short term results of complete revascularization in diabetic patients by off- pump coronary artery bypass graft [OPCAG]

Complete revascularization in diabetic patients due to small size and diffuse involvement of vessels is a problem in cardiac surgery. Due to known complications of on-pump CABG, the off-pump CABG has been suggested in these patients. This study was carried out to assess the short term results of complete revascularization in diabetic patients. This retrospective study was done during 2002 to 2006 at Imam Reza Cardiac Surgery Ward on 500 patients who were operated by off-pump CABG. The patients were divided into two groups, a: diabetic [235 pts] and b: non diabetic [265 pts]. The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups compared. The observed number of grafts [O] after surgery compared with the number of grafts predicted [P] before surgery. The O/P ratio or [completion index] of >/= 1 signifies complete revascularization. Logistic regression analysis used to test possibility that diabetes was a predictor of poor outcomes. Diabetic patients were older, with more comorbidity [congestive heart failure, peripheral vascular diseases, dialysis-dependent]. The number of grafts per patient was 4.2 +/- 1.3 [DM] and 4.2 +/- 1.3 [non-DM]. The size of 875 DM and 1068 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM [in millimeters] at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction [P=0.001]. patients with DM were sicker, but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signified the ability to perform complete revascularization. We were able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes

Cardiac rupture following acute myocardial infarction

Ventricular rupture following myocardial infarction [M.I] is a serious clinical problem with a high mortality. The aim of this study was to present a case with this disorder. A 73 year-old man with left ventricular rupture and cardiac tamponade following myocardial infarction was managed successfully by emergency surgery. The procedure was accomplished with the use of cardiopulmonary by pass. A large PTFE patch was sutured according to the Nunez technique. Patient survived during a mean follow-up of 12 months

[Vertical vein banding in treatment of TAPVC]

TAPVc is a rare and known cardiac malformation in which there is no direct connection between any pulmonary vein and the left atrium, rather, all pulmonary veins connect to the right atrium,thus the ASD or PFO is necessary for survival after birth. This anomaly has four types that include: cardiac -supra cardiac-infra cardiac and mixed type. Based on drainage of pulmonary veins, that treatment in all types, soon after diagnosis is made is surgical treatment. The prescribed surgical technique, after median sternotomy and hypothermic circulatory arrest, the first stage is ligation and division of vertical vein [connection between left pulmonary vein and innominat vein] and then total correction based on the anatomy. If total correction was done in neonates and infancy period, operative mortality seems to be low but in old age is high because of pulmonary artery hypertension. The aim of this study is to introduce a two stage repair in patients who dont tolerate one stage repair. The vertical vein is kept intact and snared, If pulmonary hypertension and failure occur, opening and appropriately banding this vein will relieve the pulmonary hypertension and associated failure. Two patients with TAPVC types cardiac and Supra cardiac in GHAEM HOSPITAL had cardiac surgery with CPB as usual manner, we ligated vertical vein but not divided it, and then total correction had been done via right atrium and in final of operation we closed ASD, but weaning from CPB was impossible and pulmonary edema and hypotention occurred. With opening of vertical vein, all symptoms were obscured and weaning from CPB was done very well and patients were transferred to ICU division with hemodynamically stability condition. Because of older age of these patients and occurred pulmonary hypertension [PA-pressure = 50 mmgh] and lower left atrial cavity we had hypertensive pulmonary artey crises,and with opening of vertical vein, all symptoms resolve,therfore, recommended: in older children with TAPVC, first, vertical vein should not be closed and in latest stage of operation if condition of patient is good then closure of it done