ABSTRACT
Arrow injury in the neck with subsequent pseudoaneurysm formation of the brachiocephalic artery is an uncommon type of injury in our country. Initially it was a punctured wound in the neck which was simply repaired. About 13 days after the initial injury patient came back to hospital with severe respiratory distress and backache for which emergency tracheostomy was needed. This simple puncture wound subsequently developed haematoma in the neck and two pseudoaneurysms at distal brachiocephalic artery. CT angiogram was very helpful to confirm the diagnosis. Correct referral to tertiary hospital like National Institute Cardiovascular Diseases (NICVD) ,prompt diagnosis, definitive treatment of the injury and subsequent aggressive postoperative management saved the life of this young tailor.
ABSTRACT
Background: A substantial reduction of lung volumes and pulmonary function follows cardiac surgery. Pain may prevent effective breathing and coughing, as thoracic epidural analgesia may reduce post operative pain and improve early post operative pulmonary function. We tested the effect of thoracic epidural analgesia (TEA) on pulmonary function after off- pump coronary artery bypass (OPCAB) graft surgery. Methods: 60 patients undergoing off- pump coronary artery bypass (OPCAB) graft surgery were nonrandomized in to two groups. Group-I (30 patients) receiving thoracic epidural analgesia along with general anaesthesia (G/A) but Group-II (30 patients) receiving general anaesthesia alone. Total ventilation time, intensive care unit (ICU) stay, spirometric data, arterial blood gas (ABG) and X-ray chest (CXR) were recorded in postoperative follow-up period. Results: Thirty patients were enrolled in each group. The demographics of the groups were similar. Patients in the epidural group had significantly less pain on the operative day and for the next 2 days. Total ventilation time in hours in Group-I was 6.4±1.0 and in group-II was 10.1±1.8 hours respectively. FVC and FEV1 were significantly different in group-I than group-II. On the postoperative period, ABG was done pre and postoperative period in both groups of patients. Significant differences was found in pao2 and paco2, half an hour after extubation, 1st postoperative day, 2nd postoperative day (p<0.05). Postoperative CXR revealed significant pulmonary complication in group-II than group-I, higher in the epidural group on the first and second postoperative days. There were no complications related to epidural hematoma and no permanent neurologic squeal. Conclusion: Thoracic epidural analgesia yields a slight, but significant improvement in pulmonary function most likely due to a more profound postoperative analgesia.
ABSTRACT
Background: High-pressure distension during harvesting damages the saphenous vein (SV) and may contribute to subsequent coronary artery bypass graft (CABG) occlusion. Application of vasodilator agents to the SV during harvesting may reduce the need for high-pressure distension and improve graft quality. We tested the effects of a vasodilator solution containing the conventional agent papaverine (Pap) mixed with heparinized blood on the pressure necessary to overcome SV spasm and on the structure. Methods: 150 patients undergoing CABG were nonrandomly allocated to receive an application of either intraluminal papaverine (Pap) mixed with heparinized blood(Group-A), or intraluminal heparin mixed normal saline(group-B) to the SV for distension during harvesting. The peak pressures required to distend the vein were recorded. Samples of SV were taken for microscopical analysis just before we performed the anastomosis. Results: The results for mean peak pressures (mm Hg) were: Normal saline 131.77±20.6 (range 85 to199 mmHg); and Papaverine mixed blood solution, 56.4±2.1 (range 40 to 90 mmHg); P<0.001, (Pap mixed blood solution versus normal saline); The results of histological study for endothelial injury were: Normal saline, 52.5 %; Papaverine mixed blood solution , 20%; (P<.02, untreated versus Pap mixed blood solution). Conclusions: Intraluminal use of Papaverine mixed heparinized blood solution during vein harvesting requires low distension pressure and improves endothelial coverage compared with the use of heparin mixed normal saline.
ABSTRACT
Background: The non-invasive tests like X-ray, ECG and Echocardiography are viewed as an extension of clinical art in cardiology and have become an integral part of history taking, physical examination and other diagnostic method.Atrial Septal Defect (ASD) of secundum type is defined as a through and through communication at atrial level. Previously the diagnosis and decision of surgery for ASD, mandatorily advocate cardiac catherization.Now cardiologist and cardiac surgeon very hardly asked for cardiac catheterization. Non-invasive diagnosis with the help of ECG, X-ray and Echo is sufficient for its diagnosis and treatment for surgery. In Bangladesh there is no study upon it. Considering this ground the study is perform on Bangladeshi patients. Methods: Forty six consecutive patients with clinical (auscultatory and electrocardiographic) signs of uncomplicated atrial septal defect of secundum type were examined by chest x-ray, ECG and echocardiography, before right heart catheterisation. Result: Thirty four (74%) had ASD, four patients (9%) had insignificant pulmonary stenosis, and eight subjects (17%) were normal. No false positive diagnosis of atrial septal defect was made by chest x-ray examination, whereas increased vascular markings were incorrectly interpreted as pulmonary congestion in one case. Eight patients had x-ray films showing questionable signs of left-to-right shunt. Twelve of 30 patients with a large left-to-right shunt were correctly selected for surgery based on radiological findings. Conclusion: Analysis of non invasive diagnosis and management of ASD secundum conform the usually described pattern in western literature.
ABSTRACT
Ebstein’s anomaly is a rare form of congenital heart disease with incidence of 1% of all congenital heart diseases. There are two modes of surgical correction of Ebstein’s anomaly: either biventricular repair with or without tricuspid valve replacement, or palliative univentricular repair consisting of bidirectional Glenn shunt or Fontan procedure. We treated a case of severe form of Ebstein’s anomaly with ASD secundum with WPW syndrome. Radiofrequency ablation was done to treat WPW syndrome preoperatively. Celermajer’s index is a prognostic indicator for tricuspid valve repair or replacement. On 04.03.08 tricuspid valve was replaced with 31 mm Carpentier-Edwards bovine pericardial valve under cardiopulmonary bypass. Postoperative period was uneventful. Follow up echo done on 01.06.08 which revealed normally functioning tissue valve found in tricuspid position TR Grade I. So, in conclusion, preoperative evaluation and workout of Celermajer’s index is essential before surgical intervention for decision of tricuspid valve repair or replacement. Last but not the least, any event of arrhythmia should be properly evaluated.