Role of surgical correction of aortic coarctation on hypertension in adults

To diagnose the impact of surgical intervention on systolic hypertension, a retrospective study reviewed 14 adults with a mean age of 27.3 +/- 6.2 years who underwent coarctation repair at Al-Azhar University Hospital between 1995 and 2002. All patients were hypertensive [mean systolic blood pressure 169.3 +/- 21.4 mmHg, range 140 to 220 mmHg] and 9 patients [64.2%] were on a regimen of at least one hypertensive medication at the time of surgical interference. All patients underwent cardiac catheterization and the mean peak systolic gradient across the coarctation was 57.9 +/- 24.4 mmHg [range 25 to 120 mmHg]. Operative procedures included resection of the coarctation segment with an interposition of tube graft [3 patients], resection and end-to-end anastomosis [2 patients], a bypass graft [6 patients] and patch angioplasty [3 patients]. There was no hospital mortality or late morbidity. Early and intermediate follow up was available at a mean of 2.5 +/- 2 years [range 1 to 6 years]. At last follow-up, the peak systolic gradient between the upper and lower body was trivial. All patients had significant improvement in systolic blood pressure compared with preoperative values, specially older patients requiring medication

Effect of aortic valve replacement on the severity of associated mitral valve incompetence

The study included 80 patients divided into three groups according to the severity of MVI [trivial, mild and moderate]. All the studied patients had no obvious organic MV lesions and underwent mechanical aortic valve replacement. Pre- and postoperative echo evaluated severity of MVI, mitral annular area and LV EDD, ESD. There was marked improvement in the clinical status after AVR in 78 [97.5%] patients. There was a general improvement in the seventy of MVI. In univariate analysis, there was no significant statistical effect in correlation of the changes in the severity of MVI to the studied variables as age, mitral annular area and LV dimensions. However, there was a significant statistical change in the mitral annular area in all studied groups from pre- to postoperative measures. At the last period of follow up there was improvement in the left ventricular dimensions, but was not significant statistically from pre- to postoperative measurements, especially in LVEDD. There was no incidence of valve thrombosis or endocarditis

Management of bronchial and lung injury in multiply injured patients with chest trauma

Pulmonary and/or bronchial injuries due to chest trauma are not uncommon and occur in about 0.25% of patients. .In this study, the pattern of injury is analyzed and the importance of careful clinical examination outlined. Diagnosis is confirmed by means of plain chest X-ray and bronchoscopy.Between 1998 and 2000, 600 patients with a chest trauma were admitted to our University Hospital.In only 32 of them [0.5%], a ruptured bronchus and lug injury following chest trauma was identified. All patients had sustained severe associated injuries]. In five patients presenting with an extended subcutaneous emphysema at the time of admission, an air leakage persisted after immediate tube thoracostomy, one patient showed continuous tracheal bleeding. Diagnosis was confirmed bronchoscopically and an emergency thoracotomy performed in all 32 patients.In 14 patients the main bronchus was sutured, in 2 patient a wedge resection became necessary, and in one patient with additional lung laceration a lobectomy was performed. Twenty eight of 32 patients have survived and show no sequelae 3 months after trauma, respectively.Multiply injured patients with chest trauma presenting with an extended subcutaneous emphysema and persistent air leakage after tube thoracostomy are at high risk of lesions of the tracheo-bronchial tree. Bronchoscopy will confirm the diagnosis