Role of carotid doppler in coronary artery disease

To find out the Intima media thickness [IMT] of carotid artery disease in coronary artery disease and to identify hemodynamically significant stenosis [i.e.>70%] in patients undergoing coronary artery bypass surgery. A descriptive study. The study was conduct at AFIC and MH Rawalpindi from 2003 to 2004. One hundred patients of triple, double and single vessel coronary artery disease were studied. There were 85 male and 15 female patients, ranging from 35 to 77 years. The patients were studied by Toshiba Ultrasound Machine equipped with high frequency linear transducers. In 10 patients having more that 70% ICA stenosis, conventional angiography was done. Intima-media thickness of common carotid artery was increased in 92 patients with mean value of 1.1 mm. Plaques were seen in 92 patients with commonest location at carotid bifurcation with extension into the origin of ICA. 15 patients has >70%, 10 patients > 50% stenosis and 67 patients in the range of 1-50% stenosis. 6 patients showed normal intima-media thickness with no evidence of plaque. In two patients ultrasound could not locate bifurcation of CCA. Doppler ultrasound showed 98% sensitivity in diagnosis of > 70% stenosis. Doppler ultrasound is a non-invasive imaging modality of choice in evaluation of extra-cranial carotid artery disease

Vascularized bilateral pectoralis major muscle flaps as a primary procedure in patients with sternal necrosis and infection

The current study was conducted to analyze our experience of vascularized bilateral pectoralis major muscle flaps as a primary procedure in patients with sternal necrosis and infection in terms of mortality, functional results and chest stabilization. It is a case - review analytical study conducted at Armed Forces Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1st Jan 1994 to 31st Dec 2001. Patients developing sternal dehiscence subjected to primary repair with vascularized bilateral pectoralis major flaps were studied. Relevant information was retrieved from the medical records. The procedure entails generous excision of all visibly infected soft tissues and bone followed by covering with vascularized bilateral pectoralis major flaps, raised from medial to lateral side based on thoracoacromial vessels. Patients were followed for 01 year postoperatively for complications. Twenty six patients suffered from deep mediastinal wound infection and sternal necrosis requiring bilateral pectoralis major flaps. One patient presented late after three months and all others were fresh cases. Mean age was 57.23 +/- 8.92 and there were 24 males and 2 females. Twenty five patients had coronary artery bypass surgery and 01 had closure of ventricular septal defect [VSD] with aortic valve replacement and right ventricular outflow tract [RVOT] reconstruction. One [4%] patient had complete failure of the repair requiring omentoplasty, while 02 [8%] had partial wound dehiscence needing resuturing. Twenty two [84%] patients were discharged between 8 to 10 days while 01 [4%] patient died of septicemia and mutliorgan failure in the hospital. After one year, all were alive; none had chest instability, breathing difficulty or limitation of shoulder joint movement. Primary repair with bilateral pectoralis major muscle flaps in sternal infection requiring extensive resection gives good results, with early discharge from the hospital good cosmetic results