RESUMO
BACKGROUND: Coronary artery bypass grafting is known to be associated with better outcome in ischemic heart disease patients with low ejection fraction. We aim to demonstrate the effect of coronary artery bypass grafting (CABG) on left ventricle (LV) systolic function and to identify the predictors that adversely lead to postoperative poor outcome. RESULT: This is a cross-sectional prospective study; we included 110 patients with left ventricular ejection fraction (LVEF) < 50% who underwent CABG with a mean age of 56.1 ± 12.2 years old. Those patients were classified into two groups: group I, 76 (69%) patients with LVEF > 35%, and group II, 34 (31%) patients with LVEF < 35%. Our results as regards demographic and clinical data revealed that group II patients had a significantly higher prevalence of diabetes mellitus (DM) and Euro SCORE II compared to group I patients (p = 0.05 and < 0.001 respectively); otherwise, all other clinical predictors did not differ between the two studied groups. There was a significant improvement in LVEF post-surgery (p = 0.05) in both groups with observed no significant difference recorded for in-hospital mortality rate among patients with different groups. DM, significant diastolic dysfunction, and insertion of IABP are predictors of in-hospital mortality of the patients (p = 0.001, 0.03 and < 0.001, respectively) CONCLUSION: We concluded that there is a significant improvement of LV systolic function after CABG and hence better survival rate. DM, significant diastolic dysfunction, and perioperative insertion of IABP are predictors of mortality after cardiac surgery. Special care should be provided to such patients to improve their outcome.
RESUMO
OBJECTIVE: To present our experience of the management of bronchial injuries in children. METHODS: Between 2001 and 2012, we diagnosed 11 cases of bronchial injuries in children and reviewed their records. RESULTS: The age range was 3-12 years. Etiologies were passenger traffic accidents in 55%, pedestrian traffic accidents in 27%, and a fall from a height in 18%. Clinical manifestations were pneumothorax with continuous air leak in 81%, subcutaneous emphysema in 55%, and failure of lung expansion in 64%. Three (27%) cases were diagnosed late. All patients were operated on through a posterolateral thoracotomy. Main stem bronchial rupture was identified in the right side in 72% and in the left side in 28%. Bronchial repair was feasible in 7 (64%) cases, but resection was inevitable in 4 cases (3 pneumonectomies and one lobectomy). Two of the patients who required resection died; they had associated intraabdominal injuries. All survivors were discharged in stable condition without complications. CONCLUSION: Bronchial injuries in children are rare and challenging. Clinical, radiological, and bronchoscopic examinations facilitate the diagnosis. Early diagnosis and bronchial repair offers favorable results. Delayed diagnosis, lung resection, and associated injuries adversely affect the outcome.
