ABSTRACT
The purpose of this study is to evaluate the effect of aortic valve replacement [AVR] on left ventricular function in patients with chronic rheumatic aortic regurge [AR]. This prospective selected study was conducted in the Department of Cardiothoracic Surgery, Mansoura University Hospitals from January 2005 to March 2007 including follow up period. The study involved 50 patients with chronic rheumatic AR for whom AVR was done. Group I [N = 25 patients] with FF > gt 50%. Group II [N= 25 patients] with EF = 50%. All patients were subjected to pre-operative full history taking and physical examination, routine full lab examination was performed in all patients. Echocardiography was performed pre-operatively, 3 weeks, months and after one year of surgery. Aortic valve replacement was done using Mechanical bileaflet prosthetic valves [St.Jude and amp Carbomedics] which was implanted randomly in both groups of patients. Preoperatively, Both groups were similar regarding age, gender, clinical presentation and NYHA functional class without any statistically significant difference Postoperatively, NYPLA functional class improved significantly in both groups [p value: 0.001]. LVESD was reduced in both groups, however this reduction was significant only in groups I at 3 weeks [p value: 0.023]. The end of follow-up period, this reduction was significant in both groups [p value: 0.001]. LVEDD was reduced in both groups, although it was more significant in group I [p value: 0.001]. [EF% showed initial drop in both groups early postoperatively. However, after 3 months and at 1 year, it showed significant improvement in both groups which was more significant in group I value: 0.006]. The mean ICU stay was 2.6 days in groups I Vs 8 days in group II .The mean hospital stay was 9.2 days in group IVs 16 days in group II. Aortic valve replacement has a beneficial effect on left vermicular diameters and function in patients with chronic rheumatic aortic regurge which is more obvious in patients with EF > 50% at the time of surgical intervention. So early surgery is recommended in these patients to provide faster and more significant recovery of the myocardial pump performance. Also, it is associated with shorter hospital and ICU stay and lower incidence of morbidity and mortality
Subject(s)
Humans , Male , Female , Heart Valve Prosthesis Implantation/adverse effects , Ventricular Function, Left , Electrocardiography , Echocardiography , Prospective Studies , Chronic DiseaseABSTRACT
The study was conducted to evaluate our surgical results and operative outcome after complete excision of cardiac myxoma. This retrospective study was conducted in the Department of Cardiothoracic Surgery, Mansoura University Hospital from march 1996 to January 2007, the study involved 17 patients with intracardiac myxoma for whom excision was done. All patients were subjected to full history taking, clinical examination, routine laboratory and EGG examination. Echocardiography was performed preoperatively, prior to discharge and after a mean duration of 8.47 +/- 2.72 months postoperatively. Seventeen patients of cardiac myxoma were surgically treated. The mean patient age was 37.82 +/- 9.4 years and there was 9 [52.9%] male patients and 8 [47.1%] female patients. The most common preoperative symptom was dyspnea occurring in 7 [41.2%] patients. The mean interval from the onset of symptoms to surgery was 8.29 +/- 4.98 months. The tumor was in the left atrium in 15 [88.3%] patients, in the right atrium in one [5.9%] patient and bilateral myxoma was present in one [5.9%] patient. The heart was approached via median sternotomy in all cases, left atriotomy was done in 15 [88.2%] patients, right atriotomy in one [5.9%] patient while bilateral approach was used in one [5.9%] patient. The tumour was excised completely in all cases and the defective area was repaired directly in 11 [64.7%] cases, and with pericardial patch in 6 [35.3%] cases. The mean cardiopulmonary bypass and aortic cross clamp times were 38.3 +/- 2.36 and 26.4 +/- 2.1 minutes respectively. There was one [5.9%] case hospital mortality due to fatal arrhythmia and 2 [11.8%] cases morbidity in the form of pneumonia and superficial wound infection. All patients underwent echocardiography prior to discharge and at a mean follow up period of 8.47 +/- 2.72 months postoperatively. All survival 16 [94.1%] patients showed no evidence of tumour recurrence clinically or on echocardiographic examination, also ECG abnormalities that were present before surgery had disappeared. In conclusion, in our study there was no recurrence of myxoma after complete excision so surgical excision in considered to be the curative method for treatment of cardiac myxoma that quickly relieves symptoms and must be done early after diagnosis
Subject(s)
Humans , Male , Female , Myxoma/diagnosis , Electrocardiography , Echocardiography , Signs and Symptoms , Coronary Angiography , Follow-Up StudiesABSTRACT
To evaluate the variable surgical options performed in the management of endobronchial tumors and the factors determining selection of the appropriate surgical technique. Retrospective study of a series of 24 patients with endobronchial tumors who were diagnosed and underwent surgery in the cardiothoracic surgery department, Mansoura university hospital from January 1985 to March 2006. Full history taking and complete clinical examination, routine laboratory investigations, chest x-ray, and computerized tomography, and bronchoscope were done for all cases. Surgery was the line of treatment for all patients. Close sex distribution with age ranges from 20-64 years. Cough with expectoration was the main presentation. Zonal opacity was the most common radiological finding. CT chest showed sensitivity of 79.2% for detection of endobronchial lesions. Bronchoscopic examination revealed endobronchial lesions in all patients. Benign tumors were detected in 5 patients and malignant lesions in 19 patients, 14 patients were neuroendocrine tumors and 5 patients were other malignant varieties. Surgical interference included bilobectomy [7 patients], lobectomy [5 patients] pneumonectomy [7 patients], and one patient underwent surgical exploration for open biopsy while 4 bronchoplastic procedure were performed. Endobronchial tumors occur over a wide range of age without significant sex differentiation. Endobronchial tumor should be suspected in case of prolonged chest complaint inspite of maximal medical treatment. Bronchoscope is the main diagnostic tool and is important for detection of the provisional plane for surgery. Early diagnosis and screening should be established for early detection of endobronchial tumors and more conservative resectional and bronchoplastic techniques