No abstract

Introduction: Ischemic heart disease is the most common cause of death worldwide. Coronary artery bypass grafting (CABG) is the most performed cardiac surgical procedure. Studies have shown that CABG can have a beneficial effect on left ventricular ejection fraction (LVEF) and ischemic mitral regurgitation (IMR) without intervention on the mitral valve. This study aims to assess changes in LVEF and IMR after CABG in our population. Methods: We retrospectively reviewed charts of patients who underwent only CABG at King Faisal Cardiac Center in Jeddah between January 2016 and December 2019 (N = 298). Pre- and postoperative echocardiography data were evaluated. Changes in cardiac function and mitral regurgitation were analyzed. Results: CABG was performed on 298 patients. The median age was 61 years (interquartile range (IQR)= 54–68), and 78.5% of the patients were male. The median body mass index was slightly higher in females (32.9 vs. 28.6 kg/m2, P = 0.089). Approximately 81% of patients had diabetes and hypertension, but only 24% were active smokers. The median time between pre- and postoperative echocardiography was 8 months (IQR= 3–17). The median preoperative LVEF was 51% (IQR= 44.1–57.9), and 75% of patients had normal-to-mild MR. The median postoperative EF was not different among patients who underwent echocardiography within or after 6 months (53.1% and 50.3%, respectively, P = 0.454). None of the patients progressed to severe MR after surgery, and only 2.7% had moderate-to-severe MR at follow up. Postoperative in-hospital mortality was 0.7%. Conclusion: Based on international guidelines and the best evidence, surgical revascularization is sufficient for patients with coronary artery disease (CAD) with moderate IMR and is not associated with LVEF worsening or MR progression. Complete revascularization might have an influence on ventricular recovery that might improve or stabilize IMR. Our results are consistent with larger studies reporting very low postoperative mortality of this high-risk patient group.

Injuries to the ankle ligaments are some of the most common musculoskeletal sports injuries. Ankle magnetic resonance imaging (MRI) is the standard diagnostic procedure in today's practice, but its reliability and validity remain controversial. The aim of this study was to explore the approach for patients with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy. MethodsA total of eight patients who were 14 years or older with negative ankle MRI who continue to have symptoms of ankle instability despite conservative therapy were admitted to our institution from January 1, 2015 to December 31, 2021. ResultsEight patients with a mean age of 36, and a mean body mass index (BMI) of 37.7. All patients presented with ankle pain, locking, and giving way in variable severity. All the patients had a radiograph followed by an ankle MRI, which showed normal alignment of ankle joints without abnormality. Initially, all patients were treated conservatively but did not show any improvement. After that, they underwent an operation of lateral ankle ligament reconstruction by modified Brostrom technique, followed by casting and physiotherapy. The symptoms of ankle instability resolved in all patients. The ankle pain resolved completely in six patients, improved in one patient, and did not improve in one patient. ConclusionBased on our results, we advocate reconstruction surgery by modified Brostrom technique for ligament repair in patients with clinical evidence of chronic ankle instability who have failed a trial of conservative management, even in the context of a normal ankle MRI.