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Rotational Atherectomy Before Stenting in the Body of a Saphenous Vein Graft
Paul Charbel,
Joe Shaffu,
Nadine Kaoukabani,
Pierrette Habib
Issue:
Volume 5, Issue 1, January 2019
Pages:
1-5
Received:
20 January 2019
Accepted:
25 February 2019
Published:
16 March 2019
Abstract: Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicated by the manufacturer, and has only been reported in few cases in the literature. We report a case of a calcified, non-dilatable, distal saphenous vein graft to Circumflex lesion in a heart failure patient presenting with Non STEMI. The lesion was just proximal to the anastomosis and could not be crossed. Because of high surgical risk, and against manufacturer guidelines, rotational atherectomy of the lesion was performed and was successful with a very good angiographic result. Rotational atherectomy to facilitate percutaneous interventions in saphenous vein graft lesions is feasible, and could be attempted in experienced centers provided the absence of luminal thrombus or dissection.
Abstract: Management of stenosis of saphenous vein grafts in Coronary artery bypass graft (CABG) patients remains challenging despite the advance in interventional cardiology techniques. Rotational atherectomy is an adjunctive technique used in certain anatomical conditions in native coronary arteries; its use in saphenous vein graft is still contra-indicate...
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Right Heart Failure in Young People in Emerging Countries Is Most Commonly Secondary to Tuberculous Constrictive Pericarditis
Charbel Naim,
Simon Bejjani,
Omar Boustros,
Moussa Abi Ghanem,
Nader Wansa,
Pierrette Habib,
Nadine Kawkabani,
Roula Darwish,
Paul Charbel,
Bassam Abou Khalil
Issue:
Volume 5, Issue 1, January 2019
Pages:
6-11
Received:
9 December 2018
Accepted:
25 December 2018
Published:
10 April 2019
Abstract: Constrictive pericarditis is a rare disease with a challenging diagnosis and treatment. Tuberculous pericarditis accounts to 1-2% of the cases in the United States, but is the most common cause in other countries. We report a 17-year-old male presenting with right heart failure. His initial work up that included an Electrocardiogram, chest roentgenogram and echocardiogram suspected constrictive pericarditis. Right heart catheterization and cardiac MRI confirmed the diagnosis. Total Pericardiectomy was performed. Tissue PCR showed tuberculous pericarditis and the patient was treated with anti-tuberculous drugs for 9 months. Tuberculosis is a common cause of constrictive pericarditis especially in developing countries, whereas in developed countries most cases are idiopathic. To note that the diagnosis of tuberculous pericarditis can be difficult especially in negative PPD patients However It remains a common cause of constrictive pericarditis in some parts of the world where a high index of suspicion is requested. The treatment is curative and thus an aggressive approach in diagnosis and treatment is indicated.
Abstract: Constrictive pericarditis is a rare disease with a challenging diagnosis and treatment. Tuberculous pericarditis accounts to 1-2% of the cases in the United States, but is the most common cause in other countries. We report a 17-year-old male presenting with right heart failure. His initial work up that included an Electrocardiogram, chest roentgen...
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Early Outcomes of Arterial Switch Operation Performed at a New Pediatric Cardiology Center in Mumbai
Bhadra Trivedi,
Prasanna Salvi,
Manish Chokhandre,
Naveed Khan,
Ameya Mandrekar,
Suresh Joshi
Issue:
Volume 5, Issue 1, January 2019
Pages:
12-17
Received:
24 January 2019
Accepted:
28 March 2019
Published:
13 April 2019
Abstract: Introduction: The transposition of great arteries (TGA) is one of the main causes of neonatal or early infancy open heart surgeries in pediatric cardiology. The ASO is preferred over the Atrial switch when suitable as the left ventricle remains the systemic ventricle and there are fewer incidences of postoperative arrhythmias. Method: It’s a retrospective review of the early surgical outcomes of arterial switch operation performed at the department of pediatric cardiology at Wockhardt Hospital, Mumbai Central, Mumbai from August 2014 to August 2017. Results: During the specified period, a total of 22 children were admitted to the hospital for ASO for TGA. The average age of the patient was 78 days. The mean weight of the children was 3.35 kg and height was 52.5 cm. Discussion: The early outcome of arterial switch operation at our center is as good as the other well-established centers. The surgical outcome of ASO remained consistent over the last two and a half year. The policy of our institution is to optimize the patients prior to the surgery, may need BAS if the children are of TGA with intact ventricular septum with restricted atrial level shunt group. Conclusion: The review shows the early results of postoperative cases of arterial switch operation from a new center are as encouraging as from the other high volume centers.
Abstract: Introduction: The transposition of great arteries (TGA) is one of the main causes of neonatal or early infancy open heart surgeries in pediatric cardiology. The ASO is preferred over the Atrial switch when suitable as the left ventricle remains the systemic ventricle and there are fewer incidences of postoperative arrhythmias. Method: It’s a retros...
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Massive Chylothorax Following Gunshot Injury to the Left Supraclavicular Region: Case Report and Literature Review
Abubakar Umar,
Salisu Ismail,
Abdullahi Abdulkarim Aitek,
Aliyu Abdulrahman,
Galadima Ibrahim,
Maishanu Moyijo
Issue:
Volume 5, Issue 1, January 2019
Pages:
18-20
Received:
24 December 2018
Accepted:
21 January 2019
Published:
8 May 2019
Abstract: Chylothorax is defined as accumulation of chyle in the pleural space. Various aetiologies have been identified. Direct injury to the thoracic duct following gunshot injury is rare. When it occurs close to the point of entry into the confluence of the internal jugular and subclavian veins, it can lead to massive chylothorax with devastating consequences. A case of gunshot to the root of the neck with massive chylothorax with haemodynamic instability is hereby presented.
Abstract: Chylothorax is defined as accumulation of chyle in the pleural space. Various aetiologies have been identified. Direct injury to the thoracic duct following gunshot injury is rare. When it occurs close to the point of entry into the confluence of the internal jugular and subclavian veins, it can lead to massive chylothorax with devastating conseque...
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Continuous Cardiac Doppler of the Fetus Guiding an Aortic Valve Replacement in an Eighteen Weeks Pregnant Woman with Active Endocarditis
Nadine Kawkabani,
Roula Darwish,
Moussa Abi Ghanem,
Simon Bejjani,
Omar Boustros,
Rawad Halimeh,
Joe Khalifeh,
Assaad Maalouf,
Bassam Abou Khalil,
Elie Anastasiades
Issue:
Volume 5, Issue 1, January 2019
Pages:
21-25
Received:
8 February 2019
Accepted:
19 March 2019
Published:
15 May 2019
Abstract: Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to decrease fetal morbidity and mortality such as tepid to normothermic cardiopulmonary bypass, good oxygenation, high hematocrit, pulsatile flow, alpha stat management, mean arterial pressure around 70mmhg and a pump flow above 2.4l/min. They recommend also a close monitoring of the fetal heart rate, uteroplacental blood flow and uterine contractions We report in this paper, the case of a 26 year old pregnant female who underwent at 18 weeks an aortic valve replacement. Severe fetal bradycardia occurred 30 min after going on bypass lasted for 20 min and was refractory to a further increase in pump flow, mean arterial pressure and hematocrit. The fetal heart rate returned to its baseline only after rewarming the patient to 35.5 degrees Celsius. The post-operative course was uneventful and a close follow up revealed a normal fetal status. At 38 weeks the mother delivered a healthy normal baby girl. Since fetal bradycardia occurred despite respecting all the recommendations and only reversed after rewarming the mother to 35.5 degrees Celsius, we would suggest not lowering the temperature during cardiopulmonary bypass below 35.5 degrees in pregnant patients undergoing cardiac procedures. Thus more reports and papers are mandatory in order to further elucidate the factors responsible of the adverse events that occur in such cases.
Abstract: Two percent of pregnant women experience some type of cardiac pathologic disease. In some cases surgery becomes mandatory to save the mother’s life. The maternal mortality rate in pregnant women undergoing open heart procedures is around 2.9% while the fetal mortality rate ranges between 9.5 to 29%. Many papers have advanced measures in order to de...
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