A large intracardiac hydatid cyst with concomitant cervical and hepatic involvement: A case report

Key Clinical Message Cardiac hydatidosis is a relatively rare complication of echinococcosis. Understanding the atypical manifestations, potential associated risk factors, and epidemiology leads to optimal and timely management. Abstract Cardiac hydatidosis is a relatively rare complication of echinococcosis, with a potentially life‐threatening condition. Here, we reported a large interventricular septal hydatid cyst bulging in the left ventricle accompanied by a huge cervical lamp with recurrent hepatic cysts that underwent cardiac surgery to excise the cyst uneventfully

Anesthetic implication of tricuspid valve replacement in a patient with acute intermittent porphyria

Facing a patient with acute intermittent porphyria (AIP), there is narrow safety margin which circumscribe all the therapeutic actions including choice of drugs. This would become even more complicated when it comes to a stressful and drug-dependent process like a cardiopulmonary bypass. According to author′s researches, no specific AIP case of tricuspid valve (TV) replacement is reported recently. Furthermore, fast-track anesthesia was safely used in this 37-year-old male known the case of AIP, who was a candidate for TV replacement and removing the port catheter. The patient was extubated subsequently, only 3 h after entering the Intensive Care Unit

Assessment of limited chest x-ray technique in postcardiac surgery management

Objectives: The objective of this study is to investigate the safety of elimination of chest radiography in the postcardiac surgery Intensive Care Unit (ICU). Methods and Design: We compared patients in two different groups of routine CXR (RCXR) and limited CXR (LCXR) and their diagnostic and therapeutic outcome in a University hospital-based single center from 2014 to 2016. 3 CXR in the RCXR group and 1 CXR in the limited group was performed, in addition to on-demand criteria. Measurement and Main Results: A total of 978 samples were acceptable for analysis which 55.21% of RCXR and 59.50% of LCXR were male patients. In total, 523 abnormalities in RCXR group and 154 occasions in LCXR group resulted in 26.73% diagnostic efficacy for RCXRs and 28.57% for LCXR. From 1956 CXR that was taken in RCXR group, 72 occasions required intervention (3.68%) and 84 cases out of 539 (15.58%) LCXR needed an action to therapy. This means a 14.40% in RCXRs′ abnormalities and 56.00% of LCXRs′ abnormalities were accompanied with some interventions. Conclusions: Abolishing routine CXR in the ICUs would not be harmful for the patients, and it can be managed based on their clinical status and other safer imaging techniques

The Effect of Designed Transitional Care Program on Anxiety and General Comfort of the Patients Undergoing Coronary Artery Bypass Graft during Transfer from Open Heart Surgery Intensive Care Unit to General Ward: A Clinical Trial

Background and Aim: Transferring a patient from the intensive care unit to the general ward is an anxiety-inducing process that is associated with feelings of insecurity, discomfort, dependency, and increased need. The most important goal of any care program is to satisfy the patient's needs and create a feeling of comfort. The aim of this study was to determine the effect of designed transitional care program on anxiety and general comfort of the patients undergoing coronary artery bypass graft during transfer from open-heart surgery intensive care unit to general ward. Materials and Methods: This study was a non-randomized clinical trial with a control group which included 62 patients who were candidates for transfer from the open-heart surgery intensive care unit of Imam Khomeini Hospital in Tehran to the general ward in 2021. The patients were selected by convenient method. The control group received the routine care and were followed up. The experimental group pursued the designed transitional care program in addition to routine care. This program had 4 dimensions: 1-waiting for transfer, 2-support, gradually reducing dependence and increasing independence, 3-communication and strengthening the care triad, and 4-continuity of integrated and need-based care which was implemented by selected and trained nurses in cooperation with the researcher, physician, patients and families for 5-7 days.  Spielberger's anxiety Questionnaires and general comfort scale were completed before the transfer and on the day of the patient's discharge. Using SPSS version 26, the results were analyzed by Fisher's exact, Chi-square, paired and independent t-tests at a significance level of 0.05. Results: The results showed that the designed transitional care program could significantly reduce anxiety and increase the general comfort of the patients undergoing coronary artery bypass graft (p≤0.000). Conclusion: Considering the impact of the intervention on the variables under study, use of the designed program as a suitable care program during patient transfer can be suggested

Appropriate blood component therapy can reduce postcardiac surgery acute kidney injury through packed cell transfusion reduction

Background: Acute kidney injury (AKI) can happen due to different factors such as anemia. Packed cell (PC) transfusion is an important cause of AKI occurrence. The aim of the study is to investigate whether appropriate blood component (BC) therapy can reduce blood transfusion and it would result in AKI decreasing. Materials and Methods: We conducted a cohort study of 1388 patients who underwent cardiac surgery in one university hospital. A serum creatinine higher than 2 mg/dl, renal disease history, renal replacement therapy (chronic dialysis) were our exclusion criteria. Results: from our 1088 samples, 701 (64.43%) patients had normal kidney function, 277 (25.45%) were in the AKI-1 group, 84 (7.72%) had an AKI-2 function, and the rest of patients were classified as end stage. A mean of more than three PC units were transfused for the second and third stage of AKI, which was significantly higher than other AKI groups (P = 0.009); this higher demand of blood product was also true about the fresh frozen plasma, platelet, and fibrinogen. However, there were no needs of fibrinogen in the patients with normal kidney function. The cardiopulmonary bypass time had an average of 142 ± 24.12, which obviously was higher than other groups (P = 0.032). Total mortality rate was 14 out of 1088 (1.28%), and expiration among the AKI stages 2 and 3 was meaningfully (P = 0.001) more than the other groups. Conclusion: A more occurrence of AKI reported for the patients who have taken more units of blood. However, BC indicated to be safer for compensating blood loss because of low AKI occurrence among our patients

Coronary Artery Bypass Grafting in Patients with Advanced Left Ventricular Dysfunction: Excellent Early Outcome with Improved Ejection Fraction

Background: The prevalence of patients with severe left ventricular dysfunction (LVD) referred for coronary artery bypass grafting (CABG) is increasing. Preoperative LVD is an established risk factor for early and late mortality after revascularization. The aim of the present study was to assess the early outcome of patients with severe LVD undergoing CABG. Methods: Between December 2012 and November 2014, 145 consecutive patients with severely impaired LV function (ejection fraction ≤ 30%) undergoing either on-pump or off-pump CABG were enrolled. The primary end point was all-cause mortality. Different variables (preoperative, intraoperative, and postoperative) were evaluated and compared. Results: The mean age of the patients was 58.7 years (range, 34 to 87 years), and 82.8% of the patients were male. The mean preoperative LV ejection fraction was 25.33 ± 5.07% (10 to 30%), which improved to 26.67 ± 5.38% (10 to 40%) (p value < 0.001). An average of 3.85 coronary bypass grafts per patient was performed. Significant improvement in mitral regurgitation was also observed after CABG (p value < 0.001). Moreover, 120 patients underwent conventional CABG (82.8%) and 25 patients had off-pump CABG (17.2%). In-hospital mortality was 2.1% (3 patients). Patients who underwent off-pump CABG had higher operative mortality than did those undergoing conventional CABG despite a lower severity of coronary involvement and a significantly lower number of grafts (p value < 0.050). Conversely, morbidity was significantly higher in conventional CABG (p value < 0.050). Conclusion: CABG in patients with severe LVD can be performed with low mortality. CABG can be considered a safe and effective therapy for patients with a low ejection fraction who have ischemic heart disease and predominance of tissue viability