Introducing a Method for Safe Air Evacuation from Oxygenator in Cardiac Surgery Operating Rooms during COVID-19 Pandemic

Covid-19 pandemic provides new perspectives and possibly permanent changes in some existing guidelines and safety principles. Evacuated air from the exhaust reservoir and oxygenator, after close contact with the patient’s blood added contaminated secretions, drain into the operating room, a potential source for contamination. There are two air exhaust ways from the oxygenator in cardiopulmonary bypass (CPB) circuit; which might be the potential carrier of the Covid-19 virus and resulting contamination. In the current design, these two exhausts are connected to one antibacterial and antiviral filter and then they will attach to the ventilator's exhaust port with a three-way connector, in such a way that the contaminated air will be vented outside the operating room. It is recommended to use antibacterial and antiviral filters in the passage way of the contaminated air coming from Reservoir and Oxygenator exhaust, to be directly guided outside the operating room. In this article, this design is fully described

Increased Demand for Blood Transfusion in Cardiac Surgery: Simple but Unsolved Common Problem

Background: Despite the general concern about the safety of blood transfusion and mounting evidence exist for more restrictive practice; there is no national consensus guideline and uniformity of institutions for blood transfusion associated with coronary artery bypass graft surgery in Iran. The aim of this study is an assessment of current transfusion practice and compares it with one decade ago.Method: The authors retrospectively analyzed the data of all patients undergoing elective surgery (first time operation) during one year, in two different decade interval (2003 and 2015) in a tertiary heart center.Results: A total of 801 patients were evaluated and compared (n=249 in 2015, n=552 in 2003). There is a significant increase in use of blood transfusion in both operating room and at ICU than the last decade (60.6% vs. 42.4%, P<0.001, and 54.4% vs. 39.9%, P <0.001, respectively). The incidence of preoperative anemia was four times higher in patients who received transfusion, compared to those who did not, in both groups. With compared to the past, the patients are older, have less preoperative hematocrit, more diabetic, more need to intra-aortic balloon pump, shorter operation time, and less postoperative bleeding .Conclusion: With advanced knowledge about transfusion complications and conservative approach to transfusion practice, the need to blood transfusion is increased in current cardiac operations in our center, due to association of more co-morbidities

Should a forgotten guidewire be removed after years? An undesirable complication of hemodialysis catheter wire left in the body

Today, one of the most common methods used in the emergency room or intensive care unit (ICU) in patients is the Seldinger technique to access the central venous system, shunting for hemodialysis, intra-aortic balloon pump, or arterial insertion. Accidental leaving of the guide wire is an uncommon but important complication that can occur as a result of an incorrect technique, and it is sometimes found accidentally or due to complications years after the procedure. The case is a 53-year-old patient who underwent aortic valve replacement with a mechanical valve and mitral valve repair with a ring 12 years ago and was treated with warfarin. Two years after the heart surgery, due to chronic renal failure, the patient underwent dialysis, and after the preparation of an arteriovenous fistula, he underwent stenting. After approximately ten years, the patient developed fever, chills, and shortness of breath. During the examination, endocarditis was diagnosed, and a part of the aortic valve was released. There was a severe paravalvular leak in the aortic valve, and an abscess was formed in the aorta root. We also noticed a forgotten guide wire in the superior vena cava, right atrium, inferior vena cava, and hepatic vein, and echogenic masses were located on the guidewire. The diagnosis was confirmed by echocardiography, chest x-ray, and phenocopy. After antibiotic therapy, the patients underwent heart surgery, aortic valve replacement, and aortic root repair, and the guidewire was removed (70 cm long). Unfortunately, despite all measures, the patient died a few days after the surgery. Due to complications, a forgotten guidewire should be removed immediately after diagnosis. The preferred intervention is the removal of the guidewire by endovascular interventions, but surgical treatment should also be considered in some cases

Diagnostic value of mitral Z-value in mortality of patients with tetralogy of Fallot: A seven-year experiment

Background: Tetralogy of Fallot (TF) in some Iranian patients is different in that the mitral z-value is significantly lower than normal. The present study was conducted to investigate the effect of the mitral Z-value on post-surgery mortality. Materials and Methods: The present retrospective analytical study was conducted on surgery candidate patients diagnosed with TF who had attended Shahid Modarres Hospital in Tehran between late March 2012 and late March 2019. Once the type of treatment and the need for surgery were decided and the mitral size and Z-value were determined, the patients underwent surgery, and then divided into two groups based on the outcome (death or discharge). Results: A total of 160 patients entered the study over seven years, of whom, 110 were discharged (group 1) and 50 died (group 2). There were no significant differences between the two groups in terms of gender. The patients' mean age was 8.96±8.09 years in the group 1 and 3.16±2.7 years in the group 2 (P<0.000). Mean mitral Z-value was -2.26±2.11 in the group 1 (ranging from -7.1 to +1.3) and -3.48±1.71 in the group 2 (ranging from -6 to -1.1), and Independent Sample Test showed no significant difference between the two groups (P=0.271). Conclusion: The mitral Z-value was significantly lower than normal in participating patients with TF, which could indicate hypo-plasticity of the left ventricle in Iranian patients with TF. No significant difference was found between the two groups in terms of surgical complications. In other words, the mitral Z-value had no effect on mortality of patients with TF

The Dilemma in Treatment of hemodialysis patients with catheter-induced right atrial thrombi (CRAT): A case report

Catheter-induced right atrial thrombi (CRAT) is a serious complication of central venous catheterization. Herein we report a case of large hypermobile right atrial thrombi in a 57-year-old man with hemodialysis catheter in the right internal jugular vein

Massive cardiac vegetation and cardiomyopathy in a 23‐year‐old rancher with brucellosis

Key clinical massage A 23‐year‐old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications. Abstract Brucellosis (also known as “undulant fever,” “Mediterranean fever,” or “Malta fever”) is a zoonotic infection transmitted to humans from infected animals (cattle, sheep, goats, camels, pigs, or other animals) by ingestion of food products (such as unpasteurized dairy products) or by contact with tissue or fluids. It is the most frequent zoonosis globally and a major public health issue in many resource‐poor nations. Endocarditis is one of the rarest and most dangerous consequences of brucellosis. Additionally, the combination of endocarditis with cardiomyopathy increases its rarity. This condition is usually treated with a high level of suspicion Serological, clinical, and epidemiological data can all be used to make a diagnosis. The use of echocardiography aids in the early diagnosis. Due to the high risk of recurrence and the extent of tissue destruction brought on by Brucella, the majority of experts advise an early surgical intervention; nevertheless, other writers assert that low‐risk patients also require cautious therapy. In this article, we discuss the situation of a patient who underwent surgery and had Brucella endocarditis and heart failure. In conclusion, a combination of antibiotic therapy and cardiac surgery, reduces mortality and complications associated with Brucella endocarditis and improves patient quality of life

Successful Surgical Intervention in An Unusual Case of Aspergillus Endocarditis with Acute Myeloid Leukemia

Endocarditis due to Aspergillus infection is a rare complication in patients with hematological malignancies. Here, we present a case of aspergillus endocarditis in a patient with acute myeloid leukemia (AML) successfully treated with antifungal therapy and surgical treatment. The patient was a 51 years old male, a known case of AML who was admitted to our medical center for evacuating his valvular vegetations and repairing his atrial septal defect. He underwent an open heart surgery to relinquish his thromboses and also received an antifungal regimen. The patient tolerated the procedure well and eight months after his surgery, the patient remains asymptomatic. Successful treatment of this severe case of aspergillus endocarditis justifies a multidisciplinary method to be as a safe and effective approach to manage these patients

Surgical Treatment of Primary Intracardiac Myxoma: 20-Year Experience in “Shahid Modarres Hospital”—A Tertiary University Hospital—Tehran, Iran

Although cardiac tumors are not common they may vary in terms of race and surgical approach in different countries. Method. Patients data of 20 years was collected and evaluated in the “Shahid Modarres Hospital”—a tertiary university hospital—Tehran, Iran. Results. 42 patients with cardiac myxoma (all cases in 20 years) were included in study, 17 males and 25 females, age difference: 13 to 76 years (mean 50.6). Most of patients were in functional classes I, II. 35 patients complained of dyspnea and 3 patients had embolic events. 97.6% of tumors were primary (41 patients) and one tumor was recurrent (2.4%), 85.7% of tumors (36 cases) were located in LA, and 88.1% of tumors (37 cases) were pediculated. 40 patients (95%) had one tumor. In 22 patients (52.3%) after tumor resection septal defects were repaired primarily while in 18 patients (42.8%) the defects were repaired with pericardial patch and In one patient, tumor resected without any septal defect. Mean tumor size was about 5.22 cm (range of 2.2 to 8.2 cm). Postoperatively, 33 patients discharged from hospital without any complication. Discussion. The research reveals that patients’ age and gender were similar to that of other studies in other countries while tumor’s incidence seems to be higher. 3 patients were diagnosed after remote embolic event and one patient was diagnosed after MI reflecting relatively high tumor complications and late diagnosis. Conclusion. In our study mean time from diagnosis to operation was too long. The patients had more preoperative embolic events and complication. However, size of myxoma and location of that was as same as its rate in the other literature. As recommendation we suggested that in all patients with vague chest pain or remote embolic events cardiac myxomas should be ruled out

The role of connective tissue genomics in ascending aortic dissection: A case of Marfan syndrome

Background: Aortic dissection is a rare yet life threating condition with some already discovered risk factors namely hypertension, connective tissue disorders such as Marfan syndrome (MFS), cocaine abuse and cigarette smoking.Case report: In this article we would like to present a case of MFS who presented with severe chest pain and undergone Bentall surgery due to aortic dissection and aneurysm.Conclusion: Although many risk factors and preventive measures are already investigated, there is no definite method to avoid its occurrence in genetically predisposed patients such as MFS. Patient-specific models utilizing embryonic stem cells (ESC) and induced pluripotent stem cells (iPSC) may offer some advantages