Aortic Valve Myxoma Presenting with a Stroke: A case report and review of the literature

Myxomas originating from the aortic valve are rare. We report a 40-year-old male patient who presented to the King Fahd Hospital of the University, Khobar, Saudi Arabia, in 2017 with a stroke. Transoesophageal echocardiography indicated a mobile mass measuring 6 × 2 mm attached to the right coronary cusp of the aortic valve and a mobile interatrial septum with a small patent foramen ovale (PFO). The patient underwent surgical excision of the mass and direct closure of the PFO. Histopathology confirmed the mass to be a myxoma. Despite their rarity, the recognition and treatment of valvular myxomas is very important; moreover, clinicians should be aware that affected patients may present with an embolic stroke. Keywords: Aortic Valve; Myxoma; Patent Foramen Ovale; Stroke; Transesophageal Echocardiography; Case Report; Saudi Arabia

Which level of preoperative glycated haemoglobin (HbA1c) affect early morbidity and mortality after cardiac surgery?

BackgroundDiabetics account for 34 per cent of all patients undergoing coronary artery bypass graft (CABG) surgery, and have higher rates of postoperative mortality. Furthermore, they are at risk for ICU admission postoperatively due to complications of hyperglycaemia, which in turn increases hospital mortality.AimsThe purpose of this study was to evaluate the level of glycated haemoglobin (HbA1c) in patients undergoing cardiac surgery, and to establish it is an independent predictor for postoperative mortality and morbidity.Methods This retrospective study was conducted at King Fahd University Hospital. Files of 146 diabetic patients who underwent cardiac surgery in the period between September 2015 to June 2018 were included. One hundred and five patients met the inclusion criteria. Depending on the results of HbA1c preoperatively, patients were divided into 2 groups: Group A, with a HbA1c > =8.5 per cent, accounting for 33 patients, and Group B with a HbA1c < =8.4 per cent accounting for 71 patients.Results This study included 79 males and 25 females, with ages ranging in between 17 to 87 years old, with no significant difference between both groups in age and sex. A significant difference was found between Group A and Group B in postoperative mortality (p-value < 0.002). No significant difference was found when comparing length of hospital stay, wound infection postoperatively, reoperation, or readmission.ConclusionThere was a significant difference in mortality postoperativly between the two groups, with patients who had higher HbA1c levels experiencing higher mortality. Since our sample size was small, we recommend that further studies be done in multiple centres

The feasibility of surgical patch osteoplasty in isolated left main coronary stenosis.

Background: Coronary artery bypass grafting (CABG) is perceived as the most common treatment for left main coronary artery (LMCA) disease with good results compared to left-main stenting or medical therapy.&nbsp; Surgical patch angioplasty (SPA) may present a substitute to the standard CABG in patients with isolated LMCA disease, and it offers physiological antegrade myocardial perfusion, keeps ostial patency and saves bypass material.&nbsp;The objective of this study is to demonstrate the feasibility of patch osteoplasty in patients with isolated LMCA stenosis. Methods: This is a retrospective study performed on eight patients with angiographically proven ostial or proximal LMCA stenosis who underwent surgical patch angioplasty. Two of them had associated right coronary artery bypass grafting. All patients were performed with cardiopulmonary bypass and saphenous vein patch. An anterior approach with transverse aortotomy was utilized in all cases. Patients were followed-up clinically for a mean period of 14 months (ranging from 26 to 6 months) for recurrence of symptoms and any postoperative complications. Results: The early postoperative period was uneventful in all patients. No perioperative mortality was reported. Two patients had postoperative atrial fibrillation, and one patient with poor left ventricular function required preoperative intra-aortic balloon pump. Angiography was done in the first three cases, and all showed no restenosis and no vein patch dilatation. Conclusion: Surgical patch angioplasty may be a safe and suitable alternative to CABG in selected patients with isolated ostial LMCA stenosis. Further studies are needed to compare the results of the SPA with those of standard CABG and LMCA stenting

Cutting-Edge Topics in Research on Veterinary Sciences

We are pleased to announce the first edition of the SVU-International Journal of Veterinary Sciences (SVU-IJVS). We hope that this journal will advance the field of animal sciences and related biomedical disciplines. SVU-IJVS is particularly interested to publish any work –of a high quality-in the field of animal sciences. Beside conventional animal-related work, interdisciplinary articles i.e. medicine, biology, bioinformatics and mathematics which may not be published by the narrow windows journals, are highly appreciated in the SVU-IJVS. We hope that SVU-IJVS will play a positive role in this field of research

Management of primary spontaneous pneumothorax: A single-center experience

Background: The prevalence of primary spontaneous pneumothorax is high in the Arab region. There is a lack of studies from the Eastern Province of Saudi Arabia highlighting the associated risk factors and demonstrating the effectiveness of surgical management. Objectives: To identify risk factors associated with primary spontaneous pneumothorax and to correlate the effectiveness of surgical management with the rate of disease recurrence. Subjects and Methods: This retrospective chart review included adult patients who presented with primary spontaneous pneumothorax and were managed at King Fahd Hospital of the University, Al-Khobar, Saudi Arabia, from January 1, 2005, to December 31, 2014. The results are presented as arithmetic mean for quantitative data, and chi-square test was used for statistical analysis. P ≤0.05 was considered statistically significant. Results: In total, 151 patients with primary spontaneous pneumothorax were included, with the majority being male (98.7%) and Saudis (88.7%). The mean age was 24 ± 6 years (range: 13–49 years), mean height 171 ± 8 cm (range: 144–193 cm) and mean body mass index 19.2 ± 3.8 kg/m2 (range: 13.3–39.0 kg/m2). About 62% of the patients were smokers. Ten patients had an ipsilateral recurrence of primary spontaneous pneumothorax after the first episode was successfully managed. Surgical exploration after the first episode itself was found to significantly reduce the recurrence rate. The study found that in the management of these patients, there was a shift from conventional open thoracotomy to the minimally invasive video-assisted thoracoscopic surgery method. Conclusions: The risk factors for primary spontaneous pneumothorax in this study were consistent with the current literature. Surgical exploration after the first episode of primary spontaneous pneumothorax significantly reduces the recurrence rate and there is a paradigm shift toward a less invasive surgical approach in managing these patients

Three Rare Structural Anomalies: Right Aberrant Subclavian Artery, Kommerell’s Diverticulum, and Isolated Left Vertebral Artery All Associated with Type B Aortic Dissection

Introduction and Background. Right aberrant subclavian artery accounts for 0.5-1.8% of the population as the most frequently encountered aortic arch anomaly, while the prevalence of an isolated left vertebral artery ranges from 3 to 8%. Despite the low prevalence and the asymptomatic presentation of these structural anomalies, the development of cardiovascular complications and aneurysmal formation could happen as in Kommerell’s diverticulum in a complicated right aberrant subclavian artery, which can undergo aneurysmal degeneration and dissection. Depending on the severity and the degree of the symptoms, the management of the patient can be determined. Case Presentation. A 51-year-old male hypertensive Pakistani patient was admitted complaining of chest and back pain; a CT of the aorta was done and showed type B aortic dissection associated with a right aberrant subclavian artery with an isolated left vertebral artery. A thoracic endovascular aneurysmal repair was done, and the patient improved afterward. Conclusion. The prevalence of these structural anomalies, the right aberrant subclavian artery, Kommerell’s diverticulum, and isolated left vertebral artery with type B aortic dissection, is uncommon. Therefore, the earlier the diagnosis, the better the treatment. This is the first case report explaining the occurrence of these vascular anomalies together in Saudi Arabia

Trauma-related pneumopericardium: A literature review

Trauma-related pneumopericardium (TRPP) is the collection of air in the pericardial space secondary to trauma, potentially leading to tension pneumopericardium (TPP) in which the entrapment of air generates sufficient pressure to compromise cardiac output leading to a life-threatening cardiac tamponade and circulatory failure. We aim to classify the diagnostic and therapeutic approaches of TRPP and the causes of the subsequent development of TPP. A computer-based search of all published reports on TRPP in the medical literature from database inception to March 2020, on MEDLINE, Ovid, and Scopus; analyzing the data regarding initial status at presentation, extent of injuries, diagnostic and treatment measures with the intention to have an understanding of the clinical behavior and management outcomes of TRPP. The search identified 84 published case reports of 105 patients with TRPP. In conclusion, TRPP leading to TPP is described in the literature as a condition that involves a young male who is subjected to blunt trauma, most commonly in a motor vehicle collision, presenting as a polytrauma patient in a state of shock and low systolic blood pressure, or possibly in cardiac arrest. In addition, he might have a tracheobronchial injury with or without pneumothorax or pneumomediastinum and might require mechanical ventilation