Aim: To evaluate the efficacy of multidetector CT (MDCT) and its post-processing techniques including virtual bronchoscopy in evaluation of tracheobronchial foreign body inhalation in infants and children. Patients and methods: During the period from March 2011 to October 2013, 21 consecutive patients (8 females, 13 males, age range from 18 month to 7 years) were referred to the radiology department for CT evaluation for suspected FB inhalation. CT was done on a 16-slice scanner. No IV contrast was used. MDCT findings were compared with the results of rigid bronchoscopy. Results: MDCT detected FB in 17 patients, two cases had true Àve results, one case had false +ve and one case had false Àve results compared with conventional bronchoscopy. MDCT revealed hyper-aeration of the ipsilateral lung in 42.9 % patients, atelectasis in 57.1%, pneumonic consolidation in 71.4%. According to bronchoscopy, foreign body was identified and extracted in 18 patients. The right main bronchus, left main bronchus and trachea were the commonest sites. Conclusion: Multidetector CT with the aid of virtual bronchoscopy is a reliable noninvasive method that allows detection and localization of tracheobronchial FB.

BackgroundA previous percutaneous coronary intervention (PCI) may affect the outcomes of patients who undergo coronary artery bypass grafting (CABG). The objective of this study was to compare the early in-hospital postoperative outcomes between patients who underwent CABG with or without previous PCI.MethodsThe present study included 160 patients who underwent isolated elective on-pump CABG at the department of cardiothoracic surgery, Minia University Hospital from January 2010 to December 2014. Patients who previously underwent PCI (n=38) were compared to patients who did not (n=122). Preoperative, operative, and early in-hospital postoperative data were analyzed. The end points of the study were in-hospital mortality and postoperative major adverse events.ResultsNon-significant differences were found between the study groups regarding preoperative demographic data, risk factors, left ventricular ejection fraction, New York Heart Association class, EuroSCORE, the presence of left main disease, reoperation for bleeding, postoperative acute myocardial infarction, a neurological deficit, need for renal dialysis, hospital stay, and in-hospital mortality. The average time from PCI to CABG was 13.9±5.4 years. The previous PCI group exhibited a significantly larger proportion of patients who experienced in-hospital major adverse events (15.8% vs. 2.5%, p=0.002). On multivariate analysis, only previous PCI was found to be a significant predictor of major adverse events (odds ratio, 0.16; 95% confidence interval, 0.03 to 0.71; p=0.01).ConclusionPrevious PCI was found to have a significant effect on the incidence of early major adverse events after CABG. Further large-scale and long-term studies are recommended.

Background: Small aortic annulus (AA) is a big issue during aortic valve replacement (AVR), necessitating replacement of an undersized prosthetic valve especially with double valve replacement (DVR). Despite the fact that small aortic valve prostheses can lead to prosthesis-patient mismatch (PPM), there remains reluctance to perform aortic root enlargement (ARE) procedures, fearing morbidity and mortality. Objective: To evaluate clinical and echocardiographic outcomes in patients with small aortic annulus (<18 mm) undergoing double valve replacement. Methods: The study included 100 consecutive patients who underwent DVR for combined rheumatic aortic and mitral valve diseases, between January 2016 and September 2020. Only 50 patients had ARE with DVR. ARE was performed using an autologous or bovine pericardium or Dacron patch by Nick's or Manouguian procedures. The estimated postoperative endpoints were mortality, effective orifice areas (EOA), mean aortic pressure gradient (PG), and valve-related complications. The shortest postoperative follow-up period was 6 months. Results: The study included 30 male and 70 female patients with mean age of 35±20 years, body surface area (BSA) of 1.7 ± 0.3 m2, aortic annulus diameter was 1.4 ± 0.4 mm, aortic orifice area was 0.8 ± 0.1 cm2, and mean pressure gradient 85 ± 2.5 mmHg. During the follow-up period, there was a mild to moderate paravalvular leak (1%) with 1% heart block and residual gradient on prosthetic aortic valve; this was all in DVR alone. Conclusion: Enlargement of the aortic root by Nick's or Manouguian technique is safe and effective in patients with small aortic annulus undergoing double valve replacements.

BackgroundTo evaluate our experience of early surgical plication for diaphragmatic eventration (DE) in infancy and childhood.MethodsThis study evaluated infants and children with symptomatic DE who underwent plication through an open transthoracic approach in our childhood development department between January 2005 and December 2012. Surgical plication was performed in several rows using polypropylene U-stitches with Teflon pledgets.ResultsThe study included 12 infants and children (7 boys and 5 girls) with symptomatic DE (9 congenital and 3 acquired). Reported symptoms included respiratory distress (91.7%), wheezing (75%), cough (66.7%), and recurrent pneumonia (50%). Preoperative mechanical ventilatory support was required in 41.7% of the patients. The mean length of hospital stay was 6.3±2.5 days. The mean follow-up period was 24.3±14.5 months. Preoperative symptoms were immediately relieved after surgery in 83.3% of patients and persisted in 16.7% of patients one year after surgery. All patients survived to the end of the two-year follow-up and none had recurrence of DE.ConclusionEarly diagnosis and surgical plication of the diaphragm for symptomatic congenital or acquired diaphragmatic eventration offers a good clinical outcome with no recurrence.

Background: To evaluate early and midterm outcomes of tricuspid ring annuloplasty using three-dimensional (3D) MC3 ring for treatment of functional tricuspid regurgitation (FTR) during mitral valve replacement for rheumatic valve disease. Results: This prospective study included 105 patients who underwent repair for ≥ moderate tricuspid regurgitation (TR) during mitral valve replacement for rheumatic valve disease. Between January 2016 and December 2018, a group of 23 patients who underwent ring annuloplasty with Edward MC3 rings was compared to another group of 82 patients who underwent standard suture (DeVega) repair. The primary outcome was residual TR (≥ moderate TR). During an average follow-up period of 18.84 ± 9.90 months (range 3-33 months), the preoperative grade of TR improved significantly in both groups. The postoperative mean of TR in the MC3 group was significantly lower than that in the DeVega group (0.17 ± 0.49 versus 0.77 ± 0.93, P = 0.004). The rate of TR recurrence (≥ 2+ TR) was significantly higher after MC3 ring annuloplasty (4.3% versus 23.1%, P = 0.03). Freedom from mild TR was 30.5% in the DeVega group and 61% in the ring annuloplasty group (P = 0.007). Freedom from residual TR was 76.8% in the DeVega group and 95.7% in the ring annuloplasty group (P = 0.04). Conclusions: The use of MC3 rings is a safe and effective alternative to DeVega repair for the management of FTR. However, further evaluation of long-term durability is recommended.