The Effects of Vitamin D3 in Pediatric Patients Undergoing Congenital Heart Surgery

Background: To investigate the effects of vitamin D3 on the surgical outcome of pediatric patients undergoing cardiac surgery for congenital heart conditions. Materials and Methods: Ninety pediatric cardiac surgery patients referred for preoperative evaluation were enrolled. Patients with insufficient vitamin D3 levels received intramuscular vitamin D3 (300,000 IU) three days before the surgery and those with final vitamin D3 level of ≥30 ng/dl were included and divided into 3 groups (Group A: abnormal Vit D levels, no Vit D treatment; Group B: abnormal Vit D levels, Vit D treatment up to normal serum Vit D levels before surgery; Group C: normal baseline Vit D levels, no supplemental Vit D treatment). Interleukin 1, 6, 10, tumor necrosis factor-alpha, vital signs, and arterial blood gas parameters were measured before the surgery and at 6 and 24 hours after cardiopulmonary bypass. Data on total hospital stay, reoperation rates, and inotropes scores were retrieved. Additionally, postoperative measures including hemodynamic factors, blood pressure, heart rate, cardiac output, electrocardiography changes, chest-tube drainage, and ventilation-related factors (i.e. respiratory rate, arterial blood gas, respiratory resistance, intubation time, …) were recorded. Results: We observed a significant increase in post cardiopulmonary bypass levels of IL-10 and IL-6 in all groups (p<0.002) regardless of vitamin D treatment status; however, no significant difference was seen in levels of IL-1 and TNF-alpha. Groups B had more patients with critical levels of VIS scores compared to groups A and C (p<0.002). Furthermore, no differences in hemodynamic and metabolic parameters were observed. Conclusion: No significant difference in the rates of postoperative parameters in patients with normal and those with deficient levels of vitamin D3 was observed

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

Mitral Valve Surgery in Patients with Systemic Lupus Erythematosus

Valvular heart disease is the common cardiac manifestation of systemic lupus erythematosus (SLE) with a tendency for mitral valve regurgitation. In this study we report a case of mitral valve replacement for mitral stenosis caused by Libman-Sacks endocarditis in the setting of SLE. In addition, we provide a systematic review of the literature on mitral valve surgery in the presence of Libman-Sacks endocarditis because its challenge on surgical options continues. Surgical decision depends on structural involvement of mitral valve and presence of active lupus nephritis and antiphospholipid antibody syndrome. Review of the literature has also shown that outcome is good in most SLE patients who have undergone valvular surgery, but association of antiphospholipid antibody syndrome with SLE has negative impact on the outcome

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

Hydatid Cyst in a 10-Year-Old Boy: An Unusual Location

Hydatid disease, caused by echinococcus granulosus, is a common infectious disease in endemic areas such as Southern Europe and the Middle East. The incidence of this disease, however, is on the increase in Northern Europe due to the migration of labor and also tourism. We report a case of the hydatid cyst of the mediastinum, the diagnosis of which was established by the hemagglutinin test and echocardiography and confirmed by histological examinations. The cyst was totally removed during surgery on beating heart. The patient presented herein demonstrates that the mediastinal and cardiac involvement in hydatid disease could manifest in children with fast growth and rupture

Loss of Guide Wire: A Rare Complication of Intra-Aortic Balloon Pump Insertion

At the final stages of a coronary artery bypass graft operation on a 64-year-old man, an experienced physician attempted to insert an intra-aortic balloon pump into the femoral artery via the Seldinger technique. However, while the balloon pump was being passed over the guide wire, the latter was completely lost. The guide wire should be held at the tip at all times to prevent passage into the vessel. Strict adherence to this rule will prevent guide-wire loss, which is, albeit rare and completely avoidable, a potentially life-threatening complication of central vein or artery catheterization, with reported fatality rates of up to 20% when the whole wire is lost. The literature contains several reports on guide-wire loss during central venous, arterial, and hemodialysis catheterization, but we report for the first time the loss of a guide wire as a rare complication of intra-aortic balloon pump insertion

Large right ventricular hydatid cyst in a child: a case report

Abstract Background Cystic Hydatid disease is a parasitic infection with a worldwide distribution. It is caused by the larval stages of a species of tapeworms known as Echinococcus granulosus. Even in endemic areas; Cardiac involvement by hydatidiosis is very rare and has atypical presentations as well as localization which make it undiagnosed in about 10% of cases. The left ventricle is the most Common chamber involved by the hydatid cyst and isolated involvement of the right ventricle is very rare, especially in children. The aim of the present study was to describe hydatid cardiac cyst of the right ventricle of a child. Case presentation We present a rare case of an 8 year-old boy, living in a rural area, who was diagnosed with a cardiac hydatid cyst in the right ventricle. He also had multiple pulmonary hydatid cysts and presented with dyspnea, cough and atypical chest pain. The patient underwent surgery for the resection of pulmonary cysts and, subsequently, cardiac hydatid cyst. The outcome was favorable seven weeks after surgery and there was no clinical and echocardiographic recurrence. Conclusion Cardiac Echinococcosis must be suspected in endemic areas, diagnosed with appropriate imaging techniques, and treated appropriately

Guillain–Barré Syndrome after Coronary Artery Bypass Graft Surgery: a Case Report

Guillain-Barre syndrome is a neurologic disorder that may appear after infection or major surgery.  Guillian-Barre syndrome following cardiac surgery is rare and only based on case reports, and we review all of the published cases. A 52-year-old man after 5 months suffering from chest pain was referred to our hospital and underwent coronary artery bypass graft for 3 vessel disease. The patient was discharged without complication on the 5th postoperative day. He presented Guillain- Barre syndrome after 12 months. He has not completely recovered weakness of upper extremities grade 4/5 with atrophy of both upper extremities remains after 18 months. This disorder is similar to classic GBS. It is important to be alert to de novo autoimmune neurological disorders after cardiac surgery. These disorders are similar to classic autoimmune disease and treated with standard therapies

How to extract a losing intra-aortic balloon pump guide wire

Guidewire loss is a serious complication that in case of a complete wire loss could cause death in about 20% of cases. Although it is essential to retrieve an intravenous foreign body as soon as possible, there are only a few recommendations regarding the removal of an intra-arterial foreign body. This study reports on a rare complication of guidewire loss during the insertion of an Intra-Aortic Balloon Pump (IABP), which has not yet been reported in the literature. The approach to this problem has been described, including the extraction time and the technique