فهرست مطالب

  • Volume:7 Issue:3, 2019
  • تاریخ انتشار: 1398/06/10
  • تعداد عناوین: 8
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  • Ehsan Shahverdi *, Massoumeh Maki, Mahkameh Rasouli, Hadi Rad, Maryam Allahverdi Pages 462-468
    Introduction

    Mitral valve insufficiency in adults is often a complication of ischemic heart disease. Coronary artery bypass grafting (CABG) is performed as a strategy for the treatment of coronary artery disease. The aim of this study was to evaluate mitral regurgitation (MR) before and after CABG.

    Materials and Methods

    This Experimental study was conducted on 100 patients who underwent CABG in University Hospitals of Tehran, Iran, from 2009 to 2013. Statistical Package for the Social Sciences (SPSS) version 16 (SPSS Inc. Chicago, IL) for Windows was used for data analysis..

    Results

    Out of 100 patients (i.e., 60 males and 40 females) with the mean age of 64.97±10.64 years, 11 males (18.3%) and 12 females (30.0%) were identified with MR +2 after the surgery. There was no significant relationship between renal insufficiency and MR before the operation (P= 0.370). Furthermore, in patients with and without renal insufficiency, 2 (50.0%) and 21 (21.9%) subjects were identified with MR +2 after the operation, respectively. Out of 100 patients, 75 (75%) cases with MR +2 before the surgery were identified with MR +1 after the operation. Moreover, 23 (23%) subjects with MR +2 before the surgery were still reported with MR +2 after the operation. In this regard, there was a significant relationship before and after the surgery in MR severity (P=0.02).

    Conclusion

    It is necessary to have sufficient knowledge of the risk factors in dealing with MR for the determination of the best therapy.

    Keywords: Coronary Artery Bypass, Cardiac Surgery, mitral regurgitation, predisposing factors
  • Hamid Hoseinikhah, Omid Javdanfar, Mohamadreza Akbari, Kayhan Mizani, Mahsa Moallemi, Aliasghar Moeinipour * Pages 469-473
    Introduction
    Postoperative bleeding in cardiac surgery is not an uncommon complication and can be evaluated with surgical and nonsurgical causes. Although any type of coagulopathy should be treated before, during, and after the surgical procedure, cardiac surgeons should have perfect surgical techniques for step by step hemostasis to minimize blood loss.
    Materials and Method
    This retrospective study was conducted on 85 patients out of 1075 (0.07%) ones required Reexploration of the Mediastinal to control the excessive bleeding after different cardiac procedures in Imam Reza Hospital in Mashhad of Iran from January 2018 to January 2019.
    Results
    Out of 85 patients who required Mediastinal Reexploration, 61 (71%) and 24(29%) patients underwent the off-pump procedure and cardiopulmonary bypass, respectively. The most common sites for surgical bleeding in the order were missed branches of left internal mammary artery / saphenous vein graft (65%), proximal or distal coronary anastomosis (18%), and aortic /atrial suture line (16%). The death in patients under study was 7 (8%), half of which were not related to Mediastinal Reexploration.
    Conclusion
    The possibility of postoperative bleeding can be minimized through correction of clotting factor deficiencies, improvement of surgical techniques in hemostasis.
    Keywords: Cardiac Surgery, CABG, Postoperative Bleeding
  • Rajkamal Vishnu, Guruprasad Rai *, Arvind Bishnoi, Ganesh Sevagur, Pranav Balakrishnan, Yogesh Gaude, Navin Patil, Lokvendra Budania Pages 474-483
    INTRODUCTION- Cardiovascular disease has emerged as a major health burden worldwide with coronary artery disease [CAD] causing highest mortality and morbidity. Coronary revascularization is the preferred treatment for patients with multivessel CAD. Based on the application of cardiopulmonary bypass [CPB], Coronary revascularization can be on-pump [OPCAB] or off-pump [CABG].The CPB is known to have multifactorial effects on all end-organ functions due to nonpulsatile flow and inflammation response. Renal function alteration is one of the multiple deleterious effects. There have been reports on superior renal function using off-pump CABG . The present study aimed to investigate and compare the prevalence of renal dysfunction in the two techniques [OPCAB versus CABG].METHODS- This was a single-center retrospective study conducted with the data from 199 patients categorized into two groups of off-pump [n=106] and on-pump [n=93]. Renal parameters were monitored on the days 0, 1, 3, 5 after the operation using Glomerular Filtration Rate [GFR]. Creatinine clearance [CrCl] of patients with diabetes, hypertension, both diabetes and hypertension, and normal patients was also correlated.RESULTS- Two groups of on-pump and off-pump were combined and classified according to Propensity Score. Renal functions were compared between the two groups no significant difference in renal function between the off-pump and on-pump groups.CONCLUSION-In the present study, there were no significant differences between the two techniques in renal outcomes. Both groups shared an almost similar change of trends in renal functions.
    Keywords: Acute renal failure, Coronary Artery Disease, Cardiopulmonary Bypass, glomerular filtration rate, Creatinine clearance
  • Ahmad Separham, Masoud Nouri, Mehdi Maleki Pages 484-490
    Introduction

    Although left anterior descending (LAD) artery supplies a large portion of the myocardium, the amount of blood supply provided by LAD is depended on the length of the LAD. The aim of the current study was to evaluate the association between coronary artery dominance and LAD anatomic types in patients with normal epicardial coronary arteries.

    Methods

    This retrospective study was conducted at a tertiary teaching hospital on a total of 252 patients with normal coronary artery angiographic findings between April 2018 to March 2019. Patient’s medical records were utilized to collect demographic and catheterization data, as well as their clinical characteristics. Qualitative and quantitative catheterization data, including the anatomical type of LAD, dominance, LAD slow flow phenomenon, LAD ectasia, and Muscle Bridge were obtained from the angiographic examination. The three anatomical LAD types, including type I (LAD terminating before the apex), type II (LAD reached the apex), and type III (LAD wrapping around the apex) were compared in the left and right dominant coronary artery patients.

    Results

    The mean age of patients was 58.06±10.89 years (age range: 27-79 years). The slow flow phenomenon was more significantly observed in patients with type C LAD (P=0.015); however, there was no significant difference between LAD types regarding LAD Muscle Bridge (P=0.099) and ectasia (P=0.810). In total, 54.8% and 45.2% of the patients had right and left dominant coronary artery systems, respectively. Moreover, there was a statistically significant association between wrap-around LAD and left coronary artery dominance (P<0.001).

    Conclusion

    The type C LAD is more prevalent in patients with left dominant coronary artery.

    Keywords: Coronary Circulation, Coronary Angiography, Left Anterior Descending Artery, Left Coronary Dominancy
  • Shima Ghahremani, Esmat Asaei, Mahmoud Shabestari, Majid Jalalyazdi * Pages 491-498
    Introduction
    Rivaroxaban is a new anticoagulant medication for pulmonary thromboembolism (PTE) and deep vein thrombosis (DVT). There are limited data on the effect of body mass index (BMI) on the pharmacokinetics of rivaroxaban. This study aimed to assess the effect of rivaroxaban on coagulation assays in relation to BMI in PTE and DVT patients.
    Materials and Methods
    the present cohort studywas conducted on patients with DVT and PTE who were planned to receive rivaroxaban (15 mg bid). Demographic characteristics, as well as anthropometric measurements, were recorded before the rivaroxaban administration. Prothrombin time (PT), partial thromboplastin time (PTT), and international normalized ratio (INR) were measured before and after 4-6 days of treatment with rivaroxaban. The data were analyzed using paired t-test and analysis of covariance in SPSS software, version 20 (IBM Inc., Chicago, Il, USA)
    Results
    This study was carried out on 100subjects (i.e., 45 males and 55 females) with the mean age of 38.8±1.7 years. The majority of the subjects (68%) had normal creatinine clearance. The results of the research revealed a significant increase in PT, PT, and INR after the administration of rivaroxaban in both normal-weight and obese subjects (P40 years), gender, and creatinine clearance (i.e., normal and abnormal) groups (P
    Conclusion
    The findings of this study indicated a significant increase in coagulation assays in both normal weight and obese subjects; however, the final PT increment was reduced by BMI.
    Keywords: Blood coagulant assays, Rivaroxaban, Deep Vein Thrombosis, Pulmonary Thromboembolism
  • Varuna Jethani, Rashmi Jindal, Shirazi Nadia, Rakhee Sodhi * Pages 499-502

    Anti-tuberculosis medications can cause various side effects, including drug rash. When a patient on anti-tuberculosis treatment (ATT) develops rash, we usually stop all medicines, rechallenge the patient with medications individually, and find the offending agent. It should be mentioned that drug rash can be also a manifestation of other diseases. Herein, we report a case of tuberculosis who developed rash while on ATT regimen but was later diagnosed to be concomitantly suffering from leprosy.

    Keywords: Anti-Tuberculosis Medications, rash, leprosy
  • Rakhee Sodhi *, Suchita Pant, Varuna Jethani, Shirazi Nadia, Mamta Aggarwal, Sushant Khanduri Pages 503-506
    Chronic cough and chest pain should be dealt seriously in a young adult. Sometimes we may miss a diagnosis in such patients. We present a case of Pulmonary Langerhans Histiocytosis who presented with complaints of cough and chest pain
    Keywords: Chronic Cough, Chest pain, young male
  • Reza Bagheri * Pages 507-508
    A 16-year-old female with a history of neck hemangioma surgery presented with irritable coughs. A computed tomography scan showed anterosuperior and middle mediastinal masses (Figure 1). The patient underwent surgery and the upper and middle mediastinal lesions were removed (Figure 2A). Pathological examination confirmed that the upper and middle mediastina contained hemangioma  (Figure 2B) and pericardium cyst (Figure 2C)
    Keywords: Cysts, mediastinum, Chest X-ray