Management of retroperitoneal haematoma

To find out the frequency of different visceral injuries and morbidity and mortality related to different zones in retro peritoneal haematoma due to trauma. D.H.Q Teaching Hospital Rawalpindi. Prospective study. June 1998 to May 1999. There were total 45 patients with retro peritoneal haematoma. The policy for exploration of retro peritoneal haematoma included mandatory exploration of Zone I and selective exploration of Zone II and III. Out of total 45 patients, 40 had associated intra peritoneal injuries and Zone I was most commonly involved [n=21] followed by Zone II [n=13] and Zone III [n=11]. Vascular, genitourinary and pelvic fracture injuries were the common injuries. Overall mortality was 6.5% mainly due to irreversible shock in patients with Zone I vascular injuries. Mandatory exploration of Zone I and selective exploration of Zone II and III is a valid policy in the management of retro peritoneal haematomas. Penetrating Zone I trauma causing vascular injuries is most common of all. Shock is the most common presentation, complication and cause of mortality

Aortic valve replacement for aortic stenosis - 12 Year experience of a single surgeon

Aortic Valve Replacement [AVR] is a standard procedure carried out for severe pathological changes in aortic valve. In our study 30 patients had AVR for aortic stenosis from Dec. 1989 to Dec. 2002. There were 25 male and 5 female. Most of the patients were from poor socioeconomic group. Rheumatic heart disease was the most common cause [72.2%]. Syncope, angina and heart failure were the major indications of surgery. The mean age was 37 years. Starr Edward Valve was most commonly used valve [72.4%]. LV diastolic diameter was associated with increased pre-op NYHA grading, increased inotropic support. Hospital mortality was 5 [16.6%] and late death was 1[3.3%],4 [13.2%] patients were lost to follow up while 20[66.6%] are attending the follow up clinic with most of the cases in NYHA grade 0/I. Bleeding, infarction and postoperative arrhythmias affected the mortality significantly

Supra-valvular aortic stenosis with mental retardation: a case of William Beuren syndrome

Supravalvular Aortic Stenosis [SVAS] with elfin fades and mental sub normality is the hallmark of William Beuren Syndrome [WBS]. The diagnostic confirmation abroad is done with cytogenetic studies with fluorescent in situ hybridization [FISH]. We have to base our diagnosis on available clinical information alone

Comparison and efficacy of different cardioprotective techniques during CABG assessed by metabolic and chemical markers

It was a prospective and randomized study of 124 consecutive patients scheduled for elective surgery at AFIC/NIHD. Patients were assigned to cold crystalloid cardioplegia, warm blood cardioplegia and cold blood cardioplegia groups. Patients were comparable with respect to preoperative data and cardiac status. Biochemical measurements, metabolic indices and post operative morbidity and mortality were evaluated before and after the operation. CPK, CK-MB, AST, LDH and ALT measurements were significant among different groups. Their concentrations were highest after cold crystalloid cardioplegia and least after warm blood cardioplegia. The warm blood cardioplegia appears to confirm best myocardial protection, cold blood cardioplegia lies in the center and cold crystalloid ardioplegia exerts sub-optimal degree of myocardial protection. This study provides guidelines for the selection of a better cardioplegia solution giving optimal results

Immediate and mid term results of balloon angioplasty of native coarctation of aorta in children and aduts: a 7 years review

The purpose of our study is to analyze the immediate and midterm results of BA of native CoA in different age groups. Between June 1995 and Oct 2002, 31 BA for native CoA were performed in our department at AFIC/NIHD Rawalpindi. Age ranged between 66 days to 30 years, mean of 9.6 yrs +/- 9.2 and sex distribution of 21:6, M: F. Eleven pts [41 percent] had other associated cardiac defects. Three pts were with poor left ventricle [LV]. All pts had > 20mmHg BP difference between upper and lower limbs. All pts had significant improvement with BA. The mean peak systolic pressure gradient [PG] across the CoA decreased from 44.74mmHg SD 13.75 to 8.66mmHg SD 7.8 [p < 0.0001]. There was one, mortality in the group. In 4 pts we had sub optimal results. All of our pts had easily palpable foot pulses after BA and enjoying good health. We conclude that BA of native CoA in all age groups can be performed safely with acceptable mortality and morbidity

Multiple valve replacement, a decade's experience

Multiple Valve Replacement is the procedure involving replacement of more than one valve due to pathological changes. It was a prospective and randomized study of 72 patients for Multiple Valve Replacement at Armed Forces Institute of Cardiology [AFIC], by one surgeon. The major cause of multiple valve replacement in our country is Rheumatic heart disease and occurs in younger age group as compared to Caucasians. In this study most of the cases were of Mitral regurgitation with Aortic regurgitation [39.4 percent]. The procedures done were according to the valves involved. Aortic valve replacement [AVR] with Mitral valve replacement [MVR] was maximum in 73.7 percent. Starr Edward Valve was used in the majority of cases [59 percent]. Postoperative complications were present in 54.5 percent of cases. ICU problems were LCO, excessive bleeding, arrhythmias and pulmonary complications. Overall hospital mortality for the whole group was 28.8 percent, late mortality was 15.1 percent. Patients who were lost to follow up were 28.6 percent and 30.4 percent are still having the follow up. The relation of hospital mortality with disease pattern and NYHA grading was significant [p=0.0001]