Role of posterior pericardiotomy in prevention of Pericardial Effusion and Atrial Fibrillation after coronary artery bypass grafting surgery

The aim of this prospective study was to evaluate the efficacy of Posterior Pericardiotomy in decreasing the occurrence and development of Pericardial Effusion and related Atrial Fibrillation [AF] Randomized Control Trial [RCT]. Armed Forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, from Jan 2009 to Feb 2010. This prospective randomised study was performed in the first 100 patients undergoing coronary artery bypass grafting surgery [CABG] between January 2009 and February 2010. Patients were randomized into two groups, Posterior Pericardiotomy was performed in 50 patients before releasing aortic cross clamp [Group I]; remaining other 50 patients served as the control Group [Group II]. Longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in Group I. The difference between the two treatment groups, with regards to age, sex, number of bypass grafts, duration of cross clamp, total perfusion time and hospital stay time were not statistically significant. Atrial Fibrillation was noted in 02 [4%] patients in Group I and 12 [24%] patients in Group II [p 0.004]. Pericardial Effusion was present in 03 patients in Group I and 16 patients in Group II [p <0.001]. Atrial flutter and other supraventricular arrhythmias were not statistically significant. Posterior Pericardiotomy proved to be technically easy and efficient procedure in decreasing the occurrence and development of Pericardial Effusion and related Atrial Fibrillation [AF]

Does intact pleura during internal mammary artery harvesting decreases pleuropulmonary complications?

To evaluate the effects on postoperative pulmonary function of pleural integrity versus opened pleura, in patients who receive a left internal mammary artery graft. Randomized control trial. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi from June 2009 to Feb 2010. The study was conducted on 62 patients who underwent elective coronary artery bypass grafting. The patients were divided into 2 groups: Group A consisted of patients who underwent internal mammary artery harvesting with opened pleura [n=31] while Group B consisted of patients having internal mammary artery harvested with intact pleura [n=31]. To monitor pleuro-pulmonary complications, chest radiography was performed routinely 1 day before operation and on the 2nd, 4th and 6th postoperative days. The preoperative, after extubation, and 1st postoperative day values of partial oxygen pressure [PaO2], partial carbon dioxide pressure [PaCO2], oxygen [O2] saturation and haematocrit were recorded for comparison. The effect of intact pleura on IMA traction was also recorded by serial cardiac enzymes measurement and electrocardiography in the immediate postoperative period. Pleural effusion occurred more often in patients of Group A [35.5% versus 12.9%] which was statistically significant [P 0.038]. However, no significant differences were recorded in postoperative respiratory complications. Reoperation for postoperative bleeding and tamponade was done in 6.5% and 3.2% of cases in Group B respectively but none Group A; however it was not statistically significant [P 0.076]. The mean postoperative hospital stay was 7.84 days for Group A and 7.58 days for Group B. Pleural integrity during IMA harvesting decreases pleural effusion. Although, no significant differences were recorded in postoperative lung complications, intact pleural technique of IMA harvesting is recommended because of the added advantage of decreasa rate of pleural effusion

Ideal treatment for chronic pilonidal sinus

A hospital-based study was carried out from January 2001 to August 2002 to compare the results of Open excision operation and Karydakis technique for the treatment of pilonidal sinus. In Group A, 23 patients underwent Open excision operation, while in Group B, 22 patients were treated by Karydakis operation. In Group A, the mean hospital stay was 6.74 days, mean healing time and mean period off work were 7.9 weeks and 6.98 weeks respectively. The most common complications after this procedure were sepsis [17.39%] and scar pain [17.39%]. Recurrence occurred in 04 cases [17.39%]. The overall complication rate in this group was 21.74%. On the other hand, in Group B, the mean hospital stay was 3.23 days while, mean period of recovery and mean period off work were 2.95 weeks and 2.68 weeks respectively. Most common postoperative complications were sepsis [13.63%] and wound dehiscence [13.63%], the overall complication rate being 13.64%. Early recurrence occurred in 01 case only [4.5%]. From our study, it is concluded Karydakis technique is superior to Open excision operation in terms of shorter hospital stay and early recovery. Moreover, it is cost-effective procedure with low postoperative morbidity and recurrence rate