The value of pericardial window in preventing pericardial effusion after cardiac surgery

Background: Pericardial window (PW) is a technique that allows the passage of fluid from the pericardial to the pleural cavity to reduce the postoperative pericardial effusion. The purpose of this study was to evaluate the effectiveness of the pericardial window in decreasing pericardial effusions after cardiac surgery. Methods: The study included 400 adult patients who underwent cardiac surgery from 2017 to 2020. Patients were randomly assigned into two groups; the pericardial window (PW) group included 200 patients who underwent posterior pericardiotomy, and the control group included 200 patients who did not undergo this procedure. Results: Preoperative data were comparable between both groups. More patients in the PW group had chest tube drainage more than 500 cc/ 24 hours (40 (20%) vs. 5 (2.5%), respectively; p=0.005). The drainage of 500 cc/24 hours or more in the mediastinal tube was lower in the PW group (10 (5%) vs. 40 (20%) patients in the PW and control groups, respectively; p<0.001). Early pericardial collection occurred in 6 patients in the PW group (3%) vs. 46 (23%) in the control group (p<0.001), and no patient had late effusion in the PW group vs. 26 (13%) in the control group (p< 0.001). Six patients in the PW group (3%) had postoperative atrial fibrillation and 12 patients (6%) in the control group (p= 0.23). Pulmonary complications were nonsignificantly higher in the PW group (Lung collapse: 40 (20%) vs. 26 (13%); p=0.08 and pleural effusion: 34 (17%) vs. 26 (13%); p= 0.3, in the PW vs. control groups, respectively). Conclusion: Posterior pericardiotomy is a simple technique that could reduce postoperative pericardial effusion, atrial fibrillation, and the pericardial tamponade. The technique did not increase the postoperative complications compared to the standard method

Assessment of left ventricular function and aortic elastic properties in patients with Behçet’s disease using conventional and tissue Doppler echocardiography

AbstractBackgroundBehçet disease (BD) is a multisystemic, chronic inflammatory disorder of unknown etiology with diffuse clinical manifestations including the cardiovascular system.Aim of the workTo assess left ventricular (LV) function and thoracic aorta elastic properties in BD patients using Doppler echocardiography and to correlate echocardiographic findings with disease activity.Patients and methodsThe LV functions and thoracic aorta elastic properties were assessed in 30 BD patients and 30 controls using conventional and Tissue Doppler Imaging (TDI) echocardiography. Disease activity was evaluated using Behçet’s disease current activity form (BDCAF). Erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), cholesterol and triglyceride levels were measured.ResultsIn BD patients, ESR and CRP were significantly elevated while cholesterol and triglycerides were comparable to the levels in the control. In conventional echocardiography, BD patients had significantly higher aortic diastolic diameter (p<0.05), aortic stiffness index (p<0.001), isovolumic relaxation time (p<0.001), flow propagation velocity (FPV) and peak E-wave velocity/FPV (E/FPV) (p<0.001) than the control group while aortic strain was significantly lower in BD patients (p<0.05). Lateral mitral TDI echocardiography showed that myocardial performance index was statically higher in BD patients (p<0.001) while peak myocardial velocity and myocardial acceleration during isovolumic contraction were significantly lower (p<0.001). The BDCAF showed a significant correlation with different echocardiographic parameters of systolic and diastolic dysfunction.ConclusionsBehçet disease patients have impaired LV systolic and diastolic functions and altered aortic elastic properties that correlate with disease activity. TDI is more sensitive than conventional echocardiography for the detection of early ventricular dysfunction in patients with BD

Assessment of the effect of percutaneous coronary intervention on left ventricular function in patients with coronary artery disease using tissue doppler strain rate imaging

Objectives: this study aimed to assess the effects of percutaneous coronary intervention (PCI) on regional and global left ventricular (LV) functions (systolic and diastolic) in patients with coronary artery disease (CAD) using tissue Doppler strain rate (SR) imaging. Patients and Methods: in this study, we randomly assigned 100 Egyptian adult symptomatic patients with CAD that underwent coronary angiography and candidate for PCI on the left anterior descending artery. LV early diastolic and systolic SR were measured 24 h before and 48 h after PCI. Results: Most of the LV diastolic and systolic parameters (A, E', E/A, E/E', and isovolumic relaxation time [IVRT]) showed significant difference before and after elective PCI, while mitral E velocity, DT, and pulmonary vein flow before and after PCI did not show significant difference. SR imaging findings showed high significant difference mean peak systolic and mean early diastolic SR of ischemic regions after PCI; mean early diastolic SR before PCI was 1.86 ± 0.13 while after PCI was 2.57 ± 0.18 (P < 0.001) and mean peak systolic SR before PCI was 0.65 ± 0.18 while after PCI was 0.901 ± 0.15 (P < 0.001). Conclusion: Most of the LV diastolic and systolic parameters (A, E', E/A, E/E', and IVRT) improved after PCI in CAD patients. Furthermore, regional myocardial function as measured by mean peak systolic and mean early diastolic SR in the ischemic segments improved significantly compared with that in nonischemic segments