Constrictive pericarditis treated by surgery.

We reviewed the records of 45 patients (mean age, 46.6 ± 14.9 yr; range, 21-84 yr) with a diagnosis of constrictive pericarditis who had undergone pericardiectomy from 1994 through 2006. Preoperatively, 2 of the patients (4.4%) were in New York Heart Association (NYHA) functional class I, 20 (44.4%) in class II, 22 (48.9%) in class III, and 1 (2.2%) in class IV. Pericardial calcification was detected in 20% of plain chest radiographs. Constrictive pericarditis was caused by tuberculosis in 22.2%, chronic renal failure in 8.9%, a history of sternotomy in 4.4%, and malignancy in 4.4%. The cause was idiopathic in 60% of the patients. Low-output state was the most common postoperative problem (22.2%). The mean follow-up period was 40 ± 18 months (range, 3-144 mo). Three months postoperatively, only 1 of 43 available patients (2.3%) was in NYHA class III, while the rest were in class I (36 patients; 83.7%) or II (6 patients; 14%). The overall mortality rate was 4.4%: 1 patient with tuberculosis died of respiratory insufficiency while hospitalized, and 1 died of metastatic adenocarcinoma during follow-up. Our results show that pericardiectomy remains an effective procedure in the treatment of constrictive pericarditis. Tuberculosis is still an important cause of constrictive pericarditis in Iran, despite intensive vaccination and use of antitubercular drugs.

Cryoablation for surgical treatment of chronic atrial fibrillation combined with mitral valve surgery: a clinical observation.

OBJECTIVE: Although the classical Cox-Maze III is the gold standard surgical therapy with a proven efficacy in the treatment of atrial fibrillation (AF), complexity of this procedure has resulted in a search for a simpler, less invasive and more cost-effective method. In this study we evaluated the results of cryosurgical ablation in the treatment of chronic AF in patients undergoing concomitant mitral valve surgery. METHODS: Ninety patients (mean age: 50.9+/-12 years) with chronic AF who were having mitral valve surgery as the main procedure underwent cryoablation with a newly designed N(2)O-based cryotherapy device. Pulmonary vein isolation with or without left atrial appendage closure (group A) was carried out in 65 cases and cryoablative bi-atrial Cox-Maze III (group B) in 25 patients. This additional procedure took only an extra 10 min for group A and about 20 min for group B. Half of the patients received a beta-blocker following the procedure. RESULTS: The overall success rate of cryoablation was 65.5%. Normal sinus rhythm was achieved in 26.7% in the operating room, 10% in ICU and the remaining cases reverted to sinus rhythm during the follow-up period. There were no major ablation-related complications such as bleeding, thromboembolic events or A-V block. The only predictor for failure of ablative procedure was left atrial size of greater than 6 cm. CONCLUSION: Although in this study the efficacy rate of cryoablative surgery was not the same as classical Cox-Maze III, it seems that this procedure is safe, simple, cost-effective and at the same time does not increase the operative time significantly. Using cryoablation may enhance the cure rate of chronic AF during mitral valve surgery.

Predictors of postoperative atrial fibrillation after coronary artery bypass graft surgery.

OBJECTIVES: The present study was aimed to identify the preoperative, intraoperative, and postoperative predictors of AF in a pure cohort of the patients with coronary artery disease who underwent CABG surgery. METHODS: Between November 2005 and May 2006, 302 consecutive patients were included in this prospective study. All the relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in the included patients and they were also monitored for development of post-CABG AF. RESULTS: Postoperative AF occurred in 46 (15%) of patients. By univariate analysis, older age, P-wave abnormality in ECG, presence of mitral regurgitation, larger left atrium (LA), left main coronary artery involvement, failure to graft right coronary artery (RCA), and adrenergic use in ICU were significantly associated with occurrence of post-CABG AF (all P< 0.05). However, in the logistic regression model, age (OR: 1.067, 95%CI: 1.02-1.116, P=0.005), LA dimension (OR: 1.102, 95%CI: 1.017-1.1936, P=0.017), P-wave morphology (OR: 12.07, 95%CI: 3.35-48.22, P=0.0001), failure to graft RCA (OR: 3.57, 95%CI: 1.20-10.64, P=0.022), and postoperative adrenergic use (OR: 0.35, 95%CI: 0.13-0.93, P=0.036) remained independently predictive of postoperative AF. CONCLUSION: The present study suggested that age, P-wave morphology, LA dimension, failure to graft right coronary artery, and postoperative adrenergic use were independent predictors of post-CABG AF. Therefore, clinical data, ECG and echocardiography may be useful in preoperative risk stratification of the surgical patients for the occurrence of post-CABG AF.