Frequency of acute kidney injury in patients undergoing coronory artery bypass grafting

Objective: To find the frequency of acute kidney injury in patients undergoing coronary artery bypass grafting

Methodology: The study was conducted in cardiovascular unit Lady Read-ing Hospital Peshawar. It was cross sectional study. Sampling technique was non probability convenient sampling. Data was collected from 20.2.2013 to 20.8.2013. Total 179 patients included in the study. All patients with known coronary artery disease were included in the study whom were planned for revascularization in the form of coronary artery bypass grafting [CABG]. Post-operatively all patients' serum creatinine till 48th post op hour was observed to detect acute kidney injury. Acute Kidney Injury [AKI] was defined as more than 50% or elevation of 0.3 mg/dl of creatinine level from base line

Results: A total of 179 patients undergoing coronary artery bypass grafting were included in the study. Average age of the patients was 46.88 years +/- 9.91 with range 20-60 years. Patients were divided into four groups according to age. The acute kidney injury after coronary artery bypass grafting was observed in 14 [7.82%] patients. Acute kidney injury was more common in old age and it was non significantly more common in male gender

Conclusion: In spite of current highly advance cardiac surgery techniques and post operative care still there is high incidence of acute kidney injury following revascularization and subsequent worst outcomes

Frequency of complete heart block after surgical closure of perimembranous ventricular septal defect

Objective: to find the frequency of complete heart block [CHB] in patients undergoing surgical perimembranous Ventricular septal defect [VSD] closure

Methodology: this was a Descriptive cross sectional study performed in Cardiovascular Department Lady Reading Hospital Peshawar. Data was collected from 28 January 2013 to 28 July 2013 with sample size of 103.Sampling technique was non probability consecutive. All patients with perimembranous ventricular septal defect, aged 5 years to 25 years with any gender were included in the study

Results:-mean age was 12.63 years +/- 6.63. Patients were divided in four categories according to their age. Over all complete heart block in the perimembranous ventricular septal defect after surgical closure was 10[9.71%]. Age wise distribution of complete heart block shows that majority of the complete heart block 6[12.8%] were found in age less than or equal to 10 years

Conclusion:-VSD closure is less often associated with CHB but there should be arrangements for pace maker to timely pace the patient in case of any emergency

Non-invasive positive pressure ventilation facilitates early extubation in post operative cardiac patients

To assess the use of NIPPV [non-invasive positive pressure ventilation] during weaning from mechanical ventilation in post-op patients in an ICU and compared this procedure with intermittent mandatory ventilation [IMV] by analyzing cardiac and respiratory parameters and complications. A randomized clinical trial was conducted from June 2009 to July 2010 on Post-operative surgical patients that were on IMV for more than 48 hours, who failed at 30 minutes of spontaneous breathing T-piece trial [SBT]. If failure occurred before the 30th minute, he/she was included in the group previously defined by random assignment. Patients in the experimental group were extubated and placed on NIPPV, whereas other patients [the control group] returned to IMV. Daily SBT was carried out thereafter in order to evaluate the possibility of extubation in control group. Of 60 patients who failed T-piece trials, 30 patients were placed on NIPPV and 30 on [IMV]. The ages of patients in the NIPPV and IMV groups were 45.7 +/- 18.11 and 47.10 +/- 18.45 years respectively. In both groups, ventilation time before T-piece trial was 2-3 days. Patients of the NIPPV group had a shorter stay in the ICU and in the hospital i.e., 2.93 +/- 0.785 days versus 7.4+1.11 days for IMV group. No serious complications were observed in both groups. The results of this study suggest that the combination of early extubation and NIPPV is a good alternative

De vega's tricuspid annuloplasty for severe tricuspid regurgitation - early and midterm follow up

To assess early and midterm outcome of De Vega's Repair of Tricuspid Valve in Severe Tricuspid Regurgitation [TR]. This was a prospective observational study conducted from January 2007 to June 2011, at Cardiovascular department PGMI, Lady Reading Hospital Peshawar. De Vega's surgical repair of tricuspid valve was done in severe tricuspid regurgitation patients with mitral valve replacement [MVR] or with double valve replacement [DVR=MVR+ AVR [Aortic valve replacement]]. Pre operative and post operative early [with in 1month] and midterm [at 6 month] follow up data was collected and analyzed on the basis of New York Heart Association [NYHA] functional status and echocardiographic finding. The outcome of De Vega's repair was assessed. Total study population was 160, with age ranging from 14-52 years [mean age 21 years]. Out of these 160 patients 89 [55.60%] patients were female and 71 [44.40%] were male. Preoperative diagnosis of 118 patients was related to pure mitral valve disease, and 42 cases were having aortic valve disease along with mitral disease. All patients had severe TR. Patients who were free from TR in MVR group were 81.3% and 75.0% patient were TR free in DVR group at 6 months follow up and the repair was intact on echocardiography. De Vega's repair in Severe TR is a safe and economical procedure in our setup

Association of aetiology, presentation and post-operative complications of post-traumatic peripheral artery pseudoaneurysm

To describe post traumatic pseudoaneurysms and its association to causes, presentation and conventional surgical treatment modalities. This Descriptive study carried out in the Department of Cardiovascular Surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2007. Patients with associated arteriovenous fistula were excluded from this study. All the demographics including age, sex, type of injury, site, associated complications operative details, pen operative morbidity and mortality were prospectively recorded in a data base. The total number of patients was seventy five. All the patients underwent conventional surgical procedures. Reverse saphenous graft was received by 34%, 24% had end to end anastomosis, 12% had interposition synthetic graft, 8% had rent repair while 21.33% had primary ligation of the involved artery. There was no pen operative mortality. Six patients had post operative complication in the form of graft, thrombosis and or infection. Three patients had amputation, two in lower limb and one in the upper limb. Majority of them were male 90.66%. Age ranged from 7 years to 75 years. Most of the patients [77.3%] were in second to fourth decade of life. The most common cause of injury was gunshot wound [56%] followed by stab wounds [13.33%] and road traffic accidents [12%]. Few cases of bomb blast [6.66%], Post cardiac catheterization [4%], glass injury [4%] and intravenous drug abusers [2.66%] were also reported. The commonest site of injury was fern oral artery [37.33%].In this study majority of patients were male with gunshot wound as commonest cause. Reverse saphenous vein graft was treatment of choice. Infection and thrombosis were the commonest postoperative complications

Should we say good bye to closed mitral commissurotomy in our setup

To study the short-term results of closed mitral commissurotomy in patients with rheumatic mitral stenosis. Material and This study was conducted at the department of cardiovascular surgery, Lady Reading Hospital, Peshawar from January 2003 to December 2003. Data was collected on a preformed proforma. Mitral valve characteristics were evaluated according to the scoring system devised by Wilkins and Associates. All those patients who had severe mitral stenosis and echo score of < 12, raised pulmonary hypertension or patients with atrial fibrillation were included in this study. Patients having echo score > 12, left atrial and left atrial appendage clot, moderate mitral regurgitation were excluded from the study. After operation patients were followed up for six months for haemodynamic stability. During this time period, 76 patients with rheumatic mitral stenosis underwent closed mitral commissurotomy. Total patients were 76 [male 18, female 58] with age range of 10 to 60 years. Pre-op 2 2 mitral valve area ranged from 0.6 to 01 cm a mean of 0.74 + 0.13 cm. Mean mitral valve gradient was 19.7 + 6.3 mm Hg. Pulmonary artery systolic pressure ranged from 35-110 mmHg. Five patients had associated severe tricuspid regurgitation. Twenty patients had controlled atrial fibrillation. At two weeks follow-up in the out patients department after closed mitral commissurotomy the mean mitral valve 2 gradient was 9.4 + 4.2 mmHg and mitral valve area was 1.6 +/- 0.7 cm. One patient developed severe mitral regurgitation and one had left hemperesis. Pulmonary artery systolic pressure assessed by Doppler, dropped to a mean of 40 mmHg. There was no death. At six months follow-up the improved haemodynamics were maintained. Cost of the whole procedure was less than the cost of the percutaneous transmitral commissurotomy catheter alone. Closed Mitral Commissurotomy is a safe procedure. It is cost effective in developing countries with limited health budget, closed mitral commissurotomy still has a role to play

Devega's tricuspid valve annuloplasty: Still a good alternative in our setup

To assess the durability of Devega's repair of tricuspid valve in severe tricuspid regurgitation [TR]. From January 2002 to December 2003. 22 Devega's surgical repairs of tricuspid valve in severe TR were done either with mitral valve replacement or with Atrial Septal Defect [Secundum Type] repair. Clinical data was retrieved from hospital records and analyzed post-operatively on the basis of NYHA status and echocardiographic findings at the interval of 6, 12 and 24 weeks. The durability of Devega's repair was assessed. Out of 22 Devega's repair, over 80% of the patients having severe TR+3 reverted to no TR and about 20% patients had mild TR postoperatively at the interval of 6 months and the repair was intact on echocardiography. Devega's repair of tricuspid valve in severe TR is a safe and economical procedure in our setup

Abdominal aortic aneurysm surgery - local experience

The aim of this study was to evaluate the outcome of AAA referred to our unit by general surgeons/physicians.This study was conducted from Jan 1996 to Dec 2001. 25 AAA were referred. Age range 18-75 years [mean 54 years] male 19, female 6. Eight out of 25 patients presented with dissecting leaking AAA while 16 presented with non-specific symptoms. Diagnoses were made only by doppler ultrasound. Out of 8 leaking AAA 2 patients were not operated because of low pressure and no response to resuscitative measures. Six patients underwent surgery but we lost 4 out of which 1 had table death, 2 patients died on 3rd and 5th post operation day because of Acute MI, 4th patient died on 4th post operative day because of graft thrombosis. Two patients survived the operation and went home on the 10th post operation day. Out of the non-dissected group of AAA all the patients survived surgery and discharged home on the average 10th post operation day. Non-specific abdominal pains radiating to back especially in the elderly should be thoroughly investigated keeping in mind the AAA and they may be referred to the respective center for proper management