Cardiovascular Department Research Articles

Predictors of atrial fibrillation after off pump coronary artery bypass graft-a prospective observational study

Background: Postoperative atrial fibrillation (AF) is a common and potentially morbid complication following coronary artery bypass graft (CABG) surgery. Many factors have been suggested to increase the incidence of post-operative AF after CABG. Objective was to estimate the proportion of patients developing AF after off pump CABG (OPCABG) and to determine the possible predictors of AF after OPCABG.Methods: This was a prospective observational study done in the department of Cardiovascular and Thoracic Surgery of a tertiary center from December 2019 to December 2020 after obtaining Institutional review board clearance. A sample size of 334 was fixed and patients undergoing OPCABG were consecutively recruited in the study. The association of preoperative and postoperative factors with occurrence of AF were analysed using the univariate analysis with a p value <0.05 using the SPSS 16 software. Multivariate analysis was done to determine the independent predictors after OPCABG.Results: In this prospective study amongst the 334 patients recruited 60 (18%) developed atrial fibrillation and the maximum incidence was seen on the third postoperative day. Patients who developed AF were older with mean age of 61.38±7.63 years, 2.96 (95% CI 0.71-5.21) as compared to those who did not develop AF. Male gender Odds ratio 1.17 (95%CI 1.06-1.31), low ejection fraction 54.95±10.47, -3.25 (95% CI-5.99- -0.52); large atrial size 3.45±0.42, 0.12 (95% CI 0.02-0.06); long intensive care unit (ICU) stay 2.47±0.59, 0.32 (95% CI 0.06-0.21) and long hospital stay 7.62±3.36, 1.48 (95% CI 0.44-0.59) were associated with development of AF after OPCABG. Older age was found to be an independent predictor of development of AF on doing multivariate analysis.Conclusions: In our study advanced age was found to be an independent predictor of atrial fibrillation after OPCABG. Males, low ejection fraction, large atrial size and longer ICU and hospital stays were associated with occurrence of AF after OPCABG.

Analysis of Pathogen Distribution and Risk Factors of Nosocomial Infection in Hospitalized Patients in Cardiovascular Department

Analysis of Pathogen Distribution and Risk Factors of Nosocomial Infection in Hospitalized Patients in Cardiovascular Department

Right ventricular diastolic dysfunction and postoperative cardiac complications in patients undergoing coronary artery bypass grafting

Abstract Background Perioperative right ventricular (RV) dysfunction is associated with increased postoperative morbidity and mortality in patients undergoing heart surgery and large vessels. Almost all data on the importance of right ventricle function is specifically focused on its systolic dysfunction, which usually develops with severe left heart dysfunction. At the same time, the perioperative assessment of right ventricle filling during cardiac surgery has been far less studied. Purpose To evaluate whether the presence of preexisting RV diastolic dysfunction in patients undergoing coronary artery bypass grafting (CABG) is associated independently with higher incidents of postoperative cardiac complications. Design: one-center observational study. Methods The patient population consisted of those who underwent CABG in the cardiovascular surgery department from February 2017 to November 2018 (n=200, 153 males). Transthoracic echocardiography was performed on a Philips Clear Vue 550. Following RV systolic and diastolic parameters were studied: peak velocity of early (Et) and late (At) transtricuspid RV filling and their ratio. Tissue Doppler imaging was used to measure peak diastolic and systolic velocities at the tricuspid annulus (et', a't, s't), TAPSE, and RV Tei index. All patients were divided into 2 groups: with RV diastolic dysfunction (RVDD, n=92), and without RV diastolic dysfunction (control, n=108). Results Compared with those without RVDD, in patients with RVDD postoperative heart failure (HF, primary outcome) developed more frequently (p=0.026). The risk of developing postoperative HF was 3.39 in patients with RVDD compared with patients without RVDD (95% CI, 1.15–9.97; p=0.025). Left ventricular ejection fraction (LVEF) increase predicted a lower risk of postoperative HF with an OR = 0.95 (95% CI, 0.9–1.0; p=0.051). Female sex, cardiopulmonary bypass, increase of left ventricular mass index, and Et / At ratio also increased the risk of postoperative HF developing. But only RVDD, cardiopulmonary bypass and female sex were associated independently with development postoperative HF in the multivariate analyses. Conclusion Decreased preoperative RV diastolic function, cardiopulmonary bypass and female sex are independent risk factors for development postoperative HF after CABG in coronary artery disease patients. In contrast, LVEF and RV systolic dysfunction were not associated independently with this outcome. Therefore, assessment of preoperative RV diastolic function will be useful for predicting development postoperative HF following CABG. In addition, the Et / At ratio was the best echocardiographic marker associated with the postoperative HF development after CABG surgery. Funding Acknowledgement Type of funding sources: None.

Prognostic Value of Cardiac Troponin I In Infective Endocarditis

Abstract Aim The aim of this study is to assess the prognostic value of cardiac troponin I as a predictor of in-hospital morbidity and mortality in patients with infective endocarditis. Methods This study included 48 patients with definite and possible IE according to modified Duke’s criteria for diagnosis of IE. This prospective longitudinal study was conducted on patients admitted to the cardiovascular department of Cairo University hospitals. All patients were subjected to full history taking and clinical examination, all laboratory and radiological investigations which included chest radiography, echocardiogram and other diagnostic procedures as needed for diagnosis and follow-up of IE were done with emphasis on cardiac troponin I level on admission. Results Troponin I was found to be statistically significant predictor for heart failure (NYHA III/IV), septic pulmonary embolism and in-hospital mortality in infective endocarditis patients by univariate and multivariate regression analysis with P values 0.023, 0.037and 0.002 respectively. Tricuspid valve vegetations had showed significant relation to troponin I levels with p value 0.033. Also it was found that SOFA score on first day of admission showed significant relation to troponin I level with P value 0.045 and 0.004 for prediction of hospital stay duration. Shock and intracranial hemorrhage showed borderline significance with P values 0.097, 0.069. On other hand, troponin I as predictor of pulmonary edema, mechanical complications, systemic embolization, acute kidney injury and presence of aortic root abscess had no statistical significance in our studied patients. Conclusions This study showed that there is as significant predictive value of elevated cardiac troponin I with heart failure, septic pulmonary embolism and all cause in-hospital mortality. In addition, it was significant predictor of the length of hospital stay, lymphocytosis and SOFA score. These results are emphasizing that cTn I level may predict higher risk patients who would need early and aggressive control of infection medically alone or combined with surgery in IE patients.

The association between air pollution parameters and emergency department visits and hospitalizations due to cardiovascular and respiratory diseases: a time-series analysis.

In this study, the association between cardiovascular and respiratory Emergency Department (ED) visits and hospitalizations and Sulfur Dioxide (SO2) and particulate matter with an aerodynamic diameter ≤ 10µm (PM10) was determined. The records of a total of 632,223 people diagnosed with cardiovascular diseases (ICD-10 code I00-I99) and respiratory diseases (ICD-10 code J00-J99) at and over the age of 18 between 2012 and 2018 in three hospitals in Karaman in Turkey were examined in the present study. The daily 24-h averages for SO2 and PM10 concentrations were acquired in National Air Quality Monitoring. A time-series analysis with Poisson Generalized Linear Model was used. Among the air pollution parameters, the mean ± standard deviation of SO2 and PM10 were 16.2 ± 22.1 and 75.8 ± 48.2μg/m3, respectively. An increase of 10μg/m3 in SO2 was associated with a 3% [Relative Risk (RR), 95% Confidence Interval (CI): 2-4)] increase in cardiovascular ED visit and 2% (RR, 95% CI 2-3) increase in respiratory ED visit, and 1% (RR, 95% CI 1-3) increase in respiratory hospitalizations. An increase of 10μg/m3 in PM10 was associated with a 1% (RR, 95% CI 1-2) increase in cardiovascular hospitalizations. Increases in SO2 are a risk factor for cardiovascular and respiratory ED visits, and respiratory hospitalizations. Increases in PM10 are a risk factor for cardiovascular hospitalizations.

Role of tranexamic acid in reducing perioperative blood loss in transthoracic esophagectomy

Background and objectives: Transthoracic esophagectomy is usually associated with significant perioperative bleeding and blood loss. The present study investigated the role of prophylactic tranexamic acid on intra- and postoperative blood loss and the need for blood transfusion in transthoracic esophagectomy (Ivor Lewis esophagectomy). Materials and Methods: Patients who underwent laparotomy and right thoracotomy with intrathoracic anastomosis for esophageal malignancy were enrolled in the study. The enrolled cases were divided into two groups namely Group A and B. Informed consents were obtained from all the enrolled patients. Group A patients received a standard dose of 1 gram of intravenous tranexamic acid one hour before the beginning of surgery while Group B patients did not receive any tranexamic acid before or after the surgery. Peroperative blood loss was estimated and noted. Post-operative blood loss was assessed from the surgical drains. Results: A total of 55 cases were included in the study. Group A and B had 27 and 28 cases respectively. The mean age of the Group A and Group B patients was 60.1 ± 6.2 and 60 ± 6.9 years respectively. Out of 27 cases in Group A, 7 (25%) patients had a postoperative haemorrhage (blood loss) up to 300 ml and among the remaining 20, only 2 (7%) patients required blood transfusion as hematocrit fell below 20%. Compared to Group A, patients in Group B who did not receive preoperative tranexamic acid, 21(75%) patients had postoperative haemorrhage up to 300 ml (Group A vs. Group B: p=0.0002). Regarding intraoperative blood loss no significant (p >0.05) difference was observed among the cases in two groups. Conclusion: The study revealed that administration of prophylactic tranexamic acid resulted into fewer postoperative blood loss in transthoracic esophagectomy. IMC J Med Sci 2022; 16(1): 003 *Correspondence: Farooq Ahmad Ganie, Department of Cardiovascular and Thoracic Surgery, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar -190011, J & K, India. E-mail: farooq.ganie@yamil.com

COVID-19 Screening for Hospitalized Patients: The Role of Expanded Hospital Surveillance in a Low Prevalence Setting.

PurposeThe COVID-19 pandemic poses a serious threat to healthcare workers and hospitalized patients. Early detection of COVID-19 cases is essential to control the spread in healthcare facilities. However, real-world data on the screening criteria for hospitalized patients remain scarce. We aimed to explore whether patients with negative results of pre-hospital screening for COVID-19 should be rescreened after admission in a low-prevalence (less than 3% of the world average) setting.Patients and MethodsWe retrospectively included patients in central Taiwan who were negative at the first screening but were newly diagnosed with pneumonia or had a body temperature above 38 degrees Celsius during their hospitalization. Each patient might be included as an eligible case several times, and the proportions of cases who were rescreened for COVID-19 and those diagnosed with COVID-19 were calculated. A logistic regression model was constructed to identify factors associated with rescreening. Reverse transcription-polymerase chain reaction tests were used to confirm the diagnosis of COVID-19.ResultsA total of 3549 cases eligible for COVID-19 rescreening were included. There were 242 cases (6.8%) who received rescreening. In the multivariable analysis, cases aged 75 years or older, those with potential exposure to SARS-CoV-2, or patients visiting specific departments, such as the Cardiovascular Center and Department of Neurology, were more likely to be rescreened. None was diagnosed with COVID-19 after rescreening. There was no known cluster infection outbreak in the hospital or in the local community during the study period and in the following two months.ConclusionIn Taiwan, a country with a low COVID-19 prevalence, it was deemed safe to rescreen only high-risk hospitalized patients. This strategy was effective and reduced unnecessary costs.

Paraoxonase 1 Q192R (A/G) Gene Polymorphism as possible risk factor for coronary heart diseases among Egyptians. Case-control study

Background: Coronary heart disease (CHD) is the leading cause of morbidity and mortality worldwide. There are many risk factors for CHD but recently the role of oxidative stress in progression of atherosclerosis has been more recognized. Paraoxonase 1 (PON1) protects against oxidation of LDL and many polymorphisms in both of exons and promoter regions of (PON1) gene have been investigated for their association with CHD. The aim of the present study was to investigate the relation between CHD suceptibility and PON1 Q192R (A/G) gene polymorphism in a cohort of Egyptian individuals. Methods: The study included 100 subjects, 50 patients who admitted to cardiovascular department with established diagnosis of obstructive coronary artery disease by coronary angiography and 50 healthy participants. Genotyping of PON1 Q192R (A/G) was done, and then serum concentration of PON1 was assessed by ELISA after that by spectrophotometer. Results: Serum PON1 enzyme was lower in patients with CHD than in control group with a statistically significant difference p < 0.001. A statistically significant association was observed with AG and GG genotypes of PON1 gene with CHD with P= 0.003, OR=5.02(95% CI =1.66-15.26) and P= 0.038, OR= 9.4 (95% CI =1.07-82.5); respectively. The G allele of PON1 was higher in CHD patients than controls suggesting that this allele may demonstrate a susceptibility effect to CHD in our cohort with P<0.001, OR= 5.16 (95% CI = 2.1-12.5) Conclusion: The Q192R polymorphism in the PON1 gene may be a susceptibility gene associated with increased risk of CHD among Egyptians.

Role of pulmonary ultrasound in evaluation of respiratory manifestations of heart failure with preserved ejection fraction

Background Pulmonary congestion quantification is essential for follow-up of heart failure (HF). Most available tools are inaccurate or invasive. Hence, ultrasonographic B-line modes have been suggested as an alternative easy noninvasive diagnostic instrument for pulmonary congestion evaluation in patients with HF. Aim The aim was to assess the lung ultrasound role in evaluating HF in patients with preserved ejection fraction (EF). Patients and methods A total of 150 participants admitted to the cardiovascular department or followed in the outpatient clinic between July 2016 and May 2017 were included in this study. The participants were divided into five groups (each 30 patients): patients with HF having preserved EF (HFpEF) without comorbidities, patients with HFpEF with comorbidities, HF patients with midrange EF (HFmrEF) without comorbidities, patients with HFmrEF with comorbidities, and nondiabetic nonhypertensive individuals. All groups were subjected to New York Heart Association grading for cardiac diseases, echocardiography, and serum brain natriuretic peptide assessment. Results B-lines significantly increased with increased New York Heart Association class. A negative correlation was found between B-lines and the EF% (r=−0.46). The brain natriuretic peptide and B-lines showed a significant, powerful association in the first group (r=0.81), the second group (r=0.80), the third group (r=0.85), and the fourth group (r=0.098), but there was an inverse insignificant correlation in the control. Conclusion B-line assessment by lung ultrasound is considered a simple tool for the evaluation of pulmonary congestion resulting from diastolic HF (HFPEF). It can be used as a fast and reliable tool.

HYDATIC CARDIAC SYST: AN EXCEPTIONAL LOCATION

Hydatid cyst is a parasitic disease endemic in different regions of the world. Cardiac localization represents only 0.5 to 2% of all attacks, characterized by clinical, paraclinical and especially radiological polymorphism. Its spontaneous development is serious because of the risk of endocavity rupture. The diagnosis is facilitated by means of non-invasive imaging, in particular echocardiography, thoracic computed tomography and magnetic resonance imaging. Given the lack of alternative treatment options, cystectomy and pericystectomy are the only surgical techniques capable of offering chances of recovery with acceptable morbidity and mortality. Antiparasitic treatment comes in addition to surgery. Eradication of hydatid disease mainly involves effective collective and individual preventive measures. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. We present a clinical case of a 54-year-old patient who presented with asthenia followed by precordial pain, who has a normal EKG and chest x-ray. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery. Transthoracic echocardiography (TTE) a mass that bulges in the lateral aspect of the left heart chambers. The thoracic tomodensitometry objectified a cystic image which bulges in the left cardiac chambers suggesting a cardiac hydatid cyst. A hypereosinophilia was objective in the biological assessment. The patient was sent to the cardiovascular surgery department for surgery.

Salvation to Hearts in Distress under Shells of Stress: Subtotal Pericardiectomy in a Series of 9 Patients with Constrictive Pericarditis

Objective: Chronic constrictive pericarditis (CCP) is a rare entity responsible of diastolic heart failure. The true prevalence is yet to be defined. The purpose of this study was to describe the clinical and para-clinical characteristics of patients with CCP, the therapeutic management, the outcomes and impacting factors. Materials and Methods: We conducted a retrospective descriptive study from 2017 to 2020 including 9 patients hospitalized for CCP in our cardiovascular surgery department. Results: The mean age was of 32.6 years. Majority were men (n=7). Dyspnea was the most common sign. Peripheral signs were dominated by signs of right heart failure. Cardiac ultrasonography showed pericardial thickening and calcifications with Doppler adiastolic signs in 90% of cases. Thoracic CT was performed in 7 patients, cardiac MRI in one patient, showing calcifications and measuring the pericardial thickening. Cardiac catheterization performed in 6 patients showed the aspect of Dip plateau. Tuberculosis etiology was retained in 55.6%; post-radiation origin in one patient and 33.4 % of cases were idiopathic. All of patients benefited from subtotal pericardiectomy with good results in the medium and long term. Two deaths occurred, the first patient died following multi-visceral failure, the second died 3 years later from neoplasia. Conclusion: The CCP is a rare condition with poor prognosis. The diagnosis should be raised when there are signs of right heart failure associated with signs of hemodynamic adiastolia. The echocardiography, with computed tomography or cardiac MRI and especially cardiac catheterization confirm the diagnosis and also etiological orientation. Tuberculosis and idiopathic etiologies were the most common at our country. Medical treatment options are limited. Pericardiectomy remains the only radical treatment with good results in immediate, medium and long term.

Management of Posttraumatic Arterioveinous Fistulas of the Limbs in a Sub-Saharan Country

Introduction: Post-traumatic arteriovenous fistulas of the limbs most often occur after trauma but can be iatrogenic since the advent of interventional methods. Materials and methods: This is a retrospective study which took place at the thoracic and cardiovascular surgery department / FANN in Dakar, Senegal over a period from 2006 to 2021. Results: Seven patient files identified were been collected. All were male with an average age of 21 years. The mechanism and the topography of the predominant traumatism being a stabbing attack on the thigh and the average consultation time is 71 days. The limb vessel ultrasound and CT angiography can confirm the diagnosis. All patients underwent open surgery. The outcome was favorable in all patients. Conclusion: Post-traumatic arteriovenous fistulas of the limbs are rare, the diagnosis is clinical and open surgery retains its place in the management.

The challenge of assuming clinical relevance from statistical significance.

Journal of Cardiac SurgeryVolume 36, Issue 11 p. 4139-4140 COMMENTARY The challenge of assuming clinical relevance from statistical significance Bahaaldin Alsoufi MD, Corresponding Author Bahaaldin Alsoufi MD balsoufi@hotmail.com orcid.org/0000-0001-6353-7874 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA Correspondence Bahaaldin Alsoufi, MD, Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA. Email: balsoufi@hotmail.comSearch for more papers by this author Bahaaldin Alsoufi MD, Corresponding Author Bahaaldin Alsoufi MD balsoufi@hotmail.com orcid.org/0000-0001-6353-7874 Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, Louisville, Kentucky, USA Correspondence Bahaaldin Alsoufi, MD, Department of Cardiovascular and Thoracic Surgery, University of Louisville School of Medicine, Norton Children's Hospital, 201 Abraham Flexner Way, Suite 1200, Louisville, KY 40202, USA. Email: balsoufi@hotmail.comSearch for more papers by this author First published: 27 August 2021 https://doi.org/10.1111/jocs.15930Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume36, Issue11November 2021Pages 4139-4140 RelatedInformation

Short-term effects of cumulative exposure to ambient air pollution on cardiovascular emergency department visits in Mexico City

BACKGROUND AND AIM: Available data on the acute cardiovascular effects of ambient air pollution in Latin America is limited considering that over 80% of its 1 billion inhabitants live in urban centers with poor air quality. The study aim was to evaluate the acute effects and attributable burden of cumulative exposure to PM2.5, NO2, SO2 and CO, on Cardiovascular Emergency Department Visits (CEDVs) in Mexico City from May 2016 to February 2019 using a time-series analysis. METHODS: Daily count of CEDVs were collected from 38 medical units, as well as measurements of ambient air pollutants from 35 level-ground stations. We estimated daily pollutant exposure using inverse distance weighting interpolation and buffer analysis. Quasi-Poisson Generalized Additive Models and Distributed Lag Models were used to examine the percentage change of CEDVs associated to each pollutant. Then, we conducted a backward approach of time-series model to calculate attributable fractions considering the cumulative exposure effect. RESULTS:A total of 48,891 CEDVs were recorded in a period of 1,019 days. We estimated a significant percentage change of CEDVs for each 10 µg/m3 of PM2.5 at lag0-6 (3.7%, IC95% 0.1 – 7.6), O3 at lag0-5 (1.1%, IC95% 0.2 – 2.0), NO2 at lag0-4 (2.5%, IC95% 0.3 – 4.7) and for each 1 mg/m3 of CO at lag0 (6.6%, IC95% 0.3 – 13.2). The estimated effects were higher in female population. Overall, 9.5% of CEDVs in Mexico City may be related to PM2.5 ambient exposure, 10.3% to O3, 11% to NO2 and 5.7% a CO. CONCLUSIONS:Exposure to ambient air pollution has an effect on CEDVs in a Latin American city. The implementation of air quality control measures could significantly reduce the impact of cardiovascular diseases on emergency department services, which lead the main cause of death in Mexico and in the world. KEYWORDS: Ambient air pollution, Latin America, Cardiovascular, Emergency department visits, Attributable fraction

Initiating a New Era of Cardiovascular Diagnosis and Therapy in Acute Aortic Syndromes: The Mainz-Essen Experience (Part I)-Imaging and Biomarkers.

Acute aortic syndromes (AAS) encompass a group of life-threatening medical conditions (acute aortic dissection [AAD], intramural hematoma, and penetrating aortic ulcer) with a common pathophysiological pathway. Due to overlapping symptoms and signs with other cardiovascular emergencies, the diagnosis remains challenging resulting in time delays and related increased in-hospital and long-term morbidity and mortality. The Cardiovascular Department of Johannes Gutenberg University in Mainz at West-German Heart Centre in Essen (Germany) first described (in 1984) AAD by transesophageal echocardiography, AAD diagnostic features, and furtherly explored the implementation of “invasive” imaging techniques, namely, intravascular ultrasound and intraluminal phased-array imaging. Furthermore, pioneer studies were undertaken on the biomarker and imaging interplay, namely, D-dimer and F-fluorodeoxyglucose positron emission tomography/computed tomography. We discuss the unique 35-year-long Mainz–Essen experience on the diagnostic and prognostic role of serological and imaging biomarkers in AAS.

Anatomical lung resection for left lung cancer after thoracic aortic replacement.

After thoracic aortic replacement, extensive adhesions are expected to develop between the prosthesis and the lung. There have been no definitive reports on anatomical lung resection performed in patients with left lung cancer after thoracic aortic replacement. Herein, we report a series of five such cases. Our findings showed that severe adhesions were encountered after aortic arch and descending aortic replacement, but not after ascending aortic replacement. We think that these adhesions started developing in the early postoperative period and were particularly severe in the case of left upper lobe lung cancer after arch replacement. However, anatomical lobectomy and systematic lymph node dissection could still be performed safely by devising a surgical technique. In addition, there was a possibility that a new aortic aneurysm may have occurred at the time of surgery. Therefore, it is important to perform a thorough preoperative evaluation and coordinate with the cardiovascular surgery department.

Prediction of risk factors for recurrence of atrial fibrillation in patients with arterial hypertension.

This work aimed to assess the significance of risk factors for atrial fibrillation recurrence and predict the significance of these factors in the development of arterial hypertension in patients. For the first time, the authors performed prognostic analysis of atrial fibrillation recurrence probability taking into account the number and significance of risk factors. The study was conducted in 2018-2019 based on the Cardiovascular Department of Military Hospital 175, Ho Chi Minh City (Vietnam). A total of 200 patients were diagnosed with arterial hypertension of I-III degree, divided into 2 groups: Group 1 (84 patients) without recurrence of atrial fibrillation, Group 2 (116 patients) with recurrences. All patients underwent echocardiographic and veloergometric studies, as well as Holter monitoring. Group 2 consisted of a significantly higher number of overweight patients (p ≤ 0.05) compared to Group 1. Also, more patients with a prolonged period of arterial hypertension (p ≤ 0.05), high blood pressure (p ≤ 0.02), and diabetes mellitus (p ≤ 0.01) were found in Group 1. A history of atrial fibrillation was more typical for Group 2 (p ≤ 0.03). Among risk factors, arterial hypertension of III degree (0.01) and left ventricular myocardial mass index (0.02) had the highest level of significance. Maximum unfavorable prognosis of atrial fibrillation recurrence is released under the action of all three factors. Under one risk factor (arterial hypertension), the degree of risk is quite high (1.4 times), but minimal compared to the other factors. With the fibrillation, the risk of recurrence increases slightly (1.6 times, p ≤ 0.05). The risk of atrial fibrillation recurrence is maximal when all three factors are combined (with atrial dilatation attached), with the risk increasing almost 2-fold (2.2-fold, p ≤ 0.01).

A comparison of two different management plans for patients requiring both carotid endarterectomy and coronary artery bypass grafting.

Carotid endarterectomy (CEA) is a prophylactic operation that is used to mitigate the risk of stroke caused by embolism of atherosclerotic plaques in the carotid bifurcation. Previously, the large, multicentre, randomised, controlled GALA study found no significant differences in clinical outcomes between patients treated using general or local anaesthesia. While this study provided important insights into disease outcomes based on treatment modalities, it did not answer questions regarding the safety of CEA under local anaesthesia in patients at high risk for cardiovascular complications. Here, we examined the use of two different management plans in patients requiring both carotid endarterectomy and coronary artery bypass grafting (CABG), in terms of their effects on hospital mortality. Thirty-four patients consecutively operated on in our cardiovascular department were included in this analysis. The patients were divided into two groups based on the anaesthetic management plan. The first group consisted of patients who underwent CEA and CABG under general anaesthesia in the same session (GA group); the second group consisted of patients who initially underwent CEA under cervical block anaesthesia followed by CABG under general anaesthesia in a separate session (CB-GA group). These two groups were compared in terms of postoperative complications and hospital mortality. The incidence of postoperative myocardial infarction was higher in the CB-GA group, with four patients experiencing postoperative myocardial infarction, compared to no patients in the GA group. For patients requiring CEA and CABG, performing both operations under general anaesthesia in the same session was safer than initially performing CEA under cervical block anaesthesia followed by CABG under general anaesthesia.

Assessment of Left Ventricular Systolic Function by Speckle Tracking in Diabetic Patients Receiving Direct Acting Antiviral Drugs for Chronic HCV

Background: Diabetes mellitus [DB] is a well-known risk factor for cardiovascular disease. The co-existence of DM and microvascular abnormalities could lead to hypertrophy of left ventricle (LV) with diastolic and/or systolic dysfunction. However, early stages of the disease are asymptomatic due to its chronic nature and the effective control of diabetes. Aim of the work: This clinical cohort aimed to assess left ventricular systolic function in DM patients, receiving direct acting antiviral (DAA) drugs for chronic hepatitis-C virus by speckle tracking. Subjects and methods: This clinical cohort included 90 patients who were divided into three equal groups. Patients were recruited from Hepatology Outpatient Clinic of Kafr El-Shaikh University hospital, who were sent to the cardiovascular department for evaluation. Patients were evaluated just before, one month and three months after starting therapy. Results: No one in control group had diastolic dysfunction compared to 10.0% and 16.7% in DAAs and Non-DAAs groups, respectively. Conventional echocardiography returned statistically non-significant difference except significant increase of LVESD, IVST and LVPWT in study groups than control groups. However, the difference between DAAs and Non-DAAs groups was statistically non-significant. The basic strain parameters returned significant lower values at different windows in control than study groups. The strains were reduced in the follow up visits (first and third months) in DAAs groups, but not significantly reduced in non-DAAs group. Acute myocardial infarction was reported among one patient in non-DAAs group compared to none in DAAs group. Conclusion: The speckle tracking is a useful tool for early detection of subclinical left ventricular dysfunction in HCV diabetic patients and could be used for following up of response DAA treatment. DAAs therapy is associated with improvement, not of HCV disease, but also of cardiac dysfunction

Incidence and Clinical Implications of Postoperative Atrial Fibrillation in patients Undergoing On-Pump and Off-Pump Coronary Artery Bypass Grafting

Aim: Post-operative incidence and clinical implications of atrial fibrillation in patients having on-pump and off-pump CABG. Place of Study: Department of Cardiovascular &amp; Thoracic Surgery, Shaikh Zayed Hospital, Lahore. Study Duration: 1 year Design of Study: Quasi-experimental study Methodology: 140 cases were selected. Non-probability purposive sampling technique was used. Grouping: Group A (Off-pump) and Group B (On-pump). Results: In group A, cases showed atrial fibrillation and in group B 23(32.9%) cases were noted. The incidence of postoperative atrial fibrillation was low in off-pump CABG as compare to on pump CABG.Clinical implications of postoperative AF such as, length of ICU &amp; hospital stay, cerebrovascular events, wound infections and mortality of the cases are significantly reduced by using off-pump CABG. Conclusion: Incidence of P/O atrial fibrillation is low in off-pump CABG as compare to on pump CABG Keywords: Coronary Artery Bypass Graft (CABG), Atrial Fibrillation, on pump CABG.