Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological ou... more Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological outcomes in patients undergoing CABG. Methodology: This prospective double blinded observational study of patientsundergoing CABG, at Cardiac Surgery department, Punjab Institute of Cardiology,Lahore Pakistan, was conducted from January 2011 to November 2011.Preoperatively urea, creatinine, ultrasound kidney, X-Ray abdomen and CarotidDoppler study was performed. Postoperatively RIFLE criteria was used for AcuteRenal Injury. Patients with neurological deficit and seizures underwent CT andEEG. Data was analyzed by using SPSS 20. P 0.05 was considered assignificant. Results: Total number of patients included were 115. Co morbid conditions foundin patients with high MAP and PP were hypertension (34.8%; p=0.612),diabetes mellitus (39.1%; p=0.305), obesity (65.2%; p= 0.001) and COPD(21.7%; p=0.001). Acute Kidney injury was in patients with pulse pressurebetween 31-40 mmHg & mean arterial pressure between 71-90 mmHg. The onlyassociation of ARI was found with hypertension (p=0.050). Stroke, RIND, TIA,coma and seizures had no association with pulse pressure <30mmHg and Meanarterial pressure of <70mmHg. Conclusion: For post CABG patients MAP and PP are good markers for theneurological deficit but not for renal disease. Key Words: Mean Arterial Pressure, Pulse Pressure, Neurological Deficit, RenalDisease, CABG
Background: Early surgery is indicated for ventricular septal rupture (VSR) that develops after m... more Background: Early surgery is indicated for ventricular septal rupture (VSR) that develops after myocardial infarction (MI). Surgical repair carries a high mortality. The purpose of this study was to find out the in hospital outcome of the surgical repair of this complication at a tertiary care high volume centre. Methods and Results: A retrospective descriptive study was done by checking the hospital record of all those patients who had undergone surgical repair of post myocardial infarction ventricular septal rupture from January 2008 to August 2014. The hospital ethical committee gave permission for the study. All the patients underwent identical surgical procedure for the repair of septal rupture. Perioperative variables were recorded and descriptive statistics obtained. A total of 40 such patients were identified including 24 (60%) male and 16 (40%) female patients with a mean age of 55.4±10.7 years. Intra-aortic balloon pump was used in 27 (62.5%) patients preoperatively. Nine out of 40 patients were operated within 2 weeks of the occurrence of VSR. While 23 (57.5%) were operated after the 3 weeks of VSR. Six out of 9 patients died who were operated within 2 weeks. One out of 23 patients died who presented after 3 weeks duration after post MI VSR. Coclusion: Still a large number of patients suffer from post MI VSR in our setup. Surgical treatment carries high mortality especially those operated within first week. Patch repair of the ventricular septal is an acceptable treatment strategy for both anterior and posterior located septal ruptures.
Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological ou... more Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological outcomes in patients undergoing CABG. Methodology: This prospective double blinded observational study of patientsundergoing CABG, at Cardiac Surgery department, Punjab Institute of Cardiology,Lahore Pakistan, was conducted from January 2011 to November 2011.Preoperatively urea, creatinine, ultrasound kidney, X-Ray abdomen and CarotidDoppler study was performed. Postoperatively RIFLE criteria was used for AcuteRenal Injury. Patients with neurological deficit and seizures underwent CT andEEG. Data was analyzed by using SPSS 20. P 0.05 was considered assignificant. Results: Total number of patients included were 115. Co morbid conditions foundin patients with high MAP and PP were hypertension (34.8%; p=0.612),diabetes mellitus (39.1%; p=0.305), obesity (65.2%; p= 0.001) and COPD(21.7%; p=0.001). Acute Kidney injury was in patients with pulse pressurebetween 31-40 mmHg & mean arterial pressure between 71-90 mmHg. The onlyassociation of ARI was found with hypertension (p=0.050). Stroke, RIND, TIA,coma and seizures had no association with pulse pressure <30mmHg and Meanarterial pressure of <70mmHg. Conclusion: For post CABG patients MAP and PP are good markers for theneurological deficit but not for renal disease. Key Words: Mean Arterial Pressure, Pulse Pressure, Neurological Deficit, RenalDisease, CABG
OBJECTIVE:To find out the frequency of phrenic nerve injury in our patients undergoing heart valv... more OBJECTIVE:To find out the frequency of phrenic nerve injury in our patients undergoing heart valve surgeries (mitral, aortic & tricuspid, in any combination)
Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an... more Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an uncommon site for cardiac Myxoma. We present a case of an 18 years old girl who presented to us with history of shortness of breath, abdominal distension, leg swelling, palpitations and dizziness for two months. On Echocardiography there was a large pedunculated mass attached to tricuspid valve. She underwent surgical excision of the mass. Biopsy confirmed the Myxoma. In conclusion, Myxoma originating from tricuspid valve are rare tumours which can cause tricuspid valve obstruction and right heart failure symptoms due to their location. In these cases shortness of breath, embolisation and symptoms of venous congestion are commonly observed. Key Words: Case report, Myxoma, right heart, cardiac CT, tricuspid valve. Continuous...
Objective: To evaluate the effect of intravenous magnesium, on prevention of postoperative cardia... more Objective: To evaluate the effect of intravenous magnesium, on prevention of postoperative cardiac arrhythmias after open cardiac surgery.
Background and Objectives: The use of IABP is helpful for haemodynamic stability of patients with... more Background and Objectives: The use of IABP is helpful for haemodynamic stability of patients with low cardiac output and compromised left ventricular function in patients who undergo coronary artery bypass grafting. This procedure is also associated with some vascular complications due to the insertion of IABP. The objective of this research was to study the vascular complications in patients with IABP counterpulsation. We observed the clinical outcome of these patients with special reference to post IABP complications in our research. Methods: One hundred and six consecutive patients were included in this study from August 2005 to February 2007. Mean age of patients was 58.08±1.814 years. Seventy nine patients (74.5%) were male and 29 (25.5%) were females. Out of these 106 patients, 101 were operated for CABG, one for angina due to aortic stenosis, two patients had ischemic mitral regurgitation and one patient had post infarct VSD. In 102 (96.2%) patients IABP was inserted percutaneously, one patient received transthoracic and in three patients IABP was inserted with open technique. Thirteen (12.3%) patients received IABP with sheath and 93 (87.7%) received IABP without sheath. Results: Ten patients (9.4%) out of 106 developed vascular complications due to insertion of IABP. Seven patients (6.6%) had the major complications and 3 (2.8%) patients developed minor vascular complications. Mortality due to vascular complications in 106 patients was 8.49% with p<0.005. Conclusion: IABP has remarkable beneficial effects in patients with haemodynamic instability due to myocardial ischemia and low cardiac output syndrome. At the same time IABP is related to significant morbidity and mortality related to vascular complications due to its insertion which include limb ischemia, limb loss and even mortality.
Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological ou... more Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological outcomes in patients undergoing CABG. Methodology: This prospective double blinded observational study of patientsundergoing CABG, at Cardiac Surgery department, Punjab Institute of Cardiology,Lahore Pakistan, was conducted from January 2011 to November 2011.Preoperatively urea, creatinine, ultrasound kidney, X-Ray abdomen and CarotidDoppler study was performed. Postoperatively RIFLE criteria was used for AcuteRenal Injury. Patients with neurological deficit and seizures underwent CT andEEG. Data was analyzed by using SPSS 20. P 0.05 was considered assignificant. Results: Total number of patients included were 115. Co morbid conditions foundin patients with high MAP and PP were hypertension (34.8%; p=0.612),diabetes mellitus (39.1%; p=0.305), obesity (65.2%; p= 0.001) and COPD(21.7%; p=0.001). Acute Kidney injury was in patients with pulse pressurebetween 31-40 mmHg & mean arterial pressure between 71-90 mmHg. The onlyassociation of ARI was found with hypertension (p=0.050). Stroke, RIND, TIA,coma and seizures had no association with pulse pressure <30mmHg and Meanarterial pressure of <70mmHg. Conclusion: For post CABG patients MAP and PP are good markers for theneurological deficit but not for renal disease. Key Words: Mean Arterial Pressure, Pulse Pressure, Neurological Deficit, RenalDisease, CABG
Background: Early surgery is indicated for ventricular septal rupture (VSR) that develops after m... more Background: Early surgery is indicated for ventricular septal rupture (VSR) that develops after myocardial infarction (MI). Surgical repair carries a high mortality. The purpose of this study was to find out the in hospital outcome of the surgical repair of this complication at a tertiary care high volume centre. Methods and Results: A retrospective descriptive study was done by checking the hospital record of all those patients who had undergone surgical repair of post myocardial infarction ventricular septal rupture from January 2008 to August 2014. The hospital ethical committee gave permission for the study. All the patients underwent identical surgical procedure for the repair of septal rupture. Perioperative variables were recorded and descriptive statistics obtained. A total of 40 such patients were identified including 24 (60%) male and 16 (40%) female patients with a mean age of 55.4±10.7 years. Intra-aortic balloon pump was used in 27 (62.5%) patients preoperatively. Nine out of 40 patients were operated within 2 weeks of the occurrence of VSR. While 23 (57.5%) were operated after the 3 weeks of VSR. Six out of 9 patients died who were operated within 2 weeks. One out of 23 patients died who presented after 3 weeks duration after post MI VSR. Coclusion: Still a large number of patients suffer from post MI VSR in our setup. Surgical treatment carries high mortality especially those operated within first week. Patch repair of the ventricular septal is an acceptable treatment strategy for both anterior and posterior located septal ruptures.
Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological ou... more Objectives: To observe the impact of bothMAPand PP for the postoperative renaland neurological outcomes in patients undergoing CABG. Methodology: This prospective double blinded observational study of patientsundergoing CABG, at Cardiac Surgery department, Punjab Institute of Cardiology,Lahore Pakistan, was conducted from January 2011 to November 2011.Preoperatively urea, creatinine, ultrasound kidney, X-Ray abdomen and CarotidDoppler study was performed. Postoperatively RIFLE criteria was used for AcuteRenal Injury. Patients with neurological deficit and seizures underwent CT andEEG. Data was analyzed by using SPSS 20. P 0.05 was considered assignificant. Results: Total number of patients included were 115. Co morbid conditions foundin patients with high MAP and PP were hypertension (34.8%; p=0.612),diabetes mellitus (39.1%; p=0.305), obesity (65.2%; p= 0.001) and COPD(21.7%; p=0.001). Acute Kidney injury was in patients with pulse pressurebetween 31-40 mmHg & mean arterial pressure between 71-90 mmHg. The onlyassociation of ARI was found with hypertension (p=0.050). Stroke, RIND, TIA,coma and seizures had no association with pulse pressure <30mmHg and Meanarterial pressure of <70mmHg. Conclusion: For post CABG patients MAP and PP are good markers for theneurological deficit but not for renal disease. Key Words: Mean Arterial Pressure, Pulse Pressure, Neurological Deficit, RenalDisease, CABG
OBJECTIVE:To find out the frequency of phrenic nerve injury in our patients undergoing heart valv... more OBJECTIVE:To find out the frequency of phrenic nerve injury in our patients undergoing heart valve surgeries (mitral, aortic & tricuspid, in any combination)
Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an... more Amongst the benign cardiac tumors atrial Myxomas are commonest. Tricuspid valve attachment is an uncommon site for cardiac Myxoma. We present a case of an 18 years old girl who presented to us with history of shortness of breath, abdominal distension, leg swelling, palpitations and dizziness for two months. On Echocardiography there was a large pedunculated mass attached to tricuspid valve. She underwent surgical excision of the mass. Biopsy confirmed the Myxoma. In conclusion, Myxoma originating from tricuspid valve are rare tumours which can cause tricuspid valve obstruction and right heart failure symptoms due to their location. In these cases shortness of breath, embolisation and symptoms of venous congestion are commonly observed. Key Words: Case report, Myxoma, right heart, cardiac CT, tricuspid valve. Continuous...
Objective: To evaluate the effect of intravenous magnesium, on prevention of postoperative cardia... more Objective: To evaluate the effect of intravenous magnesium, on prevention of postoperative cardiac arrhythmias after open cardiac surgery.
Background and Objectives: The use of IABP is helpful for haemodynamic stability of patients with... more Background and Objectives: The use of IABP is helpful for haemodynamic stability of patients with low cardiac output and compromised left ventricular function in patients who undergo coronary artery bypass grafting. This procedure is also associated with some vascular complications due to the insertion of IABP. The objective of this research was to study the vascular complications in patients with IABP counterpulsation. We observed the clinical outcome of these patients with special reference to post IABP complications in our research. Methods: One hundred and six consecutive patients were included in this study from August 2005 to February 2007. Mean age of patients was 58.08±1.814 years. Seventy nine patients (74.5%) were male and 29 (25.5%) were females. Out of these 106 patients, 101 were operated for CABG, one for angina due to aortic stenosis, two patients had ischemic mitral regurgitation and one patient had post infarct VSD. In 102 (96.2%) patients IABP was inserted percutaneously, one patient received transthoracic and in three patients IABP was inserted with open technique. Thirteen (12.3%) patients received IABP with sheath and 93 (87.7%) received IABP without sheath. Results: Ten patients (9.4%) out of 106 developed vascular complications due to insertion of IABP. Seven patients (6.6%) had the major complications and 3 (2.8%) patients developed minor vascular complications. Mortality due to vascular complications in 106 patients was 8.49% with p<0.005. Conclusion: IABP has remarkable beneficial effects in patients with haemodynamic instability due to myocardial ischemia and low cardiac output syndrome. At the same time IABP is related to significant morbidity and mortality related to vascular complications due to its insertion which include limb ischemia, limb loss and even mortality.
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