Single lung transplantation for alveolar microlithiasis: the first clinical experience

Pulmonary alveolar microlithiasis[P. A. M.] is a rare pulmonary disorder that pursues usually an asymptomatic course and can culminate in severe respiratory failure. We report a 48year old Saudi female patient with P. A. M. who deteriorated rather steadily after the initial 18 years of asympotomatic course until a frank type I respiratory failure is established. Single lung transplantation [S. L. T.]was performed successfully and the patient returned to full daily activity and has now survived 12 months post S. L. The immunosuppression consisted of Cyclosporine-A 10 mg/kg/day, azathioprine [Immuran] 2mg/kg/day and perdnisolone 10 m. daily. The bronchial anastomosis was done by telescoping the recipient and donor main bronchus without omental wrap. A significant bronchial stricture of the anastomotic site occurred 4 months post S. L. T. which was dilated endoscopically with good clinical and bronchoscopic result. No episodes of rejection or infection were encountered so far

Constrictive pericarditis causing mitral stenosis: a case report

External compression of the cardiac valves giving symptoms is a known pathological entity. We report a 35-year old male patient who presented with a history of palpitations and shortness of breath on exercise of four months' duration. Clinical, radiographic, electrocardiographic, and echocardiographic examination, as well as cardiac catheterization revealed mitral stenosis and constrictive pericarditis. After a near radical pericardiectomy, all intraoperatively measured haemodynamic data normalised and the subjective and objective clinical signs and symptoms of mitral stenosis disappeared, and mitral valve surgery was therefore unnecessary and avoidable

How successfully can open heart surgery be introduced to the developing countries?

Since the late 1960's the growth of cardiac surgery has received worldwide acknowledgement in the treatment of various heart diseases including valvular, congenital, as well as myocardial revascularization using the reversed saphenous vein and the internal mammary arteries. Operations for these various heart ailments is now a routine in the developed courtiers. In this paper, we examine the possibility of introducing open heart surgery to the developing countries. All the various difficulties involved, such as the huge cost of such gigantic project are discussed. We also look into ways and means of reducing the cost without effecting the standard by reviewing the Saudi Cardiac Airlift experience to the country of Mauritius. This is a typical example of where introduction of cardiac surgery was successfully carried out with minimal cost and complications in a country with limited financial resources

Discrete subaortic stenosis: surgical experience at the King Fahd heart centre in Jeddah

Twenty-four consecutive patients with discrete subaortic stenosis were operated on over a Seven-year period [l983-1989]'at the King Fabad Heart Centre, Jeddah. Twenty patients [83.3%] had discrete subaortic membranes [type I] while 3 patients [16.6%] had fibromuscular tunnels [type II]. There were more adults than children] in our series, with a male predominance. Operation included resection of the subaortic membranes in 21 patients and left ventricular myectomy in 3 patients. There was a significant decrease in the intraoperative gradient measured post cardiopulmonary bypass. Six patients [27.2%] have recently presented with symptoms of recurrence, but none.has been reoperated upon. Operative mortality in this series was 4.5%

Saudi cardiac airlift for patients in developing countries: and update

Supported by the Saudi Heart Charitable Society, the Saudi Heart Team performed 642 surgical procedures in five developing countries. These consisted of 571 open heart and 71 closed heart cases. A mortality of 5.2% was recorded. The Saudi Heart Team introduced open heart surgery to Mauritius and Yemen and established four additional cardiac surgical programs in Sudan, Bangladesh, and Egypt

Coronary artery fistula in Jeddah Saudi Arabia

During a nine year period, three patients underwent surgical treatment or congenital coronary arteriovenous fistula. In two patients, the right coronary artery [RCA] was draining into the right atrium. In the third patient, the left coronary artery drained into right atrium. Distal filling of the coronary arteries involved was good as seen in the cineangiography. There was no associated aortic or pulmonary valve disorders in the three patients. The fistulous openings were oversewn from within the right atrium [the recipient chamber] using cardiopulmonary bypass. Preservation of the coronary artery continuity and distal myocardial perfusion was achieved

Coronary artery fistulae in Jeddah

During a nine-year period, three patients underwent surgical treatment for congenital coronary arteriovenous fistulae. In two patients, the right coronary artery [RCA] was draining into the right atrium. In the third patient, the left coronary artery drained into the right atrium. Distal filling of the coronary arteries involved was good as seen in the cineangiography. There was no associated aortic or pulmonary valve disorders in the three patients. The fistulous openings were oversewn from within the right atrium [the recipient chamber] using cardiopulmonary bypass. Preservation of the coronary artery continuity and distal myocardial perfusion was achieved

Orthotopic cardiac transplantation in a child with restrictive cardiomyopathy and secundum atrial septal defect

Orthotopic cardiac transplantation was performed in a child with end-stage cardiac failure due to restrictive cardiomyopathy associated with the presence of a large secundum type atrial septal defect [A. S. D.] which made patching of the interatrial septum with autologous pericardium necessary after the cardiectomy of the native heart was performed. The association of restrictive cardiomyopathy with a simple congenital cardiac anomaly such as an atrial septal defect is a rare event and indication for cardiac transplantation both in adults and pediatric age group. The surgical technique demands patching of the deficient interatrial septum with autologous pericardium free lappet and correction of the atrial size mismatch

Rheumatic fever and valvular heart disease in four developing countries: an update

Rheumatic fever and rheumatic disease in the four developing countries of Saudi Arabia, Yemen, Sudan and Mauritius, has a relentless, malignant and accelerated course with significant morbidity and mortality. Children and young pre-teenage adults are affected most. Severe cardiac and valvular rheumatic pathological changes are usually found, which often make valve replacement necessary. Implantation of a prosthetic cardiac value in developing countries is associated with many potential complications. Infective endocarditis of native or prosthetic valves has a higher rate than seen in the West. Rheumatic activity found in patients presenting with N.Y.H.A. functional class IV and congestive heart failure, pulmonary edema or low cardiac output remains a serious practical problem with great morbidity and mortality in such countries. Cardiac surgery aims towards a valve preserving, reconstructive procedure, rather than a valve replacing procedure, as the majority of such patients are young. Primary and secondary prevention of rheumatic fever and rheumatic heart disease respectively must be urgently reorganized and optimised in these countries. Our experience with more than 2500 patients, seen, evaluated and operated upon in Saudi Arabia, Yemen, Sudan and Mauritius is analyzed and described and the epidemiological and actual problems seen with these patients in the daily medical and surgical practice are highlighted and updated

Saudi coarctation: the King Fahd Heart Centre experience

From 1980 through1989, 32 patients with coarctation of the aorta were operated upon in our Heart Center. 62.5% of the patients had associated cardiac anomalies. High gradient across the coarcted area was seen in 21 patients [65.6%]. 87.5% of the patients were more than 10 years old. Immediate post operative paradoxical hypertension is more common in the older age group undergoing coarctation repair than in neonates and children, and they are more likely to remain hypertensive even after coarctation repair [3]. Patch aortoplasty [Knitted Teflon. Gortex or Dacron] were the more commonly used operative method of repair in our center. Postoperative complications were minimal. Operative mortality of 3.12% is reported. We advocate early repair of coarctation where possible but in the developing countries, most of our patients present late. This group stand the danger of having to live with persistent hypertension after coarctation repair

Multiple digital gangrene after hypothermic open heart surgery in a scleroderma patient: case report

The case of a 40 years old female who suffers from scleroderma and Raynaud's Phenomenon and who underwent open heart surgery for mitral valve replacement with a bi=leaflet mechanical valve and tricuspid valve annuloplasty with a Puig Massana Ring and developed post operative irreversible bilateral symmetric digital gangrene, reversible acute renal failure and temporary complete third degree atrioventricular block is presented. Systemic hypothermia during cardiopulmonary bypass has activated the cryoglobulins with their precipitation in the small digital and renal arteriolar vessels and eventually capillary and arteriolar vasopasm was induced by the hypothermia which led to consequent ischemia and digital gangrene. The picture of vasopasm, acute renal failure and complete third degree block reflect acute exacerbation of scleroderma after hypothermic open heart surgery

Report on the consecutive first one hundred cardiac surgeries at the King Fahad Hospital Heart Center

From February 1, 1989 to April 2, 1989, 100 consecutive pastients were operated on at the new King Fahad Hospital Heart Center was completely renovated to provide a sophisticated and modern cardiac surgical care to our patients, their relatives and staff. The new rebuilt intensive care unit houses 16 beds. The 2 operating rooms have been totally modernized. With this, we are now capable of performing 4-5 open heart surgery per day, facilities are underway for future heart transplantation. During this period, under review, seventy five [75%] open heart surgery was done; and twenty five [25%] closed heart surgery was performed. 61 patients [61%] were males, and 39 patients[39%]were females. The mean age was 23.4 years [range 10 months-60 years]. Aftermath of rheumatic heart disease was significantly seen. Congenital heart disease was also common due to consanguinity in marriage. Valve repair where suitable was given utmost consideration. Where valve replacement is considered, we preferred mechanical to tissue valves. An overall mortality of 2% was registered. There were 2deaths; one was due to low cardiac output in a 17year old patient who had a repair of congenital aortic valve/supravalvular stenosis. The other was due to severe chest complications in a patient who was in N. Y. H. A. class IV preoperatively. Morbidity was reduced to a minimum. We hope that the newly well furnished and well equipped King Fahad Hospital Heart Center will provide adequate cardiac surgical care with least morbidity and mortality. It will also serve as a training center for Saudi doctors, who would like to pursue cardiac surgery as career. In this article we review our experience with the first 100 consecutive cases in this new Heart Center

Open mitral valve repair in pregnancy: the first Saudi experience

We present a 24 weeks pregnant lady with tight mitral stenosis and severe pulmonary edema. This patient was subjected to open heart surgery with cardiopulmonary bypass. The operation was successful, the mother and the normaly delivered neonate are doing well. Measures to prevent neonate are avoiding perfusion hypothermia were taken as recommended by R. M. Becker [1]. This was achieved by cooling the patient to -33

Renovascular hypertension: balloon dilatation angioplasty for bilateral renal artery stenosis

A case of 38 year old male Yemeni patient with chronic systemic hypertension of 12 years duration is presented. Selective renal arteriography revealed bilateral severe renal artery stenosis with radiographic appearance of fibromuscular dysplasia. Successful bilateral balloon dilatation angioplasty was performed with immediate favourable reduction of systolic and diastolic hypertension. Indications, techniques, early and long-term results and comparison with surgical results are discussed. This is the first reported case of successful balloon dilatation angioplasty for reno-vascular hypertension due to bilateral renal artery stenosis in Kingdom of Saudi Arabia