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Coronary artery disease is the most common form of heart disease and the single most important cause of premature death world-wide. Thymomas are anterior mediastinal neoplasms, characterized by epithelial cells and lymphocytes. Although they are often encapsulated and well differentiated tumors, they can show local invasion, pleural invasion or extrathoracic metastasis. In this article, we report the case of a rare patient who underwent thymectomy along with off-pump coronary artery bypass graft surgery.
RESUMO
Dr Parafulla Kumar Sen, popularly known as P K Sen was a great Bengali surgeon of Twentieth century. Regarded as the founder of cardiothoracic surgery in India, Dr Sen performed the first intracardiac operation of any kind, the first open heart surgery and also the first heart transplantation in this subcontinent. He also made very significant contribution in the development of transmyocardial revascularization, a new technique for aortic arch replacement and described a group of nonspecific vasculitis. Dr P K Sen was born in Kolkata, the then capital of undivided Bengal in 1915. But he is little known in Bangladesh. This article is an attempt to notify the deeds of this Bengali surgeon.
RESUMO
Objective: Off-pump CABG (OPCAB) is a well established surgical procedure in Bangladesh now. Majority of Bangladeshi patients having CABG are undergoing OPCAB procedures these days. Patients with left ventricular dysfunction are known to be particularly at risk of complications after surgical coronary revascularization. Off-pump procedure can be considered in these patients, avoiding the potentially damaging effect of cardiopulmonary bypass (CPB). Patients with left ventricular dysfunction are thus thought to be ideal OPCAB candidates. This study is undertaken to check the advantage of OPCAB over conventional CABG of Bangladeshi patients with left ventricular dysfunction. Methods: This is a prospective clinical trial done in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2006 to Dec 2007. Among the 52 patients 26 patients underwent OPCAB with preoperative ejection fraction (EF) 35.2±3.2% and rest 26 patients had conventional bypass (CCABG) with preoperative EF 33.4±3.8%. Different variables were evaluated and compared. Echocardiography was used both pre and postoperatively to assess the LVEF, LVIDd and LVIDs and regional wall motion abnormality and to assess the presence or absence of ischemia or infarction. Data were collected by interview schedule and checklist. Data were analyzed by standard statistical methods. Results: In this small series of patients with left ventricular dysfunction, off-pump CABG was carried out with good early outcome; with low mortality and morbidity and significant improvement in postoperative left ventricular function. There was no significant difference between the groups in terms of change in EF, LVIDd and LVIDs. Conclusion: From this study it can be concluded that both the surgical strategies improved the myocardial function and early outcome in patients with left ventricular dysfunction. However OPCAB surgery has a somewhat better result regarding ventilation time and ICU stay. Thus both OPCAB and on pump surgery can be performed safely and effectively in patients with left ventricular dysfunction with good results and low mortality.
RESUMO
A 35 years old male living in Jamalpur district of Bangladesh working as a shopkeeper presented with dyspnea, fatigue, occasional fever and cough for two years. He did not give any history of hemoptysis or weight loss. He was smoker and non-alcoholic. He had a soft systolic murmur over pulmonary area and wide fixed splitting of the second heart sound. An Atrial septal defect (ASD) was detected by echocardiography. The patient had high circulating eosinophil count and Complement Fixation Test for filarial antibody revealed positive result. Moreover the patient's response to drug Diethylcarbamazime indicated suspected tropical pulmonary eosinophilia with Atrial Septal Defect.