Control of heparin anticoagulation during cardiopulmonary bypass experience with a small initial dose

Forty adult patients of both sex undergoing cardiac surgical procedures requiring cardiopulmonary bypass were included in the present study. Patients were classified into two equal groups [each of 20 patients], group I were given the usual initial dose of heparin 400 IU/Kg while group II were given an initial dose of heparin 200 IU/Kg. Additional doses of heparin 50 IU/Kg added to attain ACT just above 400 sec in both groups to study this small initial dose for safe anticoagulation during CPB. It is found that the total heaparin dose before cannulation, the mean ACT values, the total heparin during surgery and the protamine dose for reversal were significantly lower in group II than in group I. So, starting with an initial heparin dose of 200 IU/Kg, adding small incremental doses to attain ACT just above 400 sec and proper ACT monitoring is a safe technique for heparin anticoagulation during CPB avoiding heparin overdosager

Early results of aortic valve replacement

Twenty patients 5 females and 15 males with age ranging from 15-50 years [mean 24.50 years] were operated upon in the Cardio-Thoracic Surgery Department, Tanta University Hospital. They were evaluated preoperatively in the Cardiology Department and reevaluated postoperatively 1 to 3 months after surgery. There were significant changes postoperatively in functional class [F.C.], left ventricle end systolic dimension [LVESD] and left ventricle end diastolic dimension [LVEDD] in all patients, but there was no significant change in fractional shortening [FS] or ejection fraction [EF]. Patients are divided according to their postoperative FS into 2 groups; the first one with FS of 30 mm Hg and the second one with FS less than 30 mm Hg. It is found that the only factors that determine the good outcome were the functional class, the ischemic time and total bypass time, while preoperative LVESD, LVEDD or FS did not affect the postoperative outcome. Eight patients had postoperative gradient across aortic valve of 30 mm Hg or more which was considered as non-satisfactory gradient, while 12 patients gave satisfactory transvalvular gradient of less than 30 mm Hg. The effective orifice area of the prosthetic valve and in turn the valve size have good correlation with the post- operative gradient so with small valve size used there was non satisfactory gradient

Mediastinal tumours review of 22 cases

Twenty-two patients with mediastinal tumours were studied. The age ranged between 2-60 years with a mean of 32.2 years, 63.6% of the patients were males and 36.4% were females. Respiratory symptoms were the main complaint in this series. Ten patients had their tumours located in the anterior mediastinum and 12 patients [54.6%] in the posterior mediastinum

Closed mitral valvotomy, one year experience in Tanta University Hospital

This study included 20 patients with rheumatic mitral stenosis. All patients were treated by closed mitral valvotomy. Those patients were assessed pre and post-operatively by clinical, electrocardiographic and echocardiographic studies, and also during operation. We got excellent results in 13 patients [65 percent], good results in 5 patients [25 percent] and fair results in 2 patients [10 percent]. We concluded that closed mitral valvotomy remains a simple, safe and effective mean of treatment of mitral stenosis