Off-pump Bidirectional Glenn shunt using clamp and sew technique

To evaluate the efficacy of performing Bidirectional Glenns [BDG] using "clamp and sew technique". Quasi-experimental study. Armed Institute of Cardiology / National Institute of Heart Diseases, Rawalpindi from 1[st] January 2011 to 31[st] December 2013. All patients subjected to BDG using clamp and sew technique during study period were included. The salient operative steps included. 1] Dissection of superior vena cava, azygous vein and pulmonary arteries 2] Clamping and division of superior vena cava at cardiac end 3] Clamping of ipsilateral branch pulmonary artery and its anastomosis to the divided superior vena cava. Observed variables included oxygen saturations and internal jugular venous pressure before, during and after the procedure, postoperative ventilation requirements, ICU stay, neuro-cognitive assessment, pleural drainage and mortality. A total of 27 patients were included. 85.2% patients had unilateral BDG while 14.8% patients had bilateral BDG. Mean internal jugular venous pressure on clamping superior vena cava was 29.21 +/- 6.13 mmHg [range 19-23 mmHg] and mean clamp time was 14.32 +/- 3.39 minutes with a range of 11-21 minutes. Mean Glenn pressure was 14.29 +/- 2.53 [range 12-18 mmHg]. Mean postoperative Oxygen saturation was 86.07 +/- 2.71% which was significantly increased as compared to preoperative oxygen saturation of 71 +/- 5.16% [p < 0.001]. Mean ICU stay was 70.45 +/- 8.94 hours [38-210 hours]. No neuro-cognitive impairment was observed and there was no 30 day in hospital mortality. Off-pump BDG with clamp and sew technique is a safe procedure in selective patients. It avoids the need for cardiopulmonary bypass and high cost associated with it

School children training for basic life support

To determine the background knowledge of high school children on basic life support by calculating the points scored in a MCQ-based test; to evaluate results of teaching basic life support skills to them; and assessing their power of retention by re-testing them on skills and MCQ test after the workshop. Quasi-experimental study. Armed Forces Institute of Cardiology and National Institute of Heart Diseases, Rawalpindi, Pakistan, from 1st September to 31st December 2008. Thirty children aged 11 - 15 years from 9 different schools of Rawalpindi were subjected to knowledge and skill based test at three different times. First was taken just after brief introduction to the subject of CPR and its related definitions, second after providing them hands-on CPR training, and last, after 3 months of CPR training, knowledge as well as CPR skills were tested. The children showed highly significant improvement in knowledge after CPR training and retention of knowledge and skills of CPR after 3 months period. There was no correlation of age, gender and weight to depth of compression and fatigue. There was a correlation between height and depth of compression. Children can learn and perform basic life support skills with reasonable accuracy and can retain these skills for longer periods. CPR training should be provided to all school children after 6[th] grade

Amiodarone prophylaxis for atrial fibrillation after coronary artery bypass grafting

This study was planned to evaluate the preventive role of Amiodarone against atrial fibrillation after coronary artery bypass grafting. A comparative and interventional study. The study was done at Armed Institute of Cardiology / National Institute of Heart Diseases AFIC/NIHD Rawalpindi. In this study, 100 patients admitted three days before coronary artery bypass grafting were divided into Control and Amiodarone groups of 50 patients each. Patients in Control group did not receive any prophylaxis against atrial fibrillation before and after the coronary artery bypass grafting. While the patients in Amiodarone group received 200 mg oral Amiodarone thrice daily for three days, then 200 mg once daily on operative day and continued so until discharge. Postoperative atrial fibrillation occurred in 8 of 50 patients in the Control group [16%] and 2 of 50 patients in the Amiodarone group [4%] [p=0.045]. Maximum ventricular rate during atrial fibrillation episode in Control group was 122 +/- 5.83 beats per minute and 108 +/- 2.89 beats per minute in amiodarone group. Preoperative amiodarone was found to be significantly useful prophylactic agent to prevent atrial fibrillation after coronary artery bypass grafting and this drug can be used safely