rare case of right-sided heart failure after bentall procedure

Pseudoaneurysms of the ascending aorta, which are rare and life-threatening complications in cardiovascular surgeries, can be caused by the Bentall procedure. We describe a 44-year-old woman, who had a medical history of acute aortic dissection [Type A] and the Bentall procedure and was admitted because of exertional dyspnea, edema of the lower extremities, ascites, and holosystolic murmur in the left lower sternal border. Preoperative echocardiography revealed a pseudoaneurysm of the ascending aorta and fistulization of the pseudoaneurysm to the right atrium. Multi-slice computed tomographic scan also showed a large pseudoaneurysm of the ascending aorta around the tube graft. The patient underwent surgery, during which the pseudoaneurysm was resected, the ostium of the right coronary artery was reimplanted, and the orifice of the right atrial fistula was sutured. Intraoperative transesophageal echocardiography revealed the perfect result of the surgery. The patient was discharged uneventfully

Impact of intact pleura during left internal mammary artery harvesting on clinical outcome

Pleurotomy during coronary artery bypass grafting [CABG] may cause post-operative events, mostly pulmonary complications. In this study, we evaluated the influence of pleurotomy during CABG on the clinical outcome following left internal mammary artery [LIMA] harvesting. Between March and August 2009, 102 patients who underwent cardiac surgery were enrolled in this study and divided into two groups: group A [n = 48, 36 male and 12 female patients at a mean age of 56.5 +/- 11.2 years] underwent routine CABG and pleurotomy and group B [n = 54, 46 male and 8 female patients at a mean age of 55.4 +/- 10.3 year] had CABG with intact pleura. The patients were compared regarding their demographic data, surgical data, and postoperative events. The incidence of postoperative pericardial effusion was similar between the groups, but the incidence of postoperative pulmonary complications such as pleural effusion [except for mildpleural effusion] on the second [no: 10.4%, mild: 41.7%, moderate: 45.8% and severe: 2.7% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B] and fifth postoperative days [no: 27.1%, mild: 33.3%, moderate: 35.4%, and severe: 4.2% in group A versus no: 42.6%, mild: 44.4%, moderate: 13%, and severe: 0 in group B] was significantly lower in group B [p value < 0.001 and p value = 0.007, respectively]. Also, the incidence of atelectasis [except for mild atelectasis] on the second [no: 2.1%, mild: 22.9%, moderate: 72.9%, and severe: 2.1% in group A versus no: 9.2%, mild: 59.3%, moderate: 31.5%, and severe: 0 in group B] and fifth postoperative days [no: 22.9%, mild: 39.6%, moderate: 35.4%, and severe: 2.1% in group A versus no: 39.6%, mild: 49.1%, moderate: 11.3%, and severe: 0 in group B] was significantly higher in group A [p value < 0.001 and p value = 0.004, respectively]. Postoperative partial oxygen pressure and 02 saturation were similar between the groups, but partial carbon dioxide pressure was significantly lower in group A [p value = 0.017]. Amount of bleeding [p value = 0.008] and duration ofhospitalization [p value =0.002] were significantly higher in group A than those in group B. Our results indicate that keeping the pleura intact has beneficial effects on the respiratory function, without increasing the incidence of postoperative pericardial effusion

[Incidence rate of pressure sores after cardiac surgery during hospitalization and its relevant factors]

This study was conducted to assess incidence rate sores after cardiac surgery during hospitalization and its relevant factors, also discussed differences between sore and burn as a result of unstandard connections of electrocautery system in operating room. Surgical patients because of risk factors that exist in operating room, have more potential to develop pressure sore than general acut patients. Pressure sores and burn may both occur in the intraoperative environments and are often difficult for personnel to differentiate upon postoperative inspection. This descriptive cross-sectional study was conducted on 333 patients in 6 month, who were operated in Shaheed Rajaei Cardiovascular Medical and Research Center. Samples were selected Unrandomly. Demographic information, pre-intra-post operation [ICU and surgical ward] were collected by questionnaire.Data were analyzed using software SPSS 15 and descriptive statistical tests. Incidence rate of pressure sores after cardiac surgery was 21.3%.71 patients were involved with pressure sores, 67 cases in ICU and 4 cases after admission in ward.68[95.7%]were first degree and 3[4.2%]were second degree. This Shows meaning relationship with, sex, hypertension, myocardial infarction, intraoperative Hypoxemia ,Using mattress postoperatively, inotropic drugs, blood pressure<80mmhg,reoperation,decreased hematocrit and albumin, hospitalization and duration of staying in ward. More skin damage were seen after operation in ICU immediately or in the first 24 hours. It is worthful to control comorbidities before, during and after operation. Incidence of pressure sores can be minimized by providing enough perfusion during operation, using silicon mattress on bed of operating room, using mattress and changing position especially during stay in ICU, also paying attention to nutritional states and other known factors in study. Electrocautery system of operating rooms must always and periodically be checked, also taking care of probably bums to prevent from converting into pressure sores is very important

Very late effects of postoperative atrial fibrillation on outcome of coronary artery bypass graft surgery

Atrial fibrillation [AF] after coronary artery bypass graft [CABG] is a common complication with potentially higher risk of adverse outcome and prolonged hospital stay. To determine the impact of postoperative AF [POAF] on long-term outcome in a large cohort of patients who underwent CABG. We conducted an observational cohort study of 989 patients who underwent isolated CABG with more than 5-year follow-up. Patient divided in two groups: patients with and without POAF. In this study, atrial fibrillation developed after CABG in 156 patients [15.8%]. Patients with POAF were generally older [P = 0.001] and presented more often with comorbidities including congestive heart failure [P = 0.001], hypertension [P = 0.001], peripheral vascular disease [P = 0.001], hyperlipidemia [P = 0.009], and renal failure [P = 0.001]. Five-year mortality was observed in 23 [2.3%] patients. Patients with POAF had higher five-year mortality rate than those without POAF. Multivariate logistic analysis showed that AF after surgery has a strong effect on mortality [HR, 3.3; 95% CI, 0.04-10.8, P = 0.04] and morbidity rates [HR, 4.0; 95% CI, 2.35-6.96, P = 0.001]. Postoperative atrial fibrillation strongly predicts higher long-term mortality and morbidity following coronary artery bypass graft

Pregnancy outcome after mechanical mitral valve replacement: a prospective study

Pregnant patients with mechanical heart valves require anticoagulation. The risk of bleeding and embryopathy associated with oral anticoagulants must be weighed against the risk of valve thrombosis. In this prospective study, undertaken between 1999 and 2009, 53 pregnancies [47 women with mechanical mitral valves; 29.8 +/- 4.8 years old] were studied. Patients were divided into two groups: group I [n = 43] received Warfarin throughout the pregnancy, while group II [n = 10] received Heparin in the first trimester and then Warfarin until the 36th week. Thirty-two [60.4%] pregnancies resulted in live births, whereas 18 [34%] abortions, 2 [3.8%] stillbirths, and one [1.9%] maternal death occurred. In group I, there were 26 [60.5%] live births, one [2.3%] stillbirth, and 15 [34.9%] abortions. In group II, there were 6 [60%] live births, one [10%] stillbirth, and 3 [30%] abortions. There were no significant differences between the two groups in terms of fetal outcome. Thirty-nine [90.7%] of the pregnancies in group I and 50% of those in group II [p value = 0.001] were without complications. There were no congenital malformations in the two groups. Fetal outcome was almost the same between the Warfarin and Heparin regimens. In maternal outcome, the Warfarin regimen is safer than Heparin

Huge arteriovenous fistula between a giant aneurismal right coronary artery and coronary sinus

Coronary arteriovenous fistulas are rare and may be congenital, traumatic, or iatrogenic. We report one of these rare congenital anomalies with a giant aneurismal right coronary artery [RCA] in a middle-aged lady who was asymptomatic for a long time

Association between periodontal pathogens and coronary artery disease: a case-control study

We sought to answer the questions about the role of inflammatory factors in the formation of pathological lesions in the endothelium of the coronary vessels and also the role of host-based bacteria, including chronic periodontitis, in the clot formation in the blood vessels, all of which destabilize the atherosclerotic plaque. This case-control study was done on 40 patients who underwent elective coronary artery bypass grafting surgery [CABG] with the need of coronary endarterectomy. In Group A, patients had chronic periodontitis and group B consisted of patients without it. Both groups were well matched regarding their demographic data. The subgingival plaque was collected by a sterile curette from periodontal pockets >/= 5mm and CAL >/= 4mm. Also, atherosclerotic plaque was collected during the coronary endarterectomy surgery from all of the 40 patients. The specimens were assessed using the PCR technique to detect the specific bacteria responsible for chronic periodontitis such as actinobacillus actinomycetemcomitans [Aa], prevotella intermedia [Pi], porphyromonas gingivalis [Pg], Tanerella forsythensis [Tf], Treponema denticola [Td], and fusobacterium nucleatum [Fn]. In the atherosclerotic plaque of group A patients, Aa was identified in 18 [90%], Pg in 16 [80%], Tf in 13[65%],Td in 11 [55%], Pi in 10 [50%], and Fn in 6 [30%] specimens, whereas in group B the incidence was significantly lower [p< 0.0001]. In the subgingival plaque of group A, Aa and Tf were found in all 20 individuals and Pg, Pi, Td and Fn were identified in 19 specimens [95%]. The differences in the incidence of Aa and Pg in two plaque samples were not significant, but the two plaque samples showed significant differences regarding the incidence of the other pathogens [Pi: p<0.001, Tf: p<0.008, Td: p<0.003 and Fn :p<0.0001]. In the present study, the same organisms were found in both coronary atherosclerotic and subgingival plaques. The findings support the potential role of the periodontopathogenic bacteria species in some steps of the atherosclerotic process as a contributor that worsens this disease. However, further studies are required to achieve more definite results regarding the role of periodontal diseases in the atherosclerotic disease, focusing on patients' background variables

Atrial septal aneurysm concomitant with severe mitral stenosis

An atrial septal aneurysm is an uncommon abnormality and may be the origin of thromboembolic events. We herein present an unusual case of this septal abnormality with mitral stenosis and history of thromboembolic cerebrovascular accident

Pregnancy outcome with intracytoplasmic sperm injection method in a woman with prosthetic heart valves

There is an increased risk of thromboembolism, anticoagulant-related hemorrhage, fetal-wastage and congestive cardiac failure in pregnant women with mechanical heart valves. In order to have a good outcome, the care of such patients must necessarily be multidisciplinary and in a well- equipped centre with adequate support services. One such patient who had mechanical mitral and aortic valves replacement in 2000 receiving warfarin anticoagulant therapy, presented with a first trimester pregnancy by ICSI method in 2006. She remained in stable homodynamic state and went through pregnancy without event. Delivery was done by caesarian section at 37 weeks gestation age. With considering use of warfarin during pregnancy, use of stimulation protocol during ICSI and delivering normal neonate ultimately, this interesting case is presented here