Right ventricular infarction and refractory hypoxemia following coronary artery bypass graft surgery

Right ventricular [RV] infarction occurs in 19% to 51% of patients with left ventricular inferior wall acute myocardial infarction. The importance of RV infarction and its unique hemodynamic consequences were not well understood until the early 1970s. Among these consequences are hemodynamic disturbances, which may be mistaken for left ventricular dysfunction, pericardial tamponade, and pulmonary embolism. Another serious consequence associated with RV infarction is sudden right-to-left shunting through a previously unsuspected atrial septal defect [ASD] or patent foramen ovale [PFO]. We herein describe a patient in whom postoperative RV infarction was associated with refractory hypoxemia through a PFO

Superior vena cava syndrome following central venous cannulation

Superior vena cava syndrome caused by blockage of the vein that carried blood from the head, neck, chest, and arms to the heart may occur due to various etiologies including thrombosis, occlusion and pressure on the superior vena cava. Foreign instruments in the vein, infections and also intimae injuries can lead to venacaval thrombosis. One of the most common causes of caval thrombosis is central venous catheterization for fluid administration and hemodialysis. This report presents an 8 years-old girls with chronic benign superior vena cava syndrome related to the long-term use of central venous catheters for hemodialysis. Treatment included resection of the obstructed segment and repair of the superior vena cava with an autologous pericardial patch. Reconstruction with an autologous pericardial patch without bypass of superior vena cava to right atrium is a safe and simple method but more importantly it is preferable and easier to prevent these events by simple nursing care in dialysis unit to secure the dialysis access

Maternal and Fetal outcomes following open heart surgery during pregnancy

This study is aimed at evaluation fetal and maternal outcome in pregnant women with heart disease candidate for open heart surgery. In this study we evaluated adverse complications in 14 pregnant women underwent open heart surgery during three years period. Variable parameters were: age, parity; gestational age, history of cardiac surgery and medications, cardiac complications during pregnancy surgical indications of cardiac disease, fetal and maternal mortality and related complications. Mean age and gestational age were 38.4 years and 17.28 weeks respectively. Most of the patients were multiparous [71.42%] and in functional NYHA class III or IV [85.70%]. During pregnancy 71.43 percent of patients showed signs and symptoms of CHF and 64.28 percent of them had atrial fibrillation. All patients underwent emergent open heart surgery. Maternal and fetal mortality following surgery were 35.71 and 78/57 percent respectively. Cardiac Surgery during pregnancy were accompanied with high fetal and maternal mortality. Such pregnancies need to be managed by a team including obstetrician, cardiologist, anesthetist and cardiac surgeon. For best result, it is better to postpone surgery whenever possible and surgery is performed only when it was indicated. The present study demonstrates that emergency surgery, poor NYHA class, Atrial Fibrilation, unstable heart disease, poor economical cultural conditions will result in adverse outcome in mother and fetus following cardiac surgery