Pre-operative carotid doppler ultrasound scanning among patients who underwent cardiac surgical procedures at Queen Alia Heart Institute, is it necessary?

To assess the frequency of significant carotid artery disease among the study group patients who underwent cardiac surgical procedures and highlight the importance of pre-operative Carotid Duplex Ultrasonography Scanning. This is a descriptive study which was conducted on a consecutive series of 102 Jordanian patients who underwent cardiac surgical procedures at Queen Alia Heart Institute between January and December 2009, and were pre-operatively examined for carotid artery disease. Median age of the study group patients was 63 [range 40-78] years, there were 84 males and 18 females, 76[74.5%] were hypertensive, 62[60.7%] diabetics, 67[65.6%] had history of smoking, 45[44%] had a Body Mass Index >30, 13[12.7%] had significant left main disease. Ten patients [9.8%] had a pre-operative history of transient ischemic attack or cerebrovascular accident. Chi-square was used to determine significance of the study variables, P value<0.05 was considered significant. Seventeen patients [16.6%] were found to have 50% or greater stenosis of one or both carotid arteries whereas for an 80% or greater stenosis; it was 6[5.8%]. Frequency of a 50% or greater stenosis of one or both carotid arteries was 3[6.5%] in patients between age 60 and 69 years, increasing to 11[42.3%] for patients age of 70 years and older. Independant risk factors for the presence of >50% stenosis in one or both carotid arteries in this group of patients were a previous history of transient ischemic attack or cerebrovascular accident, left main coronary disease, hypertension, history of smoking. Among 4 patients found to have concomitant significant carotid lesions and were hemodynamically stable with no critically stenotic coronary arteries, management was staged, carotid stenting was performed as a first stage in 2 patients and carotid endarterectomy was performed as a first stage in another 2 patients, cardiac procedures were performed successfully as a second stage in these 4 patients. Concomitant significant Carotid Artery Disease among the study group patients above the age of 70 who underwent cardiac procedures is relatively high, selective pre-operative Carotid Duplex Ultrasonography should be mandatory

Use of magnesium sulphate in the prophylaxis of atrial fibrillation post cardiac surgery, is it effective?

To assess the effectiveness of magnesium sulphate in the prophylaxis of postoperative atrial fibrillation in patients undergoing elective coronary aortic bypass grafting or valvular heart surgery in terms of reducing its incidence and decreasing the length of hospital stay. This study which was conducted at Queen Alia Heart Institute from June 2009 to June 2010 on 308 patients who underwent elective coronary artery bypass grafting or valvular heart surgery. Patients were divided into two equal groups, the magnesium-treated and control groups [154 each]. Then each group was subdivided into patients who underwent coronary artery bypass grafting alone [n = 102], and patients underwent valvular surgery with or without coronary artery bypass grafting [n = 52]. In the treatment group, patients were given 3.0gm of magnesium sulphate intra-operatively, and later on for the first 4 consequent post operative days. About 8.4% developed atrial fibrillation in the treatment group in contrast 23.3% in the control group [P< 0.001]. In the subdivided groups, those patients who underwent only coronary artery bypass grafting, 7.8% and 23.5% developed atrial fibrillation in the treatment and control group respectively. In the group of patients who underwent valvular heart surgery with or without CABG, 5 patients [9.6%] developed atrial fibrillation in the treatment group compared to 15 patients [28.8%] in the control group. Atrial fibrillation developed after 34 +/- 10.52 hours in the treatment group in comparison to 38 +/- 11.23 hours which is statistically non-significant. The length of hospital stay was 6.01 +/- 2.15 days in the treatment group while it was 5.95 +/- 1.85 days in the control group which was also found to be statistically non-significant. Use of magnesium sulphate, both intraoperativley and postoperatively proved to be safe and effective in reducing the incidence of post operative atrial fibrillation in patients undergoing elective coronary artery bypass grafting or valvular heart surgery, but with no obvious significant effect on hospital stay