Sulphate to prevent cardiac arrhythmias in Coronary Artery Bypass Grafting (CABG) patients.\u0000Study Design: Quasi-Experimental Study.\u0000Place and Duration of Study: Armed Forces Institute of Cardiology/National Institute of Heart Diseases Rawalpindi Pakistan, from Jul 2022 to Mar 2023.\u0000Methodology: Two hundred and sixty-two (n=262) Coronary Artery Bypass Graft patients, eligible for the study, wereenrolled through consecutive sampling and divided into group A - experiment group (3 mg/kg amiodarone+30 mg/kg magnesium sulphate was given, n1=131) and group B- control group (30 mg/kg magnesium sulphate was given, n2=131) by non-random allocation lottery method at the removal of the aortic cross-clamp. The statistical package for social science, SPSS version 26:00 was used to analyse the data. Mean±SD was calculated for continuous variables whereas for categorical variables, percentages and frequencies were calculated. Chi-square test was utilized to find the association and student t-test was applied to find the mean difference between the study groups.\u0000Results: Study participants consisted of 194(74.1%) males and 68(26.0%) females. The patients' mean age was 57.29±9.88 years and 58.30±10.69 years respectively, in group-A and group-B. The frequency of pre and post-operative cardiac dysrhythmias was considerably different in both groups. In group-A, 22(16.7%) patients developed dysrhythmias, while in control group,dysrhythmias occurred in 49 (37.4%) patients (p-value <0.001).\u0000Conclusion: Combined prophylactic therapy with amiodarone and magnesium sulphate significantly reduced the per and post-operative dysrhythmias in CABG surgeries.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"7 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138951954","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10671
Syed Ali Raza Ali Shah, S. S. Naqvi, Syed Muzaffar Hasan Kirmani, Syed Aqeel Hussain, Imran Bashir Malik, Muhammad Umar Farooq
Objective: To determine the dose of Protamine required for reversal of Heparin effect in Coronary Artery Bypass Grafting (CABG). Study Design: Quasi-experimental study. Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from May to Dec 2022. Methodology: Total 382 patients were included in this study through consecutive sampling and were divided into two groups (n=191 participants in each group). After induction of anesthesia, baseline Activated Clotting Time (ACT) was measured. About 300units/kg of unfractionated Heparin was given non-randomly before establishing Cardiopulmonary Bypass (CPB). After termination of CPB, Protamine was administered in doses of 1 mg/kg and 1.5 mg/kg to Group-A and Group-B respectively. Protamine was diluted in 20ml of saline, and administered at a rate of 100ml/hr. Once Protamine was administered, blood sample was taken after 5min for ACT measurement. If this ACT was within 10% of baseline, it was taken as sign for reversal of Heparin effect. Student t-test and Chi-square test were applied to compare the groups and level of significance taken was p<0.05. Results: Majority cases were males 287(75.1%), whereas 95(24.9%) were females. Statistically significant mean differences were noted between Cardiopulmonary Bypass (CPB) time, ACT after Protamine administration, and requirement for extra Protamine administration between two groups (p<0.05). However, no significant differences were noted between age, weight and ACT before Heparin administration .... Conclusion: Classical doses of 3mg/kg of Protamine in CABG patients may actually be exposing patients to higher than required ..........
{"title":"Dose of Protamine for Heparin Reversal in CABG Surgery","authors":"Syed Ali Raza Ali Shah, S. S. Naqvi, Syed Muzaffar Hasan Kirmani, Syed Aqeel Hussain, Imran Bashir Malik, Muhammad Umar Farooq","doi":"10.51253/pafmj.v73isuppl-3.10671","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10671","url":null,"abstract":"Objective: To determine the dose of Protamine required for reversal of Heparin effect in Coronary Artery Bypass Grafting (CABG).\u0000Study Design: Quasi-experimental study. \u0000Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart Diseases, Rawalpindi Pakistan, from May to Dec 2022.\u0000Methodology: Total 382 patients were included in this study through consecutive sampling and were divided into two groups (n=191 participants in each group). After induction of anesthesia, baseline Activated Clotting Time (ACT) was measured. About 300units/kg of unfractionated Heparin was given non-randomly before establishing Cardiopulmonary Bypass (CPB). After termination of CPB, Protamine was administered in doses of 1 mg/kg and 1.5 mg/kg to Group-A and Group-B respectively. Protamine was diluted in 20ml of saline, and administered at a rate of 100ml/hr. Once Protamine was administered, blood sample was taken after 5min for ACT measurement. If this ACT was within 10% of baseline, it was taken as sign for reversal of Heparin effect. Student t-test and Chi-square test were applied to compare the groups and level of significance taken was p<0.05.\u0000Results: Majority cases were males 287(75.1%), whereas 95(24.9%) were females. Statistically significant mean differences were noted between Cardiopulmonary Bypass (CPB) time, ACT after Protamine administration, and requirement for extra Protamine administration between two groups (p<0.05). However, no significant differences were noted between age, weight and ACT before Heparin administration .... \u0000Conclusion: Classical doses of 3mg/kg of Protamine in CABG patients may actually be exposing patients to higher than required ..........","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"15 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138953025","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 : 2023-12-21DOI: 10.51253/pafmj.v73isuppl-3.10514
Daniyal Ahmad Kamal, Muhammad Afsheen Iqbal, Sana Sarfraz, Atif Nawaz, Nasir Ali, Rehan Masroor, Fahad Ur Rehman, Ayesha Sana
Objective: To determine the efficacy of Ondansetron as a prophylctic agent in patients undergoing Coronary Artery Bypass Grafting. Study Design: Quasi-experimental study. Place and Duration of study: Adult Cardiac Surgery Department, AFIC/NIHD Rawalpindi Pakistan, from Nov 2022 to Feb 2023. Methodology: A total of 156 patients undergoing Coronary Artery Bypass Grafting Surgery irrespective of age and gender were included in the study via nonprobability consecutive sampling. Patients who had a previous history of psychiatric illness, and those in whom delirium could not be reliably tested were excluded from the study. The study population was divided into two groups (group A and group B). Those in the group A received 8mg Ondansetron intravenously on zero, first and second post-operative day. Group B did not receive any intervention. Descriptive statistics were used to measure percentages, frequencies and Mean±SD. Comparison between variables was made by Chi-square test for categorical variables and t-test for continuous variables. p<0.05 was considered statistically significant. Results: Total 156 patients were included in the study and mean age of the patients was 59.47±10.98 years. A total of 3(14.3%) patients who had been given Ondansetron compared to 18(85.7%) patients who were not given Ondansetron developed delirium (p<0.001). Other factors significantly associated with post cardiotomy delirium were age (p<0.001), hypertension (p<0.001), and diabetes (p=0.03). Conclusion: Our study revealed that Ondansetron can be used effectively to reduce the incidence of post cardiotomy delirium in patients of coronary artery bypass grafting.
{"title":"Ondansetron in the Prevention of Post Cardiotomy Delirium after Coronary Artery Bypass Grafting Surgery","authors":"Daniyal Ahmad Kamal, Muhammad Afsheen Iqbal, Sana Sarfraz, Atif Nawaz, Nasir Ali, Rehan Masroor, Fahad Ur Rehman, Ayesha Sana","doi":"10.51253/pafmj.v73isuppl-3.10514","DOIUrl":"https://doi.org/10.51253/pafmj.v73isuppl-3.10514","url":null,"abstract":"Objective: To determine the efficacy of Ondansetron as a prophylctic agent in patients undergoing Coronary Artery Bypass Grafting.\u0000Study Design: Quasi-experimental study.\u0000Place and Duration of study: Adult Cardiac Surgery Department, AFIC/NIHD Rawalpindi Pakistan, from Nov 2022 to Feb 2023.\u0000Methodology: A total of 156 patients undergoing Coronary Artery Bypass Grafting Surgery irrespective of age and gender were included in the study via nonprobability consecutive sampling. Patients who had a previous history of psychiatric illness, and those in whom delirium could not be reliably tested were excluded from the study. The study population was divided into two groups (group A and group B). Those in the group A received 8mg Ondansetron intravenously on zero, first and second post-operative day. Group B did not receive any intervention. Descriptive statistics were used to measure percentages, frequencies and Mean±SD. Comparison between variables was made by Chi-square test for categorical variables and t-test for continuous variables. p<0.05 was considered statistically significant.\u0000Results: Total 156 patients were included in the study and mean age of the patients was 59.47±10.98 years. A total of 3(14.3%) patients who had been given Ondansetron compared to 18(85.7%) patients who were not given Ondansetron developed delirium (p<0.001). Other factors significantly associated with post cardiotomy delirium were age (p<0.001), hypertension (p<0.001), and diabetes (p=0.03).\u0000Conclusion: Our study revealed that Ondansetron can be used effectively to reduce the incidence of post cardiotomy delirium in patients of coronary artery bypass grafting.","PeriodicalId":31059,"journal":{"name":"Pakistan Armed Forces Medical Journal","volume":"8 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138948623","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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