Safety and efficacy of del Nido cardioplegia in adult cardiac surgery: experience in NICVD

Background: Cardioplegia is used to induce and provide a depolarized diastolic cardiac arrest to provide a motionless surgical field. Del Nido cardioplegia solution has been used extensively in congenital heart surgery for more than 20 years and more recently for adults. This observational study was performed to assess the safety and efficacy of del Nido cardioplegia in adult cardiac surgery patients. Methods: Total 140 adult patients selected for cardiac surgical procedure i.e., coronary artery bypass grafting (CABG), valve surgery, or CABG with valve surgery no need requiring cardiopulmonary bypass (CPB) were purposively allocated into two groups: a) del Nido cardioplegia (n=70) and b) blood cardioplegia (n=70). Primary outcomes assessed myocardial preservation. Results: The study compared del Nido (A) and blood cardioplegia (B) groups. Mean ages were 49.5±7.86 and 48.9±6.79 years, respectively (p=0.5641). BMI (26.98±2.3 vs 27.2±2.14 kg/m2, p=0.4846) and comorbid factors, including smoking (48% versus 51%) were similar. Differences were lower hemoglobin in A (males: 11.7±1.18 versus 13.6±0.55; females: 10.2±0.58 versus 12.2±0.21, p<0.0001) and CPB/ACC times for isolated CABG (A: 112.40±15.75/78.45±11.65 versus B: 123.8±18.55/86.28±15.26 minutes, p=0.0001). Post-operatively, more blood loss occurred in A, but they had shorter mechanical ventilation, ICU stay, and hospital stay durations. Other variables, like 30-day mortality, were similar. Conclusions: Evidence from this study suggests del Nido cardioplegia use in routine adult cases may be safe, result in comparable clinical outcomes, and streamline surgical workflow. The trend for troponin should be investigated further because it may suggest superior myocardial protection with the del Nido solution.

Multiple Pseudoaneurysms of the Brachiocephalic Artery Following Penetrating Arrow Injury in the Neck.

Arrow injury in the neck with subsequent pseudoaneurysm formation of the brachiocephalic artery is an uncommon type of injury in our country. Initially it was a punctured wound in the neck which was simply repaired. About 13 days after the initial injury patient came back to hospital with severe respiratory distress and backache for which emergency tracheostomy was needed. This simple puncture wound subsequently developed haematoma in the neck and two pseudoaneurysms at distal brachiocephalic artery. CT angiogram was very helpful to confirm the diagnosis. Correct referral to tertiary hospital like National Institute Cardiovascular Diseases (NICVD) ,prompt diagnosis, definitive treatment of the injury and subsequent aggressive postoperative management saved the life of this young tailor.

A Case Report of Middle Aortic Syndrome: A Rare Vascular Disorder.

The middle aortic syndrome (MAS) is rare (about 0.5-2% of all the cases of aortic coarctation) vascular disorder characterized by severe narrowing in the descending thoracic aorta, abdominal aorta, or both. It can be congenital or acquired due to several conditions.MAS may present clinically as uncontrolled hypertension, abdominal angina or lower limb claudication. Surgical treatment is effective in controlling symptom and improves life expectancy.

Double Chamber of Right Ventricle (DCRV) - A Case Report.

Primarily double chamber of Right ventricle (DCRV) is an uncommon congenital anomaly consists of one or more anomalous muscle bundles(AMB) that divide Right ventricle into proximal high and distal low pressure chamber .Outcome of surgical treatment is excellent if diagnosed properly. A 5years old girl presented with breathlessness on exertion and repeated attack of cough, fever for last 4 years .patient ultimately diagnosed as DCRVand underwent intracardiac repair by open heart surgery. Her postoperative outcome was uneventful. Patient is discharged on 8th postoperative day after follow up postoperative chest X Ray and Echocardiography .

Fast-track Cardiac Surgery in Children: Feasibility in Bangladeshi Setting.

Background: Fast-track recovery protocols in cardiac surgery is gaining worldwide popularity and have contributed to significant reductions in the postoperative hospital stay and cost without any increase in postoperative mortality and morbidity. The aim of this study was to find out the feasibility of fast track paediatric cardiac surgery in Bangladeshi setting. Method: It was a prospective study conducted in National Institute of Cardio-vascular Diseases, Dhaka, from July 2009 to June 2010. All patients, between 3 to 18 years, underwent surgical closure of atrial or ventricular septal defect under cardio-pulmonary bypass. 20 patients from our unit served as fast track group and 30 patients from other units of the same hospital served as conventional group. Fast track patients were extubated in less than 6 hours after surgery, shifted from ICU in less than 24 hours and geared up to discharge home within 3 days of surgery. Result: 18 (90%) of the 20 patient of the fast track group were discharged within 3 days of surgery, 2 patients cannot be discharged within this time frame. Mean post operative hospital stay for study group was 3.1 days, whereas the mean hospital stay in the control group was 7.5 days. Follow-up was 100% complete at 30 days. There was no major in-hospital or out-of-hospital complications in either group. No patient was readmitted at our centre or elsewhere for any complication arising from this process. Conclusion: Fast tracking is feasible and safe in low-risk paediatric open-heart surgery in Bangladeshi scenario. A multidisciplinary approach with a set protocol is required to achieve this goal in a safe and reproducible manner.

Salmonella-a new threat to neonates.

Hospital admitted 582 neonates with suspected septicaemia were studied in Microbiology Department of Dhaka Medical College, Dhaka, Bangladesh. Samples being taken from neonatal unit of Dhaka Medical College Hospital and a Neonatal Private Hospital in one year (January to December 2004). Blood culture was done by Lytic-centrifugation method. The isolated organisms were identified using standard laboratory procedures. Among 582 sick neonates 59(10.14%) were culture positive and the predominant organisms were Gram Negative Bacteria (89.83%). Among the isolates Klebsiella spp. was the prime organism (33.90%). Salmonella was observed as the 2nd most common cause (22.03%) for sepsis of neonates. Of these isolated Salmonella strains 46.15% were Salmonella typhi and 53.85% were Salmonella spp. Next to Imipenem, Ciprofloxacin was observed as the drug of choice for treatment of Sepsis neonatorum.