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Background Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative.Objective:  is to highlight the merits and demerits of these two approaches in providing access to the MV in term of the aortic cross clamp time (ACCT), quality of exposure, and potential complications in view of the published literature. Patients and Method: Over an 18-month period ending at June 30th, 2019, 56 patients with MV disease ± other cardiac diseases were enrolled in this study. Twenty patients had surgery via LAA (one surgeon) whereas 36 were operated upon via SSA (another surgeon). Standard surgery was done via median sternotomy, cardiopulmonary bypass and hypothermia of 32 0C. Perioperative events were recorded. Results In SSA group (males=25; age ranged 23-74 years; mean=57.4), patients had chest pain and breathlessness for a mean of 3 months (>LAA) besides low ejection fraction (EF) in 44%, atrial fibrillation (AF) in 38.9% and dilated LA in 19.4%. They underwent 25 MV replacements (MVR), 11 MV repairs (0 in LAA), 11 coronary artery bypass grafts (CABGs) (2.6 graft per patient vs. 1.3 in LAA; significant) and 2 aortic valve replacement. Mean ACCT was 81.6 minutes (˂LAA). Postoperatively, 32 patients (88.9%) had a normal or improved EF, 11 of 14 AF patients (78.6%) reverted to sinus rhythm and no hospital death was recorded. Conclusion Besides excellent exposure, the SSA enabled us to perform MVR or repair ± additional interventions within a short time and without a heart block. Hence, our results matched the international literature.

Background  There are many modes of delivery for pregnant women; the commonest of these include vaginal delivery (VD) with or without episiotomy, forceps delivery, and cesarean section (CS). Whenever possible it is preferable to encourage vaginal delivery to minimize the morbidities and mortalities that are associated with cesarean section. On the other hand, when doctors estimate the risk of VD, which could be high in certain conditions for the baby and/or the mother, cesarean section will be performed. Objectives To determine the increasing rate of cesarean section in relation to vaginal delivery in Sulaimani Maternity Teaching Hospital from 2008 to 2018. Patients and Methods A retrospective study, data were collected from medical reports of pregnant ladies, delivered their babies either by vaginal delivery or cesarean section starting from January 2008 to December 2018. All data were retrieved from the department of statistics at the mentioned period of time were 180,625 cases, and numbers of each group of the patients were separately analyzed. As well as the primigravida and multigravida were sub grouped in each of these two major groups. Results From the total cases, 123,836 cases (68.6%) were vaginal delivery, and 56,789 cases (31.4%) were cesarean section. There is a notable annual increase in the percentage of CS. However, the percentage of primigravida CS is declining annually.  Conclusions The rate of cesarean section in Sulaimani Maternity Teaching Hospital from 2008-2018 was 31.4% in relation to the vaginal delivery, which is regarded as a higher than the universal standard that has been put by the world health organization, which is between 10%-15%. And this rate is increasing annually.

Coronary artery disease is the most common cardiac disease with a worldwide distribution, and it is responsible for most of the mortalities regarding cardiovascular diseases if not detected early and treated properly. There are many lines in the treatment of coronary artery disease, starting from medical therapy, percutaneous coronary intervention, and coronary artery bypass graft surgery, preference of the choice of the type of the treatment depends on many factors. In fact when coronary artery bypass graft is indicated, although it carries a considerable risk of surgery, but the long-term survival is notably better than the other ways of treatment. This study done to determine that the prevalence of multivessel coronary artery disease is more in diabetic patients than non-diabetic patients. And more in female than male. In this study hundred ninety patients were retrospectively studied, all of them underwent coronary artery bypass graft surgery with or without other concomitant cardiac procedure (like valve surgery), but most of them were coronary artery bypass graft alone. We found that the number of the coronary arteries affected is strongly related to the presence of the diabetes mellitus. And females are more prone to have coronary artery disease than male. Thus diabetes mellitus is the most common risk factor for the development of cardiovascular disease, and the severity of the condition is confirmed by the number of the coronary arteries involved as well as the calcification or multiple stenosis in the same vessel.