Multidisciplinary Cardiovascular Annals
Volume:3 Issue: 2, May 2011

Complete Atrioventricular Septal Defect (CAVSD) is a congenital heart disease treated by surgical repair. There are two strategies for surgery: 1) Primary repair at lower ages (one-stage repair). 2) PA banding in lower age and then completerepair after normalization of PAP (Two-stage repair).The purpose of this study was comparison of mortality rate and short term complications of these two strategies. Patients and This Cohort study covered 90 patients by CAVSD from a single center that underwent surgical repair from September, 2005 to October 2010. Forty seven patients operated by one-stage repair and 43 patients by two-stage method. Patients were compared based on preoperative data (age, sex, weight, Down’s syndrome, Pulmonary Artery Pressure”PAP” and Preoperative EF) intraoperative data (data of Pulmonary Artery “PA” banding, CPB time and aortic cross clamp time) post operative data (post op EF, residual septal defects, residual AV valve regurgitation, ICU stay time and tracheal intubation time) short term complications (Pulmonary complications, bleeding, CHB) and hospital mortality rate. There were no significant differences among two groups concerning age, sex, weight, PAP and Preoperative EF. Failure rate of PA banding was 9.4% in two stage group.CPB time and aortic cross clamp time in one- stage repair were significantly lower than two-stage repair (P=0, P=0.002). ICU stay and tracheal intubation time in one-stage repair were significantly lower than two-stage repair (P=0, P=0).There were no significant differences among the two groups concerning post operative EF, and residual septal defects. Severe TR was higher in two-stage repair group (P=0.016). Pulmonary complications were lower in one-stage repair group.The. hospital mortality rate in one-stage repair was 6.4% and in two-stage repair was 16.3% (P=0.136). The risk factors for mortality were increased CPB time and aortic cross clamp time. This study demonstrated that one-stage primary repair of CAVSD is a safe method with lower mortality rate and short term complications than two-stage repair and it can be considered as the preferable strategy in CAVSD repair in lower ages.

The quality of myocardial protection during Coronary Artery Bypass Grafting (CABG) has a direct effect on post-operative cardiac function, recovery and complications. The optimal route for delivery of cardioplegia is still in debate in patients with ischemic heart disease. This prospective randomized clinical study was designed to assess and compare the use of combined antegrade-retrograde cardioplegia versus antegrade cardioplegia in providing adequate myocardial preservation during coronary artery bypass graft surgery. A total number of 150 patients that underwent CABG between 2009 and 2010 were assigned randomly into two groups according to myocardial protection technique; 75patients were randomly assigned to receive antegrade cold blood cardioplegia (group A) and the other 75 patients received combined antegrade retrograde cold blood cardioplegia (groupA/R). This prospective randomized study compared clinical, echocardiographic, markers of myocardial damage, morbidity and mortality in two groups. The two randomization groups had similar demographic characteristics. The number of grafted coronary arteries averaged 3.2±0.4 in group A and 3.3±0.4 in group A/R. Total duration of cardiopulmonary bypass (64.1±23.2 and 66.3±16 minutes) and aortic cross-clamping (36.9± 13.7 and 34.6±8.6 minutes) were similar in both groups. There was one death in group A and one in group A/R, for a global early mortality of 1.3%. The cause of death was free wall LV rupture in group A and respiratory failureand pneumonia in group A/R. Release of total creatine kinase, creatine kinase–MB and troponin T were not significantly different (p > 0.05) between the two groups. The number of postoperative myocardial infarction (12% versus 8%), the need for inotropic support (17.3% versus 12%), the need for IABP (2.7% versus 1.3%), postoperative arrhythmias (4% in each groups) were similar in both groups (P>0.05). Reexploration, stroke, pulmonary complication, renal failure and wound infections also were similar (P>0.05). Our results indicate suggest that the retrograde cardioplegia administration essentially does not improve myocardial protection during the first operation for isolated coronary revascularization compared with the usual antegrade route. The data indicate that in this non-risk-stratified group of patients, the route of cardioplegia administration is not a determinant of clinical outcome.

We would report the results of 112 mechanical valve replacements in the position of pulmonary valve during 6 years in the Rajaie Heart Center. Between March 2004 and September 2010, 246 patients underwent pulmonary valve replacement for a congenital heart defect. In 112 cases (45.5%) a mechanical valve was implanted in the pulmonary position. These 112 patients were the subject of our retrospective descriptive study. All cases were followed on a predetermined regular interval in our center (2 weeks, 3 & 6 months post-operatively and then every six months). Special attention was paid to RV function and prosthetic valvular performance by trans-thoracic and/or trans-esophageal echocardiography. Statistical analyses were performed using SPSS software (version 19). All data are presented as mean values ±standard deviation (SD) or percentages. The x2 test or the Fisher's exact test was used for the comparison of categorical variables. Student's Ttest or Wilcoxon's signed rank tests were used for the comparison of parametric and non-parametric variables, respectively. Any P value of less than 0.05 was considered statistically significant. Mean age: 21.8±9.06 yrs (Range: 3.5-58 yr). They consisted of 82 (73.2%) male and 30 (26.8%) female. TF was the most common basic lesion in 89 patients (86.4%). Mean time of follow-up was 27.27±16.16 months, (Range: 6-72 months). Mean duration of ICU and hospital stay was 3.17±3.14 days & 10.12±6.13 days, respectively. A positive past history of Gore-Tex shunt was present in 21 (18.8%) and in 9 patients (8%) PVR was their first operation without prior history of any intervention. Dyspnea on exertion was the most common presenting symptom (82, 73.2%). Severe PI associated with RV-dysfunction was the most common indication for PVR. Ironically in 6 patients (5.4%), PVR was performed due to degeneration of previous biologic valve in the pulmonary position. Most patients had moderate RV dysfunction before operation (44, 39.3%).

IntroductionClopidogrel treatment is associated with a reduction in thrombotic complications in coronary stent placement, improved outcome after acute coronary syndromes and decreased mortality in patients with coronary artery disease. The purpose of this study was to analyze the effect of preoperative clopidogrel exposure on bleeding complications, blood transfusion requirement and reoperations and ICU and ward stay and mediastinitis in patients undergoing coronary artery bypass grafting (CABG).This study included 82 patients from a single institution (Shahid Rajaie Hospital) that underwent an isolated CABG who were discharged 2010. The cohort of 82 patients was classified into 2 groups. The control group consisted of 46 patients that did not receive clopidogrel or stopped 5 days before surgery but were treated with aspirin and clopidogrel group consisted of 36 patients that were taking clopidogrel within 5 days of surgery. Patients were compared based on preoperative data (age, gender, use of clopidogrel, ejection fraction), intraoperative data (cross clamp & CPB time) and postoperative data (chest tube output, rate of reoperation, units of transfused blood length of stay in the intensive care unit and ward).There were no significant differences among 2 groups concerning age, sex and ejection fraction. There were no differences in length of intensive care unit and ward stay among 2 groups. Patients in clopidogrel group had more units of platelet transfusion than the control group (P=0.001). There is also a non significant trend toward more chest tube output in clopidogrel group compared with the control group, the mean chest tube output in clopidogrel group was 1185±850 ml and in control group was 1020±590 ml (P=0.305). 7 patients of the total group required reoperation secondly to bleeding, 5 patients in clopidogrel group (13.9%) and 2 patients (4.3%) in control group but was not significant statistically (P=0.125).This study demonstrated that clopidogrel within 5 days preoperatively increases the requirement for platelet transfusion and packed cell transfusion only in clopidogrel group that needed reoperation for hemostasis. The reoperation rate of patients that took clopidogrel within 5 days of their procedure was not different from reoperation rate of the patients that did not take clopidogrel. Our results dont support the recent history of clopidogrel treatment associated with increased blood loss. Transfusion and reoperation was required after CABG.

Although pulmonary artery banding (PAB) seems to be a technically simple procedure it presents several peculiarities and is related to a significant morbidity and mortality. We lack information on this procedure in our center. Seventy patients who were randomly allocated into two groups underwent anesthesia by Total IV anesthesia, midazolam, fentanyl and atracurim and, in end of surgery each group received morphine sulfat 0.2 mg/kg after arrived in ICU, morphin PCA was started with demand (bolus) dose 1mg, lockout interval 10 minutes. The Tramadol group after separated from cardiopulmonary bypass received an intra operative initial loading dose of Tramadol (1mg/kg) and a postoperative infusion of Tramadol at 0.2 mg• kg-1• h-1. The control group received an intra operative equivalent volume of normal saline and a postoperative saline infusion (placebo). The demographic data of both groups were the same. Post-operative data were recorded in the cardiac intensive care unit at 30 min, 1 h, 2 h, 4 h, 12 h and 24 h after extubation by the same anesthesiologist, who had no knowledge of the groups, and the side-effects were also evaluated.From January 2003 to December 2009, 100 patients underwent PAB due to congenital heart disease with increased pulmonary blood flow at Imam Reza hospital. They were assessed as for hospital mortality and complications.WWe found no improvement in the hospital mortality of pulmonary artery banding. These results will support the preference for primary repair of intracardiac anomalies in small infants

Delayed sternal closure (DSC) has been shown to be useful following cardiac surgeries in case of indications including hemodynamic instability, noticeable myocardial edema, respiratory compromise, stubborn bleeding, placement of extracorporeal support device,and persistent arrhythmias. In this review, we summarize the investigations on this topic to analyze the controversial aspects of DSC in pediatrics and adults. Med-Line systematic review of the relevant literatures, which hase been published through 1970-2010, was performed. A total of 191 studies were identified, 62 of which were eventually deemed relevant to this review. According to proper indications, DSC has been used in several types of cardiac surgeries in pediatric (newborns, infants and children) and adult cardiac surgeries in recent 35 years. The outcomes concerning survival and complications seem to be acceptable. DSC is more frequent in pediatric cardiac surgery rather than adult cardiac surgery. DSC is an effective and safe strategy in patients with appropriate indications. Surgeons should be aware of its suitable use and also physiologic alterations and management of the patients when the sternum is still open. Several previous investigations showed wide variations in methods of DSC by institutions. Apparent differences in post-operative care of the patients with DSC clarify the demand for planning prospective multicenter trials with available control groups which can result in the implementation of standardized supervision protocols across institutions

We hypothesize that concomitant tricuspid annuloplasty in patients with tricuspid annular dilatation who undergo mitral valve repair could prevent progression of tricuspid regurgitation and right ventricular remodeling. In 2002, 80 patients underwent mitral valve repair. Concomitant tricuspid annuloplasty was performed in 13 patients with grade 3 or 4 tricuspid regurgitation. In 2004, 102 patients underwent mitral valve repair. Concomitant tricuspid annuloplasty was performed in 21 patients with grade 3 or 4 tricuspid regurgitation and in 43 patients with an echocardiographically determined tricuspid annular diameter of 40 mm or greater. Patients underwent transthoracic echocardiographic analysis preoperatively and at the 2-year follow-up. In the 2002 cohort right ventricular dimensions did not decrease (right ventricular long axis, 69 ± 7 vs 70 ± 8 mm; right ventricular short axis, 29 ± 7 vs 30 ± 7 mm); tricuspid regurgitation grade and gradient remained unchanged. In the 2004 cohort right ventricular reverse remodeling remodeling was observed (right ventricular long axis, 71 ± 6 vs 69 ± 9 mm; right ventricular short axis, 29 ± 5 vs 27 ± 5mm; P <. 0001); tricuspid regurgitation diminished (1.6 ± 1.0 vs 0.9 ± 0.6, P <. 0001), and transtricuspid gradient decreased (28 ± 13 vs 23 ± 15 mm Hg, P =. 021). Subanalysis of the 2002 cohort showed that in 23 patients without grade 3 or 4 tricuspid regurgitation but baseline tricuspid annular dilatation, the degree of tricuspid regurgitation was worse atthe 2-year follow-up. Moreover, this caused right ventricular dilatation. Subanalysis of the 2004 cohort demonstrated reverse right ventricular remodeling and decreased tricuspid regurgitation in 43 patients with preoperative tricuspid annular dilatation who underwent tricuspid annuloplasty. Concomitant tricuspid annuloplasty during mitral valve repair should be considered in patients withtricuspid annular dilatation despite the absence of important tricuspid regurgitation at baseline because this improves echocardiographic outcome.

Cardiac Echinococcosis is a rare and the most serious of all Hydatid manifestation. We report here the case of 12 year old boy who had Hydatid Cyst in the liver, lung, left ventricle & inter ventricular septum. The patient underwent cardiac surgery after 2 months medical therapy with Albendazole.

Congenital rubella syndrome (CRS) has a wide variety of severe systemic complications. Cardiovascular defects have always been a part of the rubella syndrome. Patent ductus arteriosus (PDA) remains the most frequent cardiac anomaly. It may occur alone or accompany other heart defects. Pulmonary stenosis and septal defects have been noted with greater frequency since the earlier reports. The classic triad is hearing impairment, heart defect, and cataract. Here we report an infant girl with classic presentations of CRS. We discuss about her malformations and compared them with other combination of manifestations in the literature.