Heart transplantation in Iran; a comprehensive single-center review of 15-year performance

Heart transplantation in Iran was first performed in July 1993. Since then, Shariati Hospital, affiliated to Tehran University of Medical Sciences, has been representing the most active center of cardiac transplantation in Iran and one of the major sites in the Middle East. This is a comprehensive review of our 15-year practice registry to make a scheme of our record and achievements. Clinical data on all consecutive transplanted patients from the Department of Cardiac Surgery, Shariati Hospital, Tehran, Iran over the last 15 years were reviewed. Descriptive and analytical statistics were extracted in regard to recipients, donors, surgical characteristics, and current status of the patients on follow-up. Totally, 90 patients were transplanted since 1993; 11, 32, and 47 in three five-year periods, respectively. The mean age of the recipients was 29.30 +/- 13.17 years. Motor-vehicle accident was the main cause of brain death of donors [48.8%]. The most common indication for surgery was idiopathic dilated cardiomyopathy [75.5%].The mean survival rate has been 6.66 +/- 0.87 years. One-year and five-year survivals had a rising trend through the five-year periods. Acute allograft rejection and infection were the two major events complicating our transplants. This study shows that despite a vast variety of obstacles, we have passed the primitive milestones. The number of transplants is increasing at a higher rate in recent years, and patients' survival rates and outcomes seem to be improving

Obstruction of endotracheal tube; a manufacturing error

Manufacturing defects in endotracheal tubes [ETT] are known to occur, and may cause ETT obstruction in various ways[-1] We report an ETT manufacturing error resulting in partial airway obstruction with a 7.0 mm cuffed tube due to partial perforation of the distal orifice of the ET tube

Anesthetic management in a case of Klippel-Feil syndrome and literature review

Klippel-Feil syndrome is known by the classic triad of shortness of the neck, limitation of neck movements, and a low posterior hairline. There are often accompanying cervical spinal abnormalities such as kyphoscoliosis as well as urogenital and cardiac abnormalities. Presented here we have a 20 year old young man with hypoesthesia and decreased motor function in the right hand. The problem began one year back following a minor head trauma and had a progressive course involving the legs, especially the feet. Cervical magnetic resonance imaging was compatible with C3-C4 cord compression as well as blocked vertebrae. The patient was evaluated to be in Mallampati class II. Endotracheal intubation was performed employing gentle manual axial traction in both anterior and posterior operative approaches without any neurological sequela. It is recommended that in situations where fiberoptic or Bullard laryngoscopes are not available and Mallampati class is low, direct laryngoscopy associated with gentle axial traction may be a plausible substitute