A dedicated stitch to allow early safe mobilization avoiding drain-induced heart injury

Abstract Placement of a mediastinal drain is a routine procedure following heart surgery. Postoperative bed rest is often imposed due to the fear of potential risk of drain displacement and cardiac injury. We developed an encapsulating stitch as a feasible, effective and low-cost technique, which does not require advanced surgical skills for placement. This simple, novel approach compartmentalizes the drain allowing for safe early mobilization following cardiac surgery.

Role of posterior pericardiotomy in prevention of Pericardial Effusion and Atrial Fibrillation after coronary artery bypass grafting surgery

The aim of this prospective study was to evaluate the efficacy of Posterior Pericardiotomy in decreasing the occurrence and development of Pericardial Effusion and related Atrial Fibrillation [AF] Randomized Control Trial [RCT]. Armed Forces Institute of Cardiology and National Institute of Heart Diseases Rawalpindi, from Jan 2009 to Feb 2010. This prospective randomised study was performed in the first 100 patients undergoing coronary artery bypass grafting surgery [CABG] between January 2009 and February 2010. Patients were randomized into two groups, Posterior Pericardiotomy was performed in 50 patients before releasing aortic cross clamp [Group I]; remaining other 50 patients served as the control Group [Group II]. Longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in Group I. The difference between the two treatment groups, with regards to age, sex, number of bypass grafts, duration of cross clamp, total perfusion time and hospital stay time were not statistically significant. Atrial Fibrillation was noted in 02 [4%] patients in Group I and 12 [24%] patients in Group II [p 0.004]. Pericardial Effusion was present in 03 patients in Group I and 16 patients in Group II [p <0.001]. Atrial flutter and other supraventricular arrhythmias were not statistically significant. Posterior Pericardiotomy proved to be technically easy and efficient procedure in decreasing the occurrence and development of Pericardial Effusion and related Atrial Fibrillation [AF]

Pericardial effusion as a cause of morbidity in patients on maintenance hemodialysis: is it preventable?

Cardiovascular diseases are the cause for 45 percent mortality and 20 percent morbidity in haemodialysis [HD] patients. Pericardial effusion [PE] accounts for 03 - 04 percent of all deaths in HD patients as a result of tamponade, arrhythmias or- heart failure. This study aims to find out the prevalence and precipitating factors for PE in haemodialysis patients. Fifty five patients were identified for echo-cartographic assessment on the basis of signs and symptoms suggestive of PE i.e., hypotension during dialysis, dyspnea, globular heart in chest x-ray, raised JVP, soft heart sounds and low voltage EGG. A matched controlled group of 55 patients for age, sex, dialysis schedule, cause of ESRD and dialysis bath, was also studied echocardiographically. Pericardial Effusion was detected in 12 patients [10.9 percent], 10 [83.3 percent] were on 2/week and only two on 3/week dialysis. Of these 75 percent were non-compliant in fluid intake and 58.3 percent were irregular in treatment. The morbidity of PE in study group [18.2 percent] is significantly higher as compared to controls [3.6 percent] [P = <0.05]. No correlation was found between development of PE and high iPTH and low albumin levels. Ten patients with mild PE responded to vigorous dialysis. Two patients developed cardiac tamponade needing pericardiocentesis. We have identified 2/week dialysis [inadequate dialysis dose], acetate bath and fluid and dialysis non-compliance as factors contributing to development of PE in HD patients

Uso de dreno fino retrocardíaco em pós-operatório de cirurgia cardíaca. Descrição de técnica / Use of a Thin Retrocardiac Drain after open Heart Surgery. Description of the Technique

PURPOSE: To describe a technique with a thin drainage system placed behind the heart, avoiding reoperation caused by tamponade due to pericardial effusion in patients who undergo open heart surgery. METHODS: We studied 59 patients, average age of 50 years. Twenty-six (44) patients had undergone CABG, 25 (42) valvar procedures and 8 (14) different procedures. The control group were 20 patients, average age 44 years. Nine (45) underwent CABG, 6 (30) valvar procedures and 5 (25) other procedures. Every patient was submitted to echocardiographic study to verify presence of pericardial effusion after operation. RESULTS: There was one patient with pericardial effusion with 8mm in the study group. Six patients showed pericardial effusion in the control group. The control group had mean drainage flow of 320 +/- 110ml and average permanence time was 45 +/- 10h. The study group had mean drainage flow of 410 +/- 122ml, the average permanence time was 46 +/- 10h. There was statistic difference between both groups when we compared the frequency of pericardial effusion. CONCLUSION: This drainage system reduces pericardial effusion comparing with the literature and causes little discomfort to the patient. The fixed rule to remove the drains did not present more discomfort to the patient and there were no complications related to its permanence.