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Pulmonary Hypertension Following Cardiac Surgery in Children with Down Syndrome: A Review
Abubakar Umar,
Abdullahi A. A.
Issue:
Volume 5, Issue 2, March 2019
Pages:
26-30
Received:
13 December 2018
Accepted:
10 January 2019
Published:
20 May 2019
Abstract: Pulmonary hypertension is a known complication in children with congenital heart lesions especially those with left-to-right shunts. Children with Down syndrome are known to have certain types of congenital heart lesions like atrioventricular septal defect, ventricular septal defect, patent ductus arteriosus etc. These lesions can cause pulmonary hypertension if left untreated in any child. In those with Down syndrome, pulmonary hypertension is said to be worse. Several factors have been identified. These factors are upper airway obstruction that is common in all children with this syndrome, abnormality in their pulmonary vascular bed, lower levels of nitric oxide production which is a known vasodilator, abnormalities in their immune system which predisposes them to respiratory tract infection, gastroesophageal reflux disease and recently pulmonary hemosiderosis has been reported. Therefore, children with Down syndrome being prepared for cardiac surgery should be thoroughly evaluated and if possible measures should be taken to minimize untoward effects of these factors.
Abstract: Pulmonary hypertension is a known complication in children with congenital heart lesions especially those with left-to-right shunts. Children with Down syndrome are known to have certain types of congenital heart lesions like atrioventricular septal defect, ventricular septal defect, patent ductus arteriosus etc. These lesions can cause pulmonary h...
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Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG
Ahmed Saber Ibrahim Elsayed,
Khalid Ragab Abdelsamad Eid
Issue:
Volume 5, Issue 2, March 2019
Pages:
31-40
Received:
7 April 2019
Accepted:
23 May 2019
Published:
5 June 2019
Abstract: Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation between them. This study aims at tracing the occurrence of the proposed adverse complications after primary CABG operations related to HbA1c values>8.6% in diabetics subjected to tight glycemic control; in a trial to conclude how far the value of HbA1c could be accepted to carry out the surgery safely. Methods:This prospective study included 80 adult diabetic patients who presented with IHD requiring primary CABG. It was conducted between January 2016 and December 2018. Group (I) included 42 patients with HbA1c values<8.6% and group (II) included 38 patients with HbA1c values>8.6%. We compared the following: perioperative MI, low cardiac output syndrome, operative mortality, rhythmic complications, hemorrhagic complications, respiratory complications, cerebrovascular accidents, acute renal failure development, superficial and deep surgical wounds infections, overall hospital complications and overall one-year mortality and survival. Results: Mean HbA1c% value was 7.5 ± 1.11% for group (I) and 9.3 ± 1.03% for group (II). Prior to surgery, the mean FBG level was 136.9±41.7 mg/dl for group (I) and 152.2±27.3 mg/dl for group (II) with tight glycemic control measures. Although group (II) showed higher values in the studied parameters (pre-, intra- and post-operatively), no statistically significant differences appeared between the two subsets of patients regarding the proposed adverse complications. The overall hospital complication rate was 13(30.95%) and 14(36.84%) for group (I) and (II) respectively (p>0.05). In the follow-up period, both groups expressed comparable results with no statistical significance. The overall one-year survival was 95.23% and 94.73% in group (I) and (II) respectively (p>0.05) and the overall mortality was 5% (two deaths from each group) (p>0.05). Conclusion:Although patients with IHD undergoing primary CABG and having decompensated diabetes with HbA1c values>8.6% have more insulted cardiovascular condition, these higher HbA1c values do not add more additional impact on the proposed adverse intra- and postoperative complications as with lower values with the aid of strict (tight) glycemic control measures in the immediate preoperative period.
Abstract: Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation ...
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Coronary Endarterectomy Improve Left Ventricle Ejection Fraction After Coronary Artery Bypass Grafting Surgery
Manochihr Timorian,
Mirwais Amiri,
Abdullah Alimi
Issue:
Volume 5, Issue 2, March 2019
Pages:
41-46
Received:
28 March 2019
Accepted:
28 May 2019
Published:
10 June 2019
Abstract: The diffusely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel. It may assures complete revascularization of myocardium in case of diffusely diseased vessels and prevent residual ischemia but it has not been widely used. recently cardiac surgeons are performing and increasing number of coronary artery endarterectomy and it has evolved as an important adjuvant procedure in coronary artery bypass grafting surgery. we reviewed the early clinical and hemodynamic out comes with echocardiography of 22 patients undergoing coronary artery endarterectomy of left anterior descending artery (LAD) diagonal branches (D1 or D2) and right coronary artery and posterior descending artery (RCA and PDA) with patch plasty method using left internal mammary artery (LIMA) and saphenous vein graft (SVG) between January 2017 and June 2018. mean follow up of all patients were 3-6 months postoperatively, Left internal mammary artery (LIMA) anastomosed to left anterior descending artery (LAD) with endarterectomy and artery patch plasty in 12 (54, 5%) patients, saphenous vein graft (SVG) anastomosed to left anterior descending artery (LAD) with endarterectomy and vein patch plasty in 2 (9%) patients, and saphenous vein graft (SVG) to Right coronary artery (RCA) Diagonal (D1) and posterior descending artery (PDA) with endarterectomy and vein patch plasty in 9 (40.9%) patients. Postoperative mortality was 0% and echocardiographic assessment done by modified Simpson method on outpatient department (OPD) basis, 7 patients had left ventricle ejection fraction of (50-55%) preoperatively with no changes on postoperative period and 7 patients had improvement of left ventricle ejection fraction from (30-35%) preoperatively to (40-45%) in postoperative period. principle goal in coronary artery bypass grafting surgery (CABG) is to achieve complete revascularization of diseased coronary arteries, in particular the left anterior descending artery (LAD) is very important vessel because incomplete revascularization of the LAD has been proven to be a predictor of worse mortality after coronary artery bypass grafting surgery (CABG). Recent publications have revealed that coronary endarterectomy is a safe procedure and demonstrated favorable long term out comes. In our experience coronary endarterectomy has been performed with good clinical and hemodynamic out comes with echocardiography.
Abstract: The diffusely diseased coronary artery is a challenge for cardiac surgeons, although coronary endarterectomy is an option for surgical reconstruction of a diffusely diseased vessel. It may assures complete revascularization of myocardium in case of diffusely diseased vessels and prevent residual ischemia but it has not been widely used. recently ca...
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Refractory Hypotension post Coronary Artery Bypass Graft Unmasking Hypoaldosteronism: Case Report and Literature Review
Carla Sawan,
Nadine Kawkabani,
Youmna Francis,
Omar Boustros,
Simon Bejjani,
Fadi Abou Jaoudeh,
Rola Darwiche,
Bassam Abou Khalil
Issue:
Volume 5, Issue 2, March 2019
Pages:
47-50
Received:
27 March 2019
Accepted:
17 May 2019
Published:
12 June 2019
Abstract: The sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) are the cornerstones of cardiovascular adaptation. The simultaneous presence of disorders involving both is not uncommon, especially in patients with coronary artery disease undergoing coronary artery bypass surgery (CABG). This is the case of a patient with both hyporeninemic hypoaldosteronism and autonomic dysfunction. This article describes his clinical course before and after CABG surgery, along with a literature review of those interrelated entities. Our patient is a 63-year-old male with a history of hypertension and hyperlipidemia presenting for CABG for triple vessel disease. On the day of admission, the patient had sudden unprovoked loss of consciousness along with hypotension and bradycardia. He reported having had similar episodes in the past at times of emotional stress. After stabilization, the patient underwent CABG surgery the next day and it was uneventful. Four hours later, he developed another episode of hypotension with bradycardia which resolved upon administration of fluids. On postoperative day 2, while removing the jugular line, he had loss of consciousness with 5 seconds pause recorded on his bedside monitor. A carotid massage confirmed carotid sinus hypersensitivity, which necessitated the insertion of a pacemaker. However, patient continued to have similar episodes despite a functioning device. Workup revealed hyporeninemic hypoaldosteronism with an undetectable aldosterone level, although patient was not diabetic, had normal cortisol level, and had no other risk factors for those findings. Patient was started on fludrocortisone 0.1 mg daily; his hemodynamics improved markedly, and his symptoms resolved permanently. Our patient has hyporeninemic hypoaldosteronism caused most likely by his autonomic dysfunction, rather than having of two separate entities. A review of the literature showed that primary autonomic insufficiency with reduced circulating norepinephrine levels prevent renin activation and subsequently aldosterone release, leading to hyporeninemic hypoaldosteronism. Coronary artery disease is a known cause of autonomic dysfunction and CABG surgery unmasks this entity, which explains the exacerbation of our patient’s symptoms during this phase.
Abstract: The sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) are the cornerstones of cardiovascular adaptation. The simultaneous presence of disorders involving both is not uncommon, especially in patients with coronary artery disease undergoing coronary artery bypass surgery (CABG). This is the case of a patient with both hyp...
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Effect of Levosimendan Infusion 24 Hours Before CABG Surgery in Patients with Impaired Left Ventricular Function on the Need for Postoperative IABP
Sherif Nasr,
Hesham Alkady,
Ahmed Saber,
Ahmed Elsharkawy,
Eman Mahmoud
Issue:
Volume 5, Issue 2, March 2019
Pages:
51-55
Received:
4 May 2019
Accepted:
2 June 2019
Published:
12 June 2019
Abstract: Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.
Abstract: Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function afte...
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