Coronary artery disease is increasing in developing countries. Revascularization surgery in such patients with amenable coronary anatomy is a valid option. Coronary artery bypass grafting in patients with low ejection fraction (EF <35%) is very challenging although it is performing successfully in department of Cardiac Surgery of Bangabandhu Sheikh Mujib Medical University now a days. The purpose of this study is to evaluate the safety and effectiveness of off pump coronary artery bypass grafting for EF e”35% and EF <35% and also to compare between pre and postoperative echocardiographic findings in this two groups. The preoperative, at discharge, 1 month and 3 month postoperative follow up data of total 60 patients in two groups ( EF e”35% and <35%) who underwent isolated off pump coronary artery bypass grafting between July 2012 – June 2014 was evaluated. In group 1 preoperative LVIDd and LVIDs was 54.86±3.45 mm and 45.23 ±4.13mm and LVEF was 42.7±4.66. Postoperatively at 3 month follow up the LVIDd 45.43±5.03 mm, LVIDs 34.7±5.33 mm and LVEF 53.46±5.06. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. But improvement of LVEF is not statistically significant (p>0.05). Similarly in group 2 patients preoperative LVIDd, LVIDs and LVEF is 67.06±3.67mm, 59.1±4.35mm and 29.26±4.25. Postoperatively at 3 months follow up of this group the LVIDd, LVIDs and LVEF is changed to 57.56±4.96 mm, 48.3±5.53 mm and 38.93±6.03. The improvement of mean LVIDd and LVIDs is statistically significant (p<0.001) and (p<0.05) respectively. And the improvement of LVEF is also statistically significant (p<0.001). Significant improvement in terms of CCS grade and NYHA class was also observed specially in <35% ejection fraction group at 3moths follow up. We concluded that off pump coronary artery bypass grafting can be safely performed to the patients with normal and poor left ventricular ejection. Hence we recommended that off-pump CABG can be safely carry out in case of <35% ejection fraction patients. University Heart Journal Vol. 14, No. 2, Jul 2018; 53-61
Objectives: Algorithms of risk stratification for coronary artery bypass grafting (CABG) do not include a weighting for preoperative mild to moderate renal impairment defined as a serum creatinine 130 to 199mmol/L, which may impact mortality and morbidity after CABG. Hence our first objective was to ascertain the effect of a mild-to-moderate elevation in the preoperative serum creatinine level on post-operative outcomes. Our second objective was to ascertain which patient variables contributed to an increase in the serum creatinine level in association with coronary artery bypass grafting. Materials and methods: We reviewed the prospectively collected data from the cardiac surgical database, which holds clinical information on all the patients undergoing cardiac surgery at our department since July 2014 to June 2017. A total of 101 patients who had known pre-existing mild to moderate renal disease and who were undergoing first-time coronary artery bypass grafting with cardiopulmonary bypass were recruited for the study. Patients were divided, based on preoperative serum creatinine level, into 3 groups as follows: Group A: creatinine level of less than 130μmol/L; Group B: creatinine level of 130 to 159μmol/L; and Group C: creatinine level of 160μmol/L or greater. Result: Multivariate logistic regression showed that elevation of the preoperative serum creatinine level to 130μmol/L or greater increased the likelihood of hemodialysis postoperatively (P<0.001), as well as the need for postoperative ICU stay (P<0.001). Other factors contributing to a prolonged ICU stay were being 60 years of age or older (P=0.007), having a preoperative left ventricular ejection fraction of less than 40% (P=0.001), and having a prolonged cardiopulmonary bypass time (P< 0.001). In-hospital mortality was also significantly elevated in Group B and Group C; P=0.045 and <0.001 respectively with a few factors contributing to an increase in mortality on multivariable analysis were being female (P<0.001), being 60 years of age or older (P=0.004), having a preoperative left ventricular ejection fraction of less than 40% (P=0.006), and having a prolonged cardiopulmonary bypass time (P<0.001). Of particular note, the method of myocardial protection (cardioplegia with or without topical cooling) did not significantly influence in-hospital mortality, need for mechanical renal support, or ICU stay. Conclusions: Mild to moderate renal dysfunction is an important predictor of outcome in terms of inhospital mortality, morbidity, and midterm survival in patients undergoing CABG. As the preoperative serum creatinine level increases further (³160 μmol/L), this effect is more pronounced. Journal of Surgical Sciences (2018) Vol. 22 (2) : 104-109
We are reporting a case of bilateral haemorrhagic ovarian cyst with pericarditis with atrial septal defect (ASD) in a 32 years female. Diagnosis of ASD was incidental when she was under evaluation for bilateral haemorrhagic ovarian cyst. Diagnosis was confirmed by echocardiography. During closure of ASD, pericardium was not used for patch closure because pericardium was full of multiple small nodules which was a suspected case of tubercular pericarditis, patient had also bilateral ovarian cyst which was suspected due to TB. ASD was closed by using Polytetrafluroethylene (PTFE) patch. Pericardium was sent for histopathology and report was chronic pericarditis. Postoperative course was uneventful with marked improvement of symptoms.
We are reporting a case of bilateral haemorrhagic ovarian cyst with pericarditis with atrial septal defect (ASD) in a 32 years female. Diagnosis of ASD was incidental when she was under evaluation for bilateral haemorrhagic ovarian cyst. Diagnosis was confirmed by echocardiography. ASD was closed by Polytetrafluoroethylene (PTFE) patch. Pericardium was found full of multiple small whitish granular nodules. So pericardium was discarded as a patch. Pericardium was sent for histopathology and histopathology reveals chronic pericarditis. Postoperative course was uneventful with marked improvement of symptoms. DOI: http://dx.doi.org/10.3329/uhj.v9i1.19512 University Heart Journal Vol. 9, No. 1, January 2013; 52-53
We are reporting a case of bilateral haemorrhagic ovarian cyst with pericarditis with atrial septal defect (ASD) in a 32 years female. Diagnosis of ASD was incidental when she was under evaluation for bilateral haemorrhagic ovarian cyst. Diagnosis was confirmed by echocardiography. ASD was closed by Polytetrafluoroethylene (PTFE) patch. Pericardium was found full of multiple small whitish granular nodules. So pericardium was discarded as a patch. Pericardium was sent for histopathology and histopathology reveals chronic pericarditis. Postoperative course was uneventful with marked improvement of symptoms.University Heart Journal Vol. 10, No. 2, July 2014; 102-103
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