Pulmonary Thromboembolectomy in Chronic Thromboembolic Pulmonary Hypertension: A Case Report and Review of Literature.

Chronic thromboembolic pulmonary hypertension (CTEPH) is an important cause of severe pulmonary hypertention (PH) resulting in significant morbidity and mortality. Chronic thromboembolic PH occurs when a pulmonary embolism fails to undergo complete thrombolysis leading to vascular occlusion and pulmonary hypertension. Despite the fact that CTEPH is a potential consequence of pulmonary embolus, diagnosis requires a high degree of vigilance as many patients will not have a history of thromboembolic disease. The ventilation perfusion scan is used to evaluate for the possibility of CTEPH although right heart catheterization and pulmonary artery (PA) angiogram are needed to confirm the diagnosis. Pulmonary thromboendarterectomy is the first-line treatment for patients who are surgical candidates. This case report and review describes the pathophysiology, risk factors, diagnosis, and management of CTEPH. As it is a potentially curable cause of PH, its accurate diagnosis is vital. The gold standard and effective treatment for CTEPH is pulmonary endarterectomy (PEA). Pulmonary endarterectomy is an uncommon procedure with less than 50 years of experience worldwide. Research on the development of new surgical approaches is essential. In the present case, a new successful surgical technique for PEA was introduced. Conclusion: The surgical procedure used on the present patient was a unique technique. We do not claim that our technique is better than the original San Diego technique, but it is suggested as a modification that may improve patient survival. However, this procedure has its own limitations and cannot be used for clots that are located distally. Therefore, further experience should be obtained in order to overcome the limitations and improve the applicability of the technique.

Tertiary Prevention of Ischemic Heart Disease: Post Coronary Artery Bypass Surgery.

Coronary heart disease is more prevalent in Indian urban populations and there is a clear declining gradient in its prevalence from semi-urban to rural populations. Epidemiological studies show a sizeable burden of coronary heart disease in adult rural (3-5%) and urban (7-10%) populations. Thus, of the 30 million patients with coronary heart disease in India, there would be 14 million who are in urban and 16 million in rural areas. In India, about 50% of coronary heart disease-related deaths occur in people younger than 70 years compared with only 22% in the West. Extrapolation of these numbers estimates the burden of coronary heart disease in India to be more than 32 million patients. In India, there are large spectrums of patients who present at tertiary stage when first examined. These patients are left with very little margin of safety. Heart disease is one of the commonest causes of mortality and morbidity worldwide. Coronary artery bypass graft (CABG) surgery is a frequently used cardiothoracic revascularization to treat coronary artery disease (CAD). In addition to physical impairments and activity restrictions in the immediate postoperative period, patients encounter some obstacles to exhibit improvements in quality of life in the long run. Cardiac tertiary prevention programs generally consist of the prevention of disease progression and patient suffering. Aim of these interventions is to reduce the negative impact of disease by restoring function and reducing disease-related complications and therefore, include the rehabilitation of disabling conditions. Cardiac rehabilitation programs are interventions aimed to reduce mortality and morbidity of patients with ischemic heart diseases through promoting a healthier lifestyle among patients. These programs are used to restore, maintain, or improve both physiologic and psychosocial outcomes and finally the quality of life in patients through a combination of exercise, education and psychological support.

Concomitant Repair of Superficial Femoral Artery and Vein in a Case of Peripheral Vascular Trauma.

Vascular trauma results from penetrating, blunt or iatrogenic injuries. Young males are at highest risk and the leading causes of injury include motor vehicle crashes, falls, wounds from firearms, wounds from cutting or piercing instruments and burns. Peripheral vascular injuries account for 80% of all cases of vascular trauma. We report the case of a 21-year-old male patient with history of fall from 10 feet height on to a sharp metallic plate. Patient presented to emergency department with a lacerated wound of 15 × 10 cm on right mid thigh with active pulsatile bleed. After fluid resuscitation, patient was immediately shifted to operation room where examination revealed complete transaction of superficial femoral artery and vein with 10 cm tissue loss of both. Both vessels were reconstructed using saphenous venous graft from opposite thigh. Postoperatively, patient made a steady recovery with strong pedal pulsations and no edema or neurological deficit. Patients with hard signs of arterial trauma should be taken for surgical exploration without any diagnostic investigations. Traumatic muscular lacerations with gross contamination of wound precluded the use of any prosthetic graft and hence saphenous venous graft was most appropriate. Review of literature reveals that patients with concomitant peripheral arterial and venous injuries have a very high amputation rate and simultaneous reconstruction of both leads to improved chances of limb salvage. It is our recommendation that such patients should receive postoperative anticoagulation to avoid thrombosis of graft in venous position.