Right Mini-Thoracotomy versus Standard Sternotomy for Surgical Excision of Atrial Myxomas

Introduction: Atrial myxomas are rare benign tumors; causing obstructive or embolic complications, or even death, depending on their site and size. Therefore, once diagnosed, it should be surgically resected. Atrial myxomas are present about 75% in left atrium (LA) and about 15% in right atrium (RA). Early diagnosis is a challenge because of nonspecific manifestations, and sometimes is asymptomatic and may be discovered accidentally during transthoracic echography (TTE).Minimally invasive cardiac surgery (MICS) has benefits over sternotomy include cosmetically, less pain, and shorter total hospital stay. Materials and Methods:Between January 2011 to December 2020, (50) patients [30 Sternotomy, 20 MICS] underwent surgery for isolated resection of cardiac myxoma. We reported outcomes; cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, conversion to median sternotomy (ST), total hospital stay, complications (stroke, renal failure, respiratory failure, reoperation, and infection), pain, patient¢s satisfaction, recurrence and survival. Follow-up time was from 6-months to 3-years.  Results: There is no significant difference in CPB or cross-clamp time between groups. No minimal invasive (MI) cases required conversion to a median ST. Total hospital stay is shorter in the MI group by 2.2 days (p-value = 0.045).  No differences present in morbidity or mortality between two groups. Conclusions: Surgical resection of atrial myxoma resection by minimal invasive approach is safe, feasible, and favored over sternotom

Left Ventricular Assistant Device in End Stage Heart Failure as A Step of Heart Transplantation Center: A Case Report

With increasing prevalence of patients with advanced heart failure (AHF), increasing amount of readmission frequencies, duration of maximum medical therapy, and the 50% mortality during one-year, Left ventricular assist devices (LVAD) are considered to be an acceptable treatment option in these cases. Advanced newer‑generation of LVAD devices improves outcomes, and deceases morbidity . LVAD is considered as a bridging therapy in cases of decompensated HF which are scheduled for heart transplantation (HTx), or as destination therapy (DT) for cases either elder or with severe comorbid condition . LVAD is mechanical device that assists the pumping function of left ventricle (LV) by diverting blood into an external circulatory circuit connecting to the aorta. LVAD usually consists of (A) pump implanted to LV, (B) percutaneous driveline, and (C) externally controller and batteries

Effect of Nursing Exercise Protocol on Hemodynamics and Functional Capacity among Patients after Cardiac Surgery

Context: Exercise interventions are the cornerstone of cardiac rehabilitation. The exercise program consists of respiratory physiotherapy, neck and shoulder exercises, walking, and cycling. The purpose is to prevent respiratory complications, neck and shoulder pain and increase the physical functional level.Aim: This study evaluates the effect of applying nursing exercise protocol on hemodynamics and functional capacity among post-cardiac surgery patients. Methods: Quasi-experimental research design utilized in the current study. A purposive sample, including 60 male and female patients, was classified equally into two equal groups; study group (n= 30) and control group (n= 30), collected through 14 months. This study was carried out in the inpatient cardiac surgery department and the outpatient cardiac clinic of Cardiothoracic Surgery Hospital in New Minia City. Four tools were utilized in collecting data; named Health Assessment Record; Six Minute Walk Distance Test; Modified Medical Research Council Scale (MMRC) for measuring dyspnea; and Nursing Educational Protocol Checklist. Results: Current study findings displayed an improvement of total distance walked among study groups compared to the control group. It also showed highly statistically significant differences between the groups related to total distance walked after 12th-week post-discharge documented by p-value (0.000).Conclusion: The current study findings concluded that the nursing educational protocol in the form of deep breathing, incentive spirometer; coughing, and early ambulation induces a significant improvement in hemodynamic variables and six-minute walk distance, recommending that hospitals should implement the nursing educational protocol as a routine hospital policy among all cardiac surgical patients in all age groups

Calcified Bronchogenic Cyst

Herein, we reported the case of a 32-year-old male patient presented with intermittent attacks of mild right chest pain and dyspnea for 2 years. On contrast-enhanced computed tomography (CT) of the chest, a non-enhancing subcarinal cystic lesion about 6×6.5 cm was detected in the posterior mediastinum, consistent with the features of bronchogenic cyst. The lesion showed small calcific focus changing its position posteriorly when patient changes his position from supine to prone. The flecks of calcium within the fluid in a cystic lesion constitute the origin of the future cyst wall calcifications and may reflect the long-standing nature of the lesion. Surgical excision is preferred to avoid the expected complications, including fistula formation, ulceration, and infection

Risk factors for developing congenital nasolacrimal duct obstruction

AbstractObjectiveTo identify potential risk factors for developing congenital nasolacrimal duct obstruction (CNLDO).Study design and methodsA cross-sectional study. A quantitative questionnaire was distributed to a sample of mothers attending the Pediatrics Clinic at King Khalid University Hospital, Riyadh, Saudi Arabia.ResultsA total of 756 mothers responded to our questionnaire. Of the 756 filled questionnaires, 389 (51.67%) were male children. 5.3% of the mothers lived in non-urban settings. CNLDO was reported in the children attending the clinic by 17.1% (129/756) of their mothers. Average age (±SD) of infants when persistent tearing was noticed was 3.2±2.7months, while average age (±SD) of resolution was 9.6±3.7months. Of the children with CNLDO, 37.2% (48/129) still have persistent tearing at the time of distributing the questionnaire. Among the group with CNLDO, 17% (22/129) of their mothers have experienced an infection during pregnancy (p=0.022). Within the same group, 14.7% (19/129) of the affected children were reported by their mothers to have other children with CNLDO which was statistically significant (p=<0.001).ConclusionCNLDO could have a genetic predisposition and maternal infection is a possible risk factor for developing CNLDO. Surgical management awareness should be emphasized to relieve children from this relatively common and benign condition

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10&nbsp;years; 78.2% included were male with a median age of 37&nbsp;years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

Posterior pericardiotomy in heart valve surgery; is it still performed or neglected?

Background: Posterior pericardiotomy (PP) is helpful to prevent arrhythmia; especially atrial fibrillation (AF), and cardiac tamponade postoperative cardiac valve surgery. The incidence of postoperative AF is increased due to postoperative pericardial effusion (PE). This study aimed to investigate the early outcome of PP after heart valve surgery.&nbsp;Methods: In this prospective study, 120 patients underwent elective valve heart surgery at our center from January 2020 until April 2022. Patients were followed up for AF and pericardial effusion, and reopening due to tamponade.&nbsp;Results: The mean age of patients was 35.26 years, 70.2% were female and 29.8% were male. Surgery was elective and all were valve surgery. The incidence of postoperative AF was 2%, and pericardial effusion was seen in 1% of patients. Tamponade was not seen in any case. Left PE needed intervention tube drainage of 2%.&nbsp;Conclusion: Posterior pericardiotomy is a simple and safe procedure during valve heart surgery, and it is effective in reducing the incidence of atrial fibrillation, pericardial effusion, and tamponade

Open Transthoracic Plication of the Diaphragm for Unilateral Diaphragmatic Eventration in Infants and Children

Background: To evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood. Methods: This study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets. Results: The study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE. Conclusion: Early diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence

Factors Associated with Early Adverse Events after Coronary Artery Bypass Grafting Subsequent to Percutaneous Coronary Intervention

Background: A previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI. Methods: The present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to December 2014. Patients who previously underwent PCI (n=38) were compared to patients who did not (n=122). Preoperative, operative, and early in-hospital postoperative data were analyzed. The end points of the study were in-hospital mortality and postoperative major adverse events. Results: Non-significant differences were found between the study groups regarding preoperative demographic data, risk factors, left ventricular ejection fraction, New York Heart Association class, EuroSCORE, the presence of left main disease, reoperation for bleeding, postoperative acute myocardial infarction, a neurological deficit, need for renal dialysis, hospital stay, and in-hospital mortality. The average time from PCI to CABG was 13.9±5.4 years. The previous PCI group exhibited a significantly larger proportion of patients who experienced in-hospital major adverse events (15.8% vs. 2.5%, p=0.002). On multivariate analysis, only previous PCI was found to be a significant predictor of major adverse events (odds ratio, 0.16; 95% confidence interval, 0.03 to 0.71; p=0.01). Conclusion: Previous PCI was found to have a significant effect on the incidence of early major adverse events after CABG. Further large-scale and long-term studies are recommended