Background: Intravenous drug abuse (IVDA) is a global health care problem that has tremendous socio-economic implications. Vascular complications following IVDA are not uncommon and may have serious consequences. At the National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh, there has been a steady increase in the number of cases with vascular complications of IVDA in the recent years. Objectives: The present study was undertaken to evaluate our surgical strategy for the management of various vascular complications following IVDA. Materials and Methods: Over the last 5 years, a total of 45 patients presented at the NICVD with various complications of IVDA. Thirty seven patients presented at the emergency department with bleeding from ruptured aneurysm or with impending aneurysm rupture. The remaining 8 patients presented at the vascular outpatient with deep venous thrombosis, superficial thrombophlebitis and chronic venous insufficiency. After resuscitation when necessary, excision of aneurysm was done either with simple ligation of the artery (Group A) or with restoration of arterial continuity (Group B). Outcome in the two groups were compared against the following parameters; acute limb ischemia, chronic limb ischemia, wound infection and lymphorrhoea. Results: There was no in-hospital mortality in this series. Both ligation and restoration of arterial continuity following aneurysmectomy were effective in treating the bleeding aneurysm. However, statistically significant differences were seen between the two groups in terms of acute and chronic limb ischemia. Restoration of arterial continuity was more effective in preventing acute and chronic limb ischemia. Conclusions: In Bangladesh, the incidence of IVDA with vascular complications is increasing at an alarming rate. In patients presenting with arterial pseudoaneurysms, surgical management should be aimed at restoration of arterial continuity whenever feasible. Key words: Intravenous drug abuse, Vascular complication, Aneurysm. DOI: 10.3329/cardio.v3i1.6426Cardiovasc. j. 2010; 3(1): 45-49
Background: It is arguable whether presence of transannular patch is itself a risk factor for adverse outcome at total correction(repair) of tetralogy of Fallot (TOF).This study intended to compare early outcome of intact pulmonary valve annulus with transannular patching at repair of TOF.Methods: This prospective observational study was conducted from July 2015 to January 2017.40 patients were enrolled in 2 groups- A & B.In group A,14 patients with intact pulmonary valve annulus& in group B, 26 patients with transannular patch. The diameter of pulmonary valve annulus was measured with Hegar dilator and Z value of the measured diameter were calculated from an established published nomogram. Transannular patch was placed if Z value of annular diameter < -3 or post repair operative room right ventricle/left ventricle pressure ratio (P RV/LV)> 0.7.Patients were monitored in the intensive care unit(ICU) and followed up for 3 months following discharge from hospital.Results: Patients of group B were younger and smaller body surface area. There were no significant difference of preoperative variables in terms of peripheral arterial oxygen saturation(SpO2%), haematocrit (%),NYHA functional class, right ventricular hypertrophy, and level & severity of right ventricular out flow tract obstruction. Early out come in terms of duration of ventilation time, inotrope support & ICU stay; post operative morbidity & mortality were more in group B than group A patients. Pulmonary regurgitation & right ventricular dysfunction following transannular patch at repair of TOF plays important role for adverse outcome.Conclusion: Transannular patch is associated with higher morbidity and mortality in total correction of Tetralogy of Fallot.Cardiovasc. j. 2018; 10(2): 194-200
Protein-C and Protein-S deficiency states are responsible for 3-5% (Protein-C) and 2-3% (Protein-S) of patients with venous thrombosis. Some cases of arterial thrombosis have been reported. It occurs twice as often in female as in males. A 50 years old lady presented with acute severe pain in the left upper limb for 2 days. On investigation she was diagnosed as a case of bracheal artery thrombosis with Protein-C & Protein-S deficiency. Bracheal thromboembolectomy was done and discharge her with life long warfarin therapy. In one year follow up the patient had no untoward event and INR done every month and warfarin is adjusted. Keywords: Arterial thromboembolism; Protein-C and Protein-S deficiency. DOI: 10.3329/cardio.v3i1.6433Cardiovasc. j. 2010; 3(1): 92-93
Background: coronary artery bypass surgery (CABG) is expensive, uses disposable appliances and patients require more perioperative intensive care, long stay in hospital and often have a lengthy recovery time. These complications, together with the growing trend towards less invasive techniques in other areas of surgery, have encouraged cardiac surgeons to see if minimally invasive cardiac surgery can become a reality with improved outcomes and costs. Methods: This is a prospective nonrandomized comparative clinical study done at the Department of Cardiac Surgery in National Institute of Cardiovascular Diseases (NICVD) Sher-E- Bangla Nagar, Dhaka from July 2006 to June 2008 among routine CABG patients. Purposive sampling was done with 26 patients in group A selected for MIDCAB and 24 patients in Group B selected for conventional CABG surgery. Patients were followed up for three months. Postoperative outcomes were assessed to evaluate the safety and efficacy of MIDCAB in relation to conventional CABG. Results: Mean age were 54.19 vs 53.87 in group A and Group B. 92.3% vs 87.5% were male respectively. Mean duration of operation, per operative blood loss transfusion and arrythmia were lower in MIDCAB group (p<0.05) number of grafts were also statistically significant (p< 0.001). Regarding post-operative outcome ventilation time in hours ICU stay post-operative hospital stay in days, postoperative MI and stroke rate were lower in favor of group A MIDCAB patients (p<0.001). Three months postoperatively six-meter walking distance is also statistically significant in favor of Group A MIDCAB (p<0.01) patients. However, pain score in early post-operative period was higher in group A significantly but it decreased significantly in late post-operative period which is also highly statistically different (p<0.001). However, mortality and quality of life at three months were similar in both groups. Conclusion: No difference in mortality rates detected between MIDCAB and CCABG group. But there was evidence that MIDCAB is associated with less perioperative and early postoperative morbidity and improved quality of life. The MIDCAB surgery is an effective procedure of complete revascularization in ischemic heart diseases like CCABG. The procedure is associated with shorter operating time, shorter ICU stay time, shorter hospital stays and better quality of life than for CCABG. Cardiovasc. j. 2021; 13(2): 135-143
In surgical practice management of vascular injuries are challenging. Vascular injuries are well addressed in developed countries but there is scarcity of vascular surgeons in developing countries like us and a large number of victims fail to reach specialist in time with consequent loss of limbs or lives. To observe the pattern and outcome of management of vascular injury in a developing country this retrospective study was conducted at the department of vascular surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh. All patients with vascular injury arrived alive were included in the study. Date in terms of age, sex, cause of injury, segment of vessel involved, associated injuries, time elapsed after injury, vascular procedures done and postoperative complications were taken from records of the department and were analyzed. Out of 2174 patients with vascular injury 11 patients died at resuscitation & 52 did not come back after referral to other hospitals for management of associated injuries. Most of the patients were young male & road traffic accidents was the most common cause (91.50%). Majority (53.60%) of the patients presented after 6 hours. Majority of the cases lower limb vessels were injured (64.05%). Among the associated injuries combine orthopedic & soft tissue injuries were most common (60.58%). Among the vascular procedures antilogous venous graft (42.39%) followed by end to end anastomosis (27.79%) were in majority of the cases. In case of extremity vascular injury limb amputation rate was 35.40%. This morbidity can be reduced by improvement of road safely measures, encouraging doctors to vascular surgery specialty and effective training of orthopedic & general surgeons in the management of extremity vascular injury till the availability of vascular surgeons for provision of vascular services in remote areas. Bangladesh Heart Journal 2021; 36(1) : 32-37
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