Hemi-fontan or bidirectional cavopulmonary shunt for right ventricular failure after mitral valve replacement and acute ascending aortic dissection: report of two cases

Right ventricular failure due to right coronary artery disease, right ventricular hypertrophy, stunning, abnormal septal motion, myocardial infarction, or non-homogeneous distribution of cardioplegia is an uncommon but serious complication of open heart surgery. We report a patient with severe right ventricular hypertrophy secondary to severe mitral valve stenosis and another patient with detachment of the right coronary artery due to the dissection of the ascending aorta. The patients developed right ventricular failure, which persisted after surgery and rendered weaning from cardiopulmonary bypass unsuccessful. Through a hemi-Fontan, or bidirectional cavopulmonary shunt, and an intra-aortic balloon pump, the patients were successfully weaned from cardiopulmonary bypass. This shunt may be an alternative to a right ventricular assist device in some patients with right ventricular failure. The long-term outcome and the indication of bi-directional cavopulmonary shunt has not been confirmed, although it is believed to be effective for saving the life of patients with low cardiac output and acute right ventricular failure. In our cases, six months following the operation, there was some degree of recovery of the right ventricular function. In long-term follow-up, however, it would be interesting for the authors to know if the improved right ventricular function, with better antegrade pulsatile flow in the pulmonary artery, in any way interferes with the functioning of the bidirectional cavopulmonary shunt

Myxoma of the superior vena cava origin presented as a right atrial mass

Myxomas are the most common benign cardiac tumors. Myxomas are more common in the left heart chamber than the right side chamber. An extracardiac origin presenting as a right atrial mass is very rare. We present a case of myxoma originating in the superior vena cava [SVC] in a 24-year-old man, who underwent surgical resection. Preoperative two-dimensional echocardiography demonstrated a mass in the right atrium. Intraoperatively, the tumor was found to have originated from the SVC orifice. The tumor was excised from the SVC by opening the one-third proximal portion of the SVC. Pathological examination revealed a myxoma, and one-year follow-up showed no evidence of the recurrence of any tumors in the SVC

Postoperative outcomes in patients with chronic renal failure undergoing coronary artery bypass grafting in madani heart center: 2000-2010

Renal failure predisposes patients to adverse outcome after coronary artery bypass grafting [CABG] Renal dysfunction is a predictor of increased morbidity and mortality after CABG, whether it is dialysis-dependent or not. In a retrospective study from April 2000 to December 2010, seventy-six patients [60 male and 16 female with the mean age of 58.57+7.93 years] with different categories of chronic renal failure undergoing CABG in Shahid Madani Hospital, were studied. The cardiac disease leading to the operation was coronary artery disease [CAD] in all patients. Patients demographic, surgical and laboratory data were gathered from hospital records. Data were then analyzed. Mean hospital stay was 10.16+7.16 days. The preoperative mortality rate was 10.5% [15% in non dialysis and 5.6% in dialysis dependant patients with no significant difference]. Morbidity rate was 28.9% [respectively 30% and 27.8% in dialysis and non dialysis patients with no significant difference] including in-hospital myocardial infarction [MI] [10.5%], in-hospital stroke [2.6%], in-hospital bleeding [21.1%] and in-hospital infection, pneumonia, [5.3%]. Mean creatinine and blood urea nitrogen [BUN] levels were significantly increased after surgery [p0.001]. Postoperative hemodialysis rate was 33.3%. Chronic renal failure whether dialysis-dependant or not increases in-hospital mortality and morbidity in patients undergoing CABG. For CRF patients not on dialysis with a creatinine 2.5 gm/dL, there is a strong likelihood of postoperative dialysis

Prevalence of nasal carriage of staphylococcus aureus in Madani Heart Hospital, Tabriz

Staphylococcus aurous has been known as one of the most common nosocomial pathogens which include as much as 30% to 50% of general population. Regarding to the presence of carrier staff can be considered as one of the infection source; remarking of carrier for prevention purposes is important. In a cross-sectional study we determined the prevalence of staphylococcus aurous carriage among 113 edical staff of Madani Heart Hospital, Tabriz [Iran] 28/08/2009 to 28/09/2009 on [Physicians, nurses, technicians, secretaries, the administrative personnel and services], including surgical wards, laboratory, ICU and CCU. In this study, 113 participants comprised of 60 males [53%] and 53 females [47%], and their mean age of participants in this study was 34.8 years [20-55]. Sampling was carried out from nasal of employees. Samples were place on blood agar and mannitol salt agar; suspected colonies have been cultured and identified by catalase, coagulase and DNAase. Generally, of 113 people who entered the study, 30 person [26.5%] had positive cultures and 82 [72.6%] had a negative culture. The incidence of staphylococcus aureus carriage was more in men than women 57% vs. 43% [p<0.05]. In this study staphylococcus carriage incidence in Tabriz heart centre [Madani hospital] was 50%to 80% lower than our estimation, unexpectedly

Radial artery pseudoaneurysm at the previous site of invasive monitoring

This report presents a case of left radial artery pseudoaneurysm developing at the previous site of invasive monitoring. The patient had prosthetic mitral valve replacement one month earlier, and anti-coagulation therapy had started on the first post-operative day. The patient's radial artery aneurysm with 4-centimeter diameter was resected and the radial artery was ligated

Comparison of oxidative stress content during on-pump and off-pump coronary artery bypass surgery

In contrast to conventional on-pump coronary artery bypass grafting [CABG] surgery only mild increase of parameters of oxidative stress is reported during and after off-pump coronary artery bypass grafting. In this study, we attempted to determine the role of off-pump CABG in the myocardial and systemic inflammatory responses. One hundred patients who underwent elective CABG were divided to three groups: I] patients underwent off- pump CABG or 2] on-pump CABG surgery with controlled reperfusion and 3] on-pump CABG with noncontrolled reperfusion. We took patients systemic venous blood samples for the measurement of serum level malondialde hyde [MDA], Troponin [cTnI] and total antioxidant [TAC] and blood level superoxiddismotas [SOD], before and after Ischemia and reperfusion. Mean values of decrease left ventricular ejection fraction [LVEF] after surgery in patients group 3 were higher than patients group2 and also [LVEF] in patients group2 were higher than patients group l [P

Porcelain aorta: a case report and a review of literature with especial focus on tuberculosis aortitis

A 36 years old woman with a history of treated pulmonary tuberculosis [TB] was hospitalized fir progressively worsening dyspnea on exertion. She had severe calcification of entire aorta and evidence of old 273 on chest roentgenogram Routine laboratory tests including erythrocyte sedimentation rate [ESR] and C- reactive protein [CRP] were normal and rheumatologic panel was negative. Echocardiography showed severe aortic insufficiency. Work-up for active tuberculosis was negative. The CT scan of the chest was in favor of old tuberculosis and also showed heavily calcified aorta. She underwent aortic valve replacement. Postoperative course was uneventful. At four-year follow up the patient is doing will. Considering her age and the absence of risk factors of atherosclerosis we postulated that porcelain aorta in this patient could be a sequel of remote tuberculosis aortitis