Multidisciplinary Cardiovascular Annals
Volume:2 Issue: 3, Dec 2008

Constrictive pericarditis (C.P) demonstrates a heterogeneous pattern and has different aetiologies depending on the geographic areas of reported pericarditis. Today in the western hemisphere radiation and previous cardiac surgery have become important causes of CP, but it seems that Tuberculosis is still a common cause of C.P in developing countries.Method Material: We reviewed the records of 45 patients with mean age of 46.6 years (21-84 yr.) and the diagnosis of CP who underwent pericardiectomy between1994-2006. Preoperatively 4.5% were in New York Heart Association (NYHA) Class I, 45.5% in class II, 47.7% in class III & 2.3% in class IV. Pericardial calcification was seen in 21% of plain chest X-rays. The mean follow up period was 40+/-18 months (3-144 month). Postoperatively, only 15.6% of patients were in NYHA class III and the rest were in class I (18.2%) or II (66.2%), (P<.001).The etiologic factors were Tuberculosis in 22.2%, chronic renal failure in 8.8%, post-sternotomy in 4.5% and malignancies in 4.5%. The cause of C.P was idiopathic in 60%. Low output state was the most common postoperative problem (22.3%). The overall mortality was 4.4%. There was one in-hospital death due to respiratory insufficiency in a tuberculosis patient and one patient died due to metastatic adenocarcinoma during follow up period. We conclude that tuberculosis, despite vaccination programs and anti-tubercular medications is still an important cause of chronic CP at least in our area. Pericardiectomy is an effective treatment of chronic CP because it provides an important and durable improvement in symptoms and functional status with low mortality.

The objective of our study was to assess early post operative patency and anatomy of CABGs using retrospectively ECG gated MDCT and correlation between the amount of calcium scoring and early coronary graft occlusion and also retrospective correlation between Calcium scoring and coronary artery disease. 65 patients (43 men, 12 women) who underwent CABG in Shahid Rajaii heart hospital were included in this study. The time interval between the CABG surgery and imaging protocol was less than l month.We used ECG gated 10 detector CTA (slice thickness 0.6 mm, rotation 500ms), for detection the relation between coronary calcium score and early SVG graft occlusion. The threshold of 130 Hounsfield units was set to identify calcifications by Agatston method.Results and The sensitivity and the specificity of calcification for severe stenosis (>75%) were 85% and 40%, respectively. we did not find any correlation between coronary calcium scoring and early SVG graft occlusion(pv=0.6).

the minimally invasive endoscopic dissection of vessel conduits is steadily gaining acceptance as a preferable alternative to the standard open-incision technique.. As experience and refinements in instrumentation progress, the endoscopic approach will undoubtedly become the procedure of choice for harvesting vessel conduits. This article provides a practical primer, based on our serial experience with endoscopic vein dissections, for those considering the minimally invasive endoscopic approach inharvesting vessels for CABG. Video-assisted endoscopic technique for vein harvest was introduced in our medical center in" august 2007". The procedure was evaluated and compared with the standard open vein harvest procedure with regard to primary short - term outcomes:1) leg wound complications (identified as dehiscence, drainage for greater than 2 weeks postoperatively, cellulitis, hematoma, and seroma/lymphocele and neurologic complications). 2) Short-term event free survival(focused on any cardiac events, 30 days after CABG) between August 2007 and May2008. we prospectively randomized 150 patients scheduled for elective CABG to vein harvesting via EVH and OVH. We used ClearGlide vessel harvesting system, Datascope corp, to harvest the greater saphenous vein. The groups were similar with regard to age, risks for wound complications (diabetes,sex,obesity,peripheral vascular disease), bypass time, the length of vein harvested (EVH:40±15cm vs.OVH:45±15cm) p=0.65,and total number of grafts(168 vs 175)p =0.4we randomized 150 patients schaduled for elective CABG to vein harvesting via EVH(n=75) or OVH(n=75). Average operation time was177 min in OVH group.In EVH group operation time increased approximately 45 min ±20 for the first 50 cases,but later,it didn’t realy influence the time.. In EVH group 5 patients were converted to OVH due to anatomical or device issues.The prevalence of leg complications was 4% vs 18.6% for EVH and OVH groups respectively (p=0.007), and for local infection 0% vs 12% p <0.0001.Short term event-free survival(1mo follow up) is 94.7% vs 93.4% p=0.85.consistent with earlier findings, wound complications and outpatient office visits to manage each complication, was significantly reduced following EVH compared with OVH.The use of small access incisions and well-designed endoscopic instrumentation to harvest the saphenous vein would be expected to provide cosmetically superior outcomes compared with a single long, open incision. This study also suggested that coduit quality, may not differ as a result of the EVH technique.

In 1925, Clausen identified the accumulation of lactic acid in blood as a cause of acid-base disorder. Several decades later, Huckabee's seminal work firmly established that lactic acidosis frequently accompanies severe illnesses and that tissue hypoperfusion underlies the pathogenesis. In their classic 1976 monograph, Cohen and Woods classified the causes of lactic acidosis according to the presence or absence of adequate tissue oxygenation.The normal blood lactate concentration in unstressed patients is 0.5-1 mmol/L. Patients with critical illness can be considered to have normal lactate concentrations of less than 2 mmol/L. Hyperlactatemia is defined as a mild-to-moderate persistent increase in blood lactate concentration (2-5 mmol/L) without metabolic acidosis, whereas lactic acidosis is characterized by persistently increased blood lactate levels (usually >5 mmol/L) in association with metabolic acidosis (pH < 7.35).1,2 Lactic acidosis is associated with major metabolic dysregulation, tissue hypoperfusion, effects of certain drugs or toxins, or congenital abnormalities in carbohydrate metabolism. Cohen and Woods divided lactic acidosis into 2 categories: “type A”, associated with impaired delivery of oxygen to tissues (DO2) eg, hypotension, cyanosis, cool and clammy extremities, and “type B”, where lactic acidosis occurs in the presence of normal DO2

Far from being a muni or a yogi, many years have passed since I have lost all the desire to write medical articles for medical journals. Along with this several other desires have also died in me. The following is a peripatetic discourse, not a formal paper, on sildenafil, in response to a request repeated several times by a close Friend of Old Times, Dr M.A.Youssefnia, now a prominent cardiac surgeon at several hospitals, president of the Cardiac Surgeon’s Society, and many other professional organizations.The imitation of the occidental methods, including “publish or perish” motto, has driven the underdeveloped world to the brink of insanity and chaos, with a mushrooming of many sham journals, seminars, conventions, workshops etc, etc most of which are ruminations of works already published, or mock imitation of original research works, with a premeditated, selective “publish or perish “effect at local levels.Now having vanished from the field, I am immune to perishing. Therefore the response of the author to his close friend’s request is neither a paper, nor a research report. It is simply a soliloquy.

The purpose of this study was to report our 19-year experience in redo surgery for failure of mitral valve repair (MVRep) in degenerative disease. From 1987 to 2006, 43 consecutive patients (32 males) underwent either redo MVRep (n = 21) or redo mitral valve replacement (n = 22) for failure of MVRep. Age ranged from 10 to 78 years (median, 59 years). Forty-one patients (95%) had grade 3+ or greater mitral regurgitation, and 3 patients had chronic systolic anterior motion of the anterior leaflet of the mitral valve. Repair was mainly performed using Carpentier's techniques. There was no perioperative death in the MVRep group and 2 deaths in the redo mitral valve replacement group. In univariate analysis, long-term survival was significantly superior in the MVRep group compared with redo mitral valve replacement (p = 0.011). There were three reoperations (14%) in the MVRep group for recurrent severe mitral regurgitation. One patient (5%) in the redo mitral valve replacement group underwent reoperation for prosthetic endocarditis. The 7-year freedom from reoperation rate was 95% (95% confidence interval, 84% to 99%) in both groups. At the latest follow-up, 16 (94%) patients in the MVRep group were in New York Heart Association I or II functional status. Fifteen (88%) had no or mild mitral regurgitation on echocardiography. Two patients (12%) presented with moderate (2+) mitral regurgitation. In case of failure of MVRep for severe degenerative mitral valve disease, re-repair is feasible in about 50% of the patients with encouraging results at 7 years.

A 48 years old male who was reffered to us for coronary artery bypass graft,was scheduled for surgery and during the operation it was found that the patient is suffering from Takayasu arteritis. Patient had no suitable left internal thoracic artery for revascularizaton, so, saphenous veins and off-pump coronary artery by pass graft were used for revascularization. The case is presented below and the cardiac manifestations and challenges in these patients is discussed.

We present a 35 years old man with diagnosis of a free floating clot in his inferior vena cava, extended to right side of heart after an electrophysiological study for evaluation of supra ventricular tachycardia. Because of high probability of pulmonary embolism, surgical intervention was chosen and conducted successfully.