<p>Objective: The heart sound signals captured via a digital stethoscope are often distorted by environmental and physiological noise, altering their salient and critical properties. The problem is exacerbated in crowded low-resource hospital settings with high noise levels which degrades the diagnostic performance. In this study, we present a novel deep encoder-decoder based denoising architecture (LU-Net) to suppress ambient and internal lung sound noises. Methods: Training is done using a large benchmark PCG dataset mixed with physiological noise, i.e., breathing sounds. Two different noisy datasets were prepared for experimental evaluation by mixing unseen lung sounds and hospital ambient noises with the clean heart sound recordings. We also use the inherently noisy portion of the PASCAL heart sound dataset for evaluation. Results: The proposed framework showed effective suppression of background noises in both un?seen real-world data and synthetically generated noisy heart sound recordings, improving the signal-to-noise ratio (SNR) level by 5.575 dB on an average using only 1.32 M parameters. The proposed model outperforms the current state-of-the-art U-Net model with an average SNR improvement of 5.613 dB and 5.537 dB in the presence of lung sound and unseen hospital noise, respectively. LU-Net also outperformed the state-of-the-art Fully Convolutional Network (FCN) by 1.750 dB and 1.748 dB for lung sound and unseen hospital noise conditions, respectively. In addition, the proposed denoising method model improves classification accuracy by 38.93% in the noisy portion of the PASCAL heart sound dataset. Conclusion: The results presented in the paper indicate that our proposed architecture demonstrated a robust denoising performance on different datasets with diverse levels and characteristics of noise. Significance: The proposed deep learning-based PCG denoising approach is a pioneering study that can significantly improve the accuracy of computer-aided auscultation systems for detecting cardiac diseases in noisy, low-resource hospitals and underserved communities. </p>
BackgroundDespite ample evidence of continuing preoperative aspirin to improve coronary artery bypass surgery outcomes, practice for the routine continuation of preoperative aspirin is inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG). MethodologyThis cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 and January 2018. After considering the inclusion and exclusion criteria, the patients were divided into two groups: one (n = 37) received tablet aspirin 75 mg till the day of the surgery, and for the other group (n = 37) aspirin was stopped five days before the surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables, statistical analysis was performed. ResultsThere was no significant difference between the two groups concerning peroperative and postoperative variables. In addition, no significant difference was observed between the two groups in chest tube drainage at one, two, three, twenty-four, forty-eight, and seventy-two hours (p = 0.845, 0.126, 0.568, 0.478, 0.342, and 0.717, respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP). ConclusionsContinuation of preoperative aspirin till the day of the surgery is neither associated with an increase in chest tube drainage, reoperation for bleeding complications nor transfusion of blood and FFP.
Aortopulmonary window (APW) itself is a rare congenital cardiac malformation and its association with Tetralogy of Fallot (TOF) makes it more uncommon. We report a case of APW with TOF who presented at 4-year 10 months of age. As the boy was still in operable state, after thorough preoperative evaluation successful surgical repair was done.
Background Despite ample evidence of continued preoperative aspirin to improve outcomes in coronary artery bypass surgery, practice for routine continued preoperative aspirin use is still inconsistent due to concern for increased postoperative bleeding. The purpose of this study was to investigate preoperative aspirin use and its effect on postoperative bleeding after off-pump coronary artery bypass grafting (OPCABG). Method This cohort study involved patients (n = 74) who underwent OPCABG at a single center between August 2017 to January 2018. After considering the inclusion and exclusion criteria, they were divided into two groups: one (n = 37) received tablet Aspirin 75mg till the day of surgery and for the other group (n = 37) aspirin was stopped 5 days before surgery. Postoperative bleeding was recorded in both groups. After considering preoperative, intraoperative, and postoperative variables statistical analysis was done. Results There was no significant difference between the two groups concerning preoperative and peroperative variables. No significant difference was also observed between the two groups in chest tube drainage at 1sthour, 2ndhour, 3rdhour, 24thhour, next 24 hours (at 48th hour), and next 24 hours (at 72nd hour) (p = 0.845, 0.126, 0.568, 0.478, 0.342 and 0.717 respectively). No significant difference was seen in the transfusion requirement of blood and fresh frozen plasma (FFP). Conclusions Continuation of preoperative aspirin till the day of surgery is not associated with an increase in chest tube drainage, re-operation for bleeding complications, or transfusion of blood and FFP.
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