Early outcome of off-pump versus on-pump coronary revascularization

Introduction: The use of coronary artery bypass surgery (CABG) with cardiopulmonary bypass (CPB) or without CPB technique (off-pump) can be associated with different mortality and morbidity and their outcomes remain uncertain. The goal of this study was to evaluate the early outcome of on-pump versus off-pump CABG. Methods: We conducted a retrospective database review of 13866 patients (13560 patients undergoing onpump CABG and 306 patients undergoing off-pump CABG) at Tehran Heart Center between January 2002 and January 2007. We compared preoperative, operative, and postoperative  characteristics between them. Results: In-hospital mortality in the on-pump group was 0.8% compared to 0.7% in the off-pump group (P=0.999) and in-hospital morbidity was 11.7% and 6.5%, respectively  (OR: 1.533, 95%CI: 0.902-2.605, P=0.114). Postoperative atrial fibrillation was more prevalent in on-pump versus off-pump surgery (6.0% vs 3.0%, P=0.028), however there were no statistical significant differences in other postoperative   complications with regard to cardiac arrest (P=0.733), prolonged ventilation (P=0.363), brain stroke   (P=0.999), renal failure (P=0.525), and postoperative bleeding (P=0.999). The mean length of stay in hospital (P=0.156) and in ICU (P=0.498) was also similar between the two groups.Conclusion: The results from an Iranian population-based study showed similar early mortality and morbidity of off-pump CABG in comparison to on-pump surgery.Key words: Coronary artery bypass grafting, Off-pump, Cardiopulmonary bypass, Outcom

Surgical Treatment of Atrial Fibrillation

Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results

Endovascular Treatment of Isolated Bilateral Internal Ili- ac Artery Aneurysms with a Branched Endograft: A Case Report

Isolated bilateral internal iliac artery (IIA) aneurysm is a rare and potentially lethal disease. Endovascular repair of this disorder is a matter of debate. A symptomatic 68-year-old male presented with severe pelvic pains. Computed tomography revealed a leaking 46-mm aneurysm in the right IIA, a 27-mm aneurysm in the left IIA, and ectatic changes at a diameter of 31 mm in the right common iliac artery (CIA). Due to lower rates of morbidity and mortality, an endovascular approach was chosen instead of open surgical repair. However, due to anatomical constraints, an endograft had to be implanted in a healthy aorta in order to support an iliac branch endograft in the left CIA. Subsequently, following coil embolization of the left IIA, an iliac stent graft was extended to the right external iliac artery (EIA). Two-year follow-up CT imaging showed complete exclusion of all the aneurysms and patency of the pelvic visceral arteries. The patient is currently asymptomatic. Endovascular repair of bilateral isolated IIAs can be a feasible treatment option. However, due to limited availability of sizes in iliac branch devices currently on the market, a main body device is sometimes required to be deployed in a healthy aorta for additional endograft support

Main Pulmonary Artery Hydatidosis with Seconday Involvement of the Lungs: a Shepherd Boy’s Story

Cardiac hydatid cyst (CHC) is a rare disease that was endemic in some regions especially in sheep-raising areas. The most commonly accepted theory for the routes of heart involvement in hydatid cyst was infestation by the hexacanthus embryo through coronary arteries. Here, we describe a case with the primitive cardiac hydatid cyst located around the pulmonary valve (PV) and main pulmonary artery (mPA) extended to right and left pulmonary arteries and metastasized to both lungs. Could it be possible for the embryo to adhere PV and mPA directly

Post-Traumatic Chordae Rupture of Tricuspid Valve

Blunt injury to the chest can affect any one or all components of the chest wall and thoracic cavity. The clinical presentation of patients with blunt chest trauma varies widely and ranges from minor reports of pain to florid shock. Traumatic tricuspid valve regurgitation is a rare cardiovascular complication of blunt chest trauma. Tricuspid valve regurgitation is usually begotten by disorders that cause the right ventricle to enlarge. Diagnosis is made by physical examination findings and is confirmed by echocardiography. We report two cases of severe tricuspid regurgitation secondary to the rupture of the chordae tendineae of the anterior leaflet following non-penetrating chest trauma. Both patients had uneventful postoperative courses

Immediate Postoperative Complications in Patients Undergoing CABG; Investigating the Role of Prior Coronary Stenting

Introduction: Approximately 15 to 30% of patients undergoing percutaneous coronaryintervention (PCI) will require repeated revascularization. There is an ongoing debate concerningthe impact of prior PCI on subsequent coronary artery bypass graft (CABG) surgery. This studysought to compare immediate post-CABG complications between patients with and withoutprevious coronary stenting.Methods: A total of 556 CABG candidates including 73 patients with previous coronary stentingand 483 patients without prior stenting were enrolled in this retrospective-prospective study.Demographic information, cardiac markers (CK-MB, Troponin T), and postoperative dataincluding inotrope administration, intra-aortic balloon pump (IABP) use, bleeding, pathologicalelectrocardiography (ECG) changes, and overall complications were compared between the twogroups.Results: The mean age of the patients in stented group was significantly higher than that inunstented group (63.49±7.71 vs. 61.37±9.80 years, p=0.05). The mean serum level of TroponinT 12 h postoperation was significantly higher in the same group (323.26±33.16 vs. 243.30±11.52ng/dL; p=0.03). Comparing the stented and unstented groups, the rates of inotrope use (17.8% vs.7.2%; p=0.003), significant bleeding (15.1% vs. 4.3%; p=0.001), and overall complications (32.9%vs. 11.6%; odds ratio: 3.74 with 95% confidence interval of 2.13-6.55, p<0.001) were significantly higher in the former group. The association between overall complications and prior stenting was independent (odd ratio: 3.06). No significant connections were found between postoperative complications and stent number or type.Conclusion: A positive history of previous coronary stenting significantly increases the risk of immediate post-CABG complications

Pulmonary Valve Bacterial Endocarditis in Tetralogy of Fallot

We report two cases of Tetralogy of Fallot with pulmonary valve bacterial endocarditis where one extended to the branch of pulmonary artery (PA). This is a rare occurrence. Aggressive supportive care plus early and radical surgery can be life saving

Coronary Artery Bypass Grafting Combined with Total Occlusion of Internal Carotid Artery

Background: The presence of significant carotid stenosis in coronary artery bypass grafting (CABG) patients increases the risk of either transient ischemic attack or stroke. However, there is a dearth of data on the risk for patients with unilateral total occlusion of the carotid artery. We herein report our results of cardiac surgery in patients with unilateral total occlusion of the carotid artery. Methods: We examined 10,000 patients who underwent carotid artery duplex scanning before CABG or other cardiac procedures between January 2001 and September 2006 at Tehran Heart Center. The occlusions were detected via carotid Doppler screening and were confirmed through conventional or MR angiography. Among these patients, 15 (0.15%) patients had unilateral total occlusion of the internal carotid artery, and all of them underwent elective cardiac surgery. During cardiopulmonary bypass, the mean arterial pressure was maintained at above 60 mmHg with vasopressure drugs and increasing flow pump.Results: There were 4 patients with left and 11 patients with right carotid occlusions. Four patients had a history of cerebrovascular accident. The mean cross-clamp time (min) and perfusion time (min) was 50.7±17.3 and 94.2±26.7, respectively. The mean graft number was 4.1±0.9. One of these patients expired intraoperatively because of low cardiac output. In one (6.66%) patient, postoperative cerebrovascular accident occurred on the contralateral side of the totally occluded region. All the patients recovered uneventfully. Conclusion: Our results suggest that CABG can be performed in patients with unilateral total occlusion of the internal carotid artery without ipsilateral stroke using our strategies

Hopelessness among adults with congenital heart disease: Cause for despair or hope?

Adults with congenital heart disease (CHD) face unique life courses and challenges that may negatively influence their psychological functioning. The aims of this study were to (1) examine the level of hopelessness among adults with CHD in comparison with non-CHD participants and (2) identify correlates of elevated hopelessness among adults with CHD.publisher: Elsevier articletitle: Hopelessness among adults with congenital heart disease: Cause for despair or hope? journaltitle: International Journal of Cardiology articlelink: http://dx.doi.org/10.1016/j.ijcard.2016.12.090 content_type: article copyright: © 2016 Elsevier Ireland Ltd. All rights reserved.status: publishe

Takayasu’s Arteritis Presenting with Headache and Peripheral Facial Palsy: A Case Report

Takayasu’s arteritis (TA) is a rare case of granulomatous arteritis which mainly involves the aorta and its large branches. Although arterial hypertension is the most common feature of the disease in both adults and children, patients with TA may present with numerous clinical manifestations. Our patient was a 45-year-old woman, known to have hypertension from 3 years earlier following assessments made for severe headache. One year after the diagnosis of hypertension, she developed a left-sided lower motor neuron facial palsy, which was treated with oral corticosteroids (Prednisolone). Notably, the patient's headache was relieved after she took corticosteroid therapy. Transthoracic echocardiography revealed severe aortic insufficiency and aneurysmal changes in the ascending aorta, and she was referred to our center for further evaluation. In multi-slice computed-tomography angiography, significant long stenosis of the left subclavian artery was seen and the diameter of the ascending aorta was 50 mm. The patient underwent the Bentall operation. The pathologic examination of the aortic wall specimen was compatible with giant cell aortitis and more in favor of TA with the ascending aortic aneurysm. At 6months' follow-up, the patient was in good condition and had almost recovered from facial palsy.