Management of Coarctation of The Aorta in Adult Patients: State of The Art

Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.

Management of Coarctation of The Aorta in Adult Patients: State of The Art

Coarctation of the aorta (CoA) is a common form of congenital heart disease. Adult patients with CoA may be asymptomatic or may present with hypertension. Over the last few years, endovascular management of adult patients with CoA emerged as the preferred strategy. Stent implantation, though technically challenging, offers the best and most lasting therapy. In this paper, we will review technical considerations and outcome of patients undergoing stent implantation for CoA.

Chloral hydrate versus midazolam as sedative agents for diagnostic procedures in children

To compare sedation outcomes for chloral hydrate [CH] and midazolam [MD] as sedative agents for diagnostic procedures in children. A prospective, randomized, double-blinded study conducted between July 2005 and October 2006, at the Pediatric Day Care Unit [DCU], King Abdulaziz Medical City, Riyadh, Saudi Arabia. After meeting the inclusion criteria and getting informed consent, patients were randomized, given the study drug, and monitored for sedation outcomes. Two hundred and seventy-five patients who had 292 sedation sessions for diagnostic procedures were included in the study. Due to missing data, 286 sedations were included in the final analysis; 144 in the CH and 142 in the MD group. Both groups were comparable with respect to demographic and baseline characteristics. The CH compared to MD group, had a higher sedation success rate, shorter time to achieve sedation, shorter length of stay in DCU, and longer sedation duration. In both study groups, patients who required a second dose tended to be older and heavier. No major side effects were encountered. The CH group had a significantly higher mean sedation scores at 15, 30, 45, and 60 minutes. Chloral hydrate compared to MD, had a shorter time to achieve sedation, a higher success rate, less need for a second dose, and decreased the time spent in the DCU. Older and heavier patients are more likely to require a second dose of the study drug to be sedated

Impact of chylothorax on the early post operative outcome after pediatric cardiovascular surgery

Chylothorax is the accumulation of chyle in the pleural cavity, which usually develops after disruption of the thoracic duct along its intra-thoracic route. In the majority of cases, this rupture is secondary to trauma [including cardio thoracic surgeries]. Chylothorax is a potentially serious complication after cardiovascular surgeries that require early diagnosis and adequate management. This study aims to determine the risk factors and the impact of chylothorax on the early postoperative course after pediatric cardiac surgery. A retrospective study of all cases complicated with chylothorax after pediatric cardiac surgery was conducted at King Abdulaziz Cardiac Center between January 2007 and December 2009. There were 1135 cases operated on during the study period. Of these, 57 cases [5%] were complicated by chylothorax in the postoperative period. Thirty patients [54%] were males, while 27 [47%] were females. Ages ranged from 4 to 2759 days. The most common surgeries complicated by chylothorax were the single ventricle repair surgeries [15 cases, 27%]; arch repairs [10 cases, 18%]; ventricular septal defect repairs [10 cases, 18%]; atrioventricular septal defect repairs [7 cases, 12%]; arterial switch repair [6 cases, 11%], and others [8 cases, 14%]. The intensive care unit [ICU] and the length of hospital stays were significantly longer in the chylothorax group. Additionally, some early postoperative parameters such as incidence of sepsis, ventilation time, and inotropes duration and number were higher in the chylothorax group. Chylothorax after pediatric cardiac surgery is not a rare complication. It occurs more commonly with single ventricle repair and aortic arch repair surgeries, and has a significant impact on the postoperative course and post operative morbidity

Intradermal versus staple cutaneous closure of sternum after coronary artery bypass grafting: a retrospective comparison

Cardiac surgery infections are infrequent but cause important complications. Predicting their occurrence is essential for future prevention. This study aims at determining the difference in wound complication and infection rates between suture and staple cutaneous closure techniques applied to clean sternal incisions in coronary bypass patients at King Abdullah University Hospital, Jordan. In a retrospective study, 1,338 coronary artery bypass grafting cases have been analyzed from May 5, 2002, to December 31, 2007. A sternal wound was studied retrospectively. 572 patients had wound closed with intradermal [subcuticular] sutures, 766 patients had wound closed with staples. Wounds were categorized as complicated [greater than normal erythema]. A complicated wound was identified as infected if the patient had purulent discharge, if antibiotics had been prescribed for cellulites, or drainage procedure had been performed. Wounds were examined at discharge, after discharge at one week in the clinic, and at 3 to 4 weeks after surgery. Significantly lower incidence of total wound complications with intradermal suture closure than with staple closure. Subcuticular suture closure of sternal skin incision is more cosmetic and has a lower infection rate

antibiotic prophylaxis in knee arthroscopy mandatory?

To determine the need of prophylactic antibiotics in knee arthroscopic procedures. Three thousand patients, who presented to our sport medicine clinic in The Royal Rehabilitation Center at King Hussein Medical Center between January 2002 and February 2004, were assessed. Patients who refused to be enrolled in the study, those who would need complex procedures as anterior cruciate ligament reconstruction or accompanied arthrotomy and those with predisposing factors to infection as diabetes mellitus, immune deficiency disorders and steroid therapy were excluded from the study. Patients were divided into two groups; patients in group A were given one gram 1[st] generation cephalosporins at the induction of anesthesia and patients in group B were kept without antibiotic prophylaxis. All surgeries were conducted under general anesthesia with tourniquet. The patients were followed at 1, 3, 7 days and 3, 6 months for signs of infection. Statistical analysis was performed using the student t- test. One hundred eighty patients were included in the study and divided into two groups with equal numbers. There were no significant differences between the two groups in terms of age, pathology detected in knees, surgical procedures performed and operative time. No infection was detected in both groups during follow up. No complications of antibiotic use were encountered. Our results are preliminary to an ongoing study but we can conclude that using antibiotic prophylaxis, as a routine, in operative knee arthroscopy is not mandatory. Antibiotic usage may increase cost and may lead to antibiotic complications. Antibiotic prophylaxis may have a role in complex knee arthroscopic procedures as anterior cruciate ligament reconstruction

Transcatheter Closure of Secundum Atrial Septal Defects in the Elderly

BACKGROUND AND OBJECTIVES: With the exception of bicuspid aortic valves, atrial septal defects (ASDs) are the most common congenital heart lesions found in adults. A mortality and morbidity benefit has clearly been demonstrated in the treatment of this lesion in younger patients. However, the benefits of ASD closure are less well defined in the elderly. We report our experience with transcatheter ASD closure and detail its impact on functional status and right ventricular remodeling as indicators of right heart failure in patients greater than 60 years of age. SUBJECTS AND METHODS: Fifty-five patients (median age 70 years) underwent ASD closure at a single center during an eight-year period. Data were collected and analyzed retrospectively. RESULTS: Transcatheter closure was successful in all patients. No major complications occurred during the periprocedural or follow-up periods. Complete defect closure was documented in 97% of patients during follow-up. All patients improved by at least one New York Heart Association (NYHA) functional class. Following ASD closure, no patient was in NYHA III or IV. The median right-ventricular end-diastolic diameter decreased from 39 mm to 26.6 mm (p<0.001). CONCLUSION: Atrial septal defect closure is safe and effective in elderly patients. Our data and prior published data consistently demonstrate that even patients greater than 60 years of age experience improvement in functional status and right ventricular remodeling. Therefore, patient age should not influence the decision of whether an ASD should be closed.

Pharmacologic prophylaxis and treatment of venous thromboembolism after knee arthroplasty

The objective of this study was to evaluate the efficacy of unfractionated heparin, warfarin and low molecular weight heparins [LMWH] used for the prevention of venous thromboembolism in arthroplastic surgery of the knee joint. In this prospective study from August 2002 to November 2004, 60 patients were included and divided into three groups with equal numbers, with each group receiving different treatment protocol. Postoperatively, the occurrence of symptomatic deep vein thrombosis [DVT] or pulmonary embolism [PE] was recorded during the first 30 days after surgery and at a routine follow-up visit. A significantly lower prevalence of DVT and PE was found in patients using warfarin and LMWH as prophylaxis in comparison with patients using unfractionated heparin. Warfarin and low molecular weight heparins are more beneficial and effective than unfractionated heparin for DVT and PE prophylaxis in arthroplastic knee surgeries

Effect of submersion injury on water safety practice after the event in children, Saudi Arabia

To bring to light issues surrounding water safety practices and the impact of such incidents on these practices in our community. We conducted a prospective observational study at King Abdul-Aziz Medical City, Riyadh, Kingdom of Saudi Arabia of all children <12 years of age presenting with submersion injury in the period between January 1999 through December 2004 noting the demographics and the pattern of water safety practices prior to and after event. A total of 29 patients were included. The majority of incidents took place in swimming pools. Water safety practices were lacking in most cases as evidenced by the fact that 87% of the victims were not properly supervised at the time of the event. None of swimming pools met the required safety regulations. Cardiopulmonary resuscitation knowledge was virtually nonexistent. The event did not have a positive impact on the water safety practices of the affected families. Submersion injury is also prevalent in land locked areas. Water safety practices are deficient in our community. Submersion injury was not enough to have a consistent positive impact on water safety practices of the affected families. Much can be carried out to improve water safety and save lives

Device closure of congenital [perimembranous and muscular] and acquired ventricular septal defects using the amplatzer devices: percutaneous and perventricular techniques

Ventricular septal defect [VSD] accounts for approximately 20% of all forms of congenital heart disease. The conventional treatment has been the surgical closure of these defects. Percutaneous closure of VSD had been attempted in the past but it was not until the development of Amplatzer Muscular VSD occluder device that the higher closure rates and safety of the procedure made it an attractive alternative to the surgical closure. Amplatzer VSD devices have also been designed to close perimembranous and post infarction muscular VSDs and the results have been encouraging. In addition to the percutaneous conventional approach, an intraoperative [perventricular] technique has been developed to allow safe VSD closure with Amplatzer devices in small infants with poor vascular access avoiding the need of cardiopulmonary bypass or in infants with concomitant cardiac defects requiring surgical repair. In this review the transcatheter VSD closure with Amplatzer VSD occluders will be discussed for each type of VSD and the technical aspects will be detailed