BackgroundTracheal stenosis following prolonged intubation is a relatively rare but serious probl... more BackgroundTracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome.ResultsThis study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guide...
Journal of Clinical and Medical Images, Case Reports
Due to the rarity of retained intra-cardiac sewing needles, no clear guidelines exist regarding t... more Due to the rarity of retained intra-cardiac sewing needles, no clear guidelines exist regarding the indication for their extraction. In this study we report a case of a sewing needle extracted from the right atrium of an adult female presenting with recurrent pericardial effusion after one year of accidental penetration.
Background: Among the complications noted after debanding is those related to residual pulmonary ... more Background: Among the complications noted after debanding is those related to residual pulmonary stenosis. Removal of band without repairing pulmonary artery could be enough. Others recommend patching pulmonary artery at the site of band during debanding because of possibility of residual gradient caused by a residual shelf or narrowing and distortion of the arterial wall. This may necessitate re-operation especially if it leads to pressure overload on the right ventricle. Objective: To compare between simple band removal and band removal with pulmonary artery repair using pericardial patch, at time of debanding; concerning early postoperative pressure gradients across the main pulmonary artery. Patients and methods: This retrospective observational study included 40 patients who underwent pulmonary artery debanding in the period between January 2016 and January 2020 at the Cardiothoracic Surgery Department, Cairo University hospitals and Atfal Masr Hospital. Patients were divided into two groups; group A, which included 20 patients who underwent simple band removal and group B, which included 20 patients who underwent pulmonary artery debanding with pericardial patch repair. Results: The median pressure gradient across the main pulmonary artery postoperatively was 15 mm Hg for group A (mean 22.58±18.0) and 10 mm Hg for group B (mean 11.3±8.0) with statistically significant value (p=0.020). 40.0% of cases in Group A had significant residual pressure gradient compared to only 10.0% of cases in Group B, and that difference was statistically significant (p=0.028). The median pressure gradient across the band immediate preoperatively was 60mmHg for group A (mean 62.0±9.8) and 70mmHg (mean 64.2±10.6) with statistically insignificant value (p=0.065). Conclusion: Pulmonary artery repair with pericardial patch showed the advantage of reducing the risk of significant residual pressure gradient across the band site over simple band removal in pulmonary artery debanding.
Article information Background: Surgical glue [synthetic cyanoacrylic glue] is a sealant material... more Article information Background: Surgical glue [synthetic cyanoacrylic glue] is a sealant material used in treatment of persistent air leak in primary, secondary and recurrent spontaneous pneumothorax after repair of bronco pleural fistula by synthetic sutures as polypropylene or polydioxanone materials. The aim of the work: We aimed to evaluate the effect of surgical glue in treatment of cases of persistent air leak after surgical repair in comparison to surgical repair only. Patients and Methods: A retrospective analysis was performed of 21 patients who underwent surgery for persistent air leak at our department in Al Zahra and Dar Elhekma hospital from May 2015 to December 2018 where age ranges from 32 to 55 and they were 4 females and 17 males, surgical glue used in a group of patients [group A] and another patients as a comparison group without using the glue [group B].11 patients were treated by excision of blebs or bullae with closure of feeding bronchus by synthetic sutures with application of surgical glue and 10 patients were treated by excision only without application of glue. Results: Thoracotomy done in all patients via posterolateral thoracotomy. Operative time, chest tube removal, and hospital stay were significant in group A versus group B. Superficial wound infection in one case in group A without mortality in both groups, one case of persistent air leak and 4 cases of recurrent pneumothorax within two years of follow up in group B. Conclusion: Use of surgical glue [sealant] applied in reducing air leak associated with spontaneous pneumothorax and in recurrent pneumothorax was safe and effective.
Background There is now extension of minimally invasive techniques to involve concomitantly aorti... more Background There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium. Methods Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients. Results The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm3 and 1.3 ± 0.8 unit...
Introduction:In this study, we share our experience in the Warden procedure for the repair of par... more Introduction:In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years.Patients and methods:In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study.Results:In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) coul...
Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be assoc... more Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome. Patients and methods 184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases. Results There were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output whic...
Background Functional tricuspid valve regurgitation due to left sided valve lesions remains a com... more Background Functional tricuspid valve regurgitation due to left sided valve lesions remains a common finding. Nowadays, different types of three-dimensional rings and flexible bands are considered to be the gold standard techniques for repair of such functional regurgitation. Our study aimed for long-term comparison of the durability and effectiveness of those techniques. Results The data of 170 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid 3D rings (contour 3D or MC3 ring) or prosthetic fashioned bands (Dacron or PTFE) and mitral valve surgery between March 2013 and September 2018 were collected and analysed. Patients were classified in two matched groups: ring group (group A) consisting of 90 cases and band group (group B) consisting of 80 cases. follow-up period ranged from 55.2 to 78 months (mean 67.2 ± 10.8), during this period New York heart association f...
Background: Dilated left ventricle occurs in chronic aortic and mitral regurgitations. We describ... more Background: Dilated left ventricle occurs in chronic aortic and mitral regurgitations. We describe the early outcome of mitral and aortic valve replacement for patients with severely dilated left ventricle in different surgical interventions. Methods: From March 2014 to December 2018, 620 patients with left ventricular end-diastolic diameter (LVEDD) of ≥ 70 mm underwent valve replacement procedures in 8 cardiac surgery centers in Egypt. One hundred ninety four cases (31.3%) underwent aortic valve replacement, 173 cases (27.9%) underwent mitral valve replacement, 123 cases (19.9%) underwent double valve replacement, 59 cases (9.5%) underwent double valve replacement with either tricuspid valve repair or replacement, 33 cases (5.3%) underwent mitral valve replacement with either tricuspid valve repair or replacement, 20 cases (3.2%) underwent mitral valve replacement with CABG, 10 cases (1.6%) underwent aortic valve replacement with CABG, while 8 cases (1.3%) underwent aortic valve re...
Background: Ventricular septal defect (VSD) is the most common congenital heart disease, and cond... more Background: Ventricular septal defect (VSD) is the most common congenital heart disease, and conduction disorder is one of the frequent complications after VSD closure. Suturing technique used for VSD closure may affect the occurrence of this complication. The aim of this study was to compare the outcome of VSD surgical patch closure using continuous versus interrupted suture techniques. Methods: The study included 150 VSD patients who had surgical patch closure between December 2014 and March 2017. They were subclassified into two groups according to the suture technique; continuous suture technique (n= 75) and interrupted suture technique (n= 75). Preoperative, operative, and postoperative variables were reviewed and analyzed. The postoperative rhythm was recorded using contіnuous electrocardiogram during intensive care unit stay. 12-leads electrocardiogram and echocardiography were performed immediately after surgery and repeated before discharge and after 3, 6, 12 months then ye...
Background: In this study, we evaluate different annuloplasty modalities to repair functional tri... more Background: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation. Patients and methods: Between January 2011 and January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C). Results: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation – mean vena contracta and mean jet area – significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incom...
World Journal for Pediatric and Congenital Heart Surgery, 2019
Background: Catheter-based interventions for treating congenital cardiac defects have gained wide... more Background: Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. Methods: Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. Results: There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during b...
Objectives: The optimal management of rheumatic moderate mitral regurgitation in cases with sever... more Objectives: The optimal management of rheumatic moderate mitral regurgitation in cases with severe aortic stenosis remains not well defined and it is frequently not corrected as it is claimed to improve after AVR and prompt myocardial remodeling. We evaluated the effectiveness and outcome impact of repaired mitral valve on clinical and echocardiographic parameters of the patient over follow-up of six-month duration. Methods: This prospective comparable study was conducted between January 2016 and June 2018 in Egypt (Department of Cardiothoracic Surgery, Cairo University, and other open heart surgery centers). One hundred and thirty patients diagnosed with severe aortic stenosis and moderate rheumatic mitral regurgitation was involved in the study. Half of them (Group A) were offered aortic valve replacement and mitral valve repair with a remodeling ring annuloplasy, and the other half were offered aortic valve replacement only. Preoperative, intraoperative, postoperative, and at six-month post-surgery follow-up echocardiography was done as well as clinical correlation assessment. We excluded patients with echocardiographic evidence of mitral valve apparatus pathology (rheumatic or non-rheumatic) necessitating its replacement. Also patients with associated moderate-to-severe tricuspid valve regurgitation requiring concomitant repair or replacement were excluded. We also did not involve patients with concomitant coronary artery disease as well as those having aortic aneurysms or dissections necessitating intervention. Results: Patients of both groups had properly-matching preoperative demographic data. Mean age was 40.34 ± 6.81 years in group A and 43.60 ± 6.53 in group B. Male patients represented 61.53% in group A and 53.84% for group B. Group A involved 48 (73.84%) patients in NYHA class III classification; versus 51 (78.46%) patients in group B. Mean preoperative LVEF% was 60.2 ± 5.1% for group A patients; versus 61.6 ± 7.5% for group B patients. Echocardiographic data obtained in the early postoperative and at 6-months follow-up were compared with the preoperative profile. We had the sum of 5 patients (3.84%) mortality in both groups. All patients expressed improvement of clinical symptoms of mitral regurgitation at time of hospital discharge. And at 6-months evaluation, clear statistical significance emerged where patients of group A had significant improvement of mitral regurgitation degree (improved in 75.38% compared to 50.77% of group B patients), significant improvement of MR jet area (3.91 ± 0.8 cm 2 compared to 4.78 ±0.9 cm 2 in group B patients), and significant improvement of NYHA class (21.53% of group A in NYHA class I compared to none in group B, 78.46 % of group A compared to 46.15 % of group B in NYHA class II and 53.84% of group B remained in NYHA class III compared to none in group A). Conclusion: The presence of moderate rheumatic mitral regurgitation in patients who undergo aortic valve replacement for severe aortic stenosis does not affect the immediate postoperative or early (6-months) follow-up outcome. However, statistically significant differences were found between both groups concerning the regression of the Moderate Rheumatic MR and improvement of the MR jet area; which reflects the effect of concomitant mitral valve repair on improving both the outcome of Moderate Rheumatic MR and the clinical status of the patients. However, operative parameters were statistically significant i.e. total operative time, total bypass time and total cross clamp time between both groups. Thus, patients with LV dysfunction should be considered carefully for this option selection. We recommend considering a procedure addressing the rheumatic mitral valve with moderate regurgitation in the setting of AVR for severe AS with great concern to those with a worse preoperative left ventricular profile.
International Journal of Cardiovascular and Thoracic Surgery, 2019
Background: Due to their unfavorable outcome, patients with impaired left ventricular function un... more Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.
Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary ve... more Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome. Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included. Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardi...
Indian Journal of Thoracic and Cardiovascular Surgery, 2018
Diaphragmatic hernias following cardiac surgeries in general are being reported after coronary ar... more Diaphragmatic hernias following cardiac surgeries in general are being reported after coronary artery bypass grafting using the right gastro-epiploic artery as a conduit as well as in patients with ventricular assist devices, orthotopic heart transplants, or subxiphoid epicardial pacemakers. We report a case of an iatrogenic diaphragmatic hernia following pulmonary artery banding operation through median sternotomy which was discovered 4 years later during the debanding and ventricular septal defect closure operation. The diaphragm was most likely injured during insertion of the retro-sternal tube during the first operation.
Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve ... more Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve endocarditis included patients with aortic and/or mitral valve prostheses. Here, we concentrate on isolated prosthetic mitral endocarditis due to heterogeneity of epidemiological data, anatomical factors, and surgical techniques between mitral, prosthetic mitral, and aortic endocarditis between prosthetic mitral and prosthetic aortic endocarditis. Methods Data of 40 patients reoperated upon due to isolated prosthetic mitral endocarditis between July 2015 and March 2017 were retrospectively collected and analyzed. Results Independent predictors of major postoperative complications on multivariate analysis were: no blood cultures before referral (odds ratio 6.36, 95% confidence interval: 1.44-28.15), inadequate response to medical treatment (odds ratio 11.38, 95% confidence interval: 1.29-100.25), and serum creatinine ≥2.0 mg·dL (odds ratio 4.56, 95% confidence interval: 1.07-19.36). Indep...
General thoracic and cardiovascular surgery, Jan 27, 2018
Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a... more Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma. The patient gave a history of endometriosis followed by the appearance of a low-grade ovarian endometrioid stromal sarcoma 4 years before the development of the mass in the IVC and right atrium.
We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a ... more We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a male infant with Down syndrome, who also had a perimembranous ventricular septal defect. Through a median sternotomy, the hernia sac was freed from the right pleura, and the pericardium was opened to reduce its contents (colon) into the abdomen. The diaphragmatic defect was closed with Prolene mesh and the hernia sac was used to reinforce the diaphragmatic defect. Finally, the pericardium was opened and the ventricular septal defect was closed with a polytetrafluoroethylene patch through a right atriotomy after instituting cardiopulmonary bypass.
Background Tricuspid valve (TV) endocarditis may be associated with serious complications, and 25... more Background Tricuspid valve (TV) endocarditis may be associated with serious complications, and 25% of patients require surgical intervention. However, indications and outcomes of surgery are not clearly identified. In this study, 60 patients are retrospectively reviewed to determine preoperative predictors of surgical outcome. Patients and Methods Sixty patients with isolated TV endocarditis who underwent surgery in the period between January 2012 and December 2016 are reviewed retrospectively from the medical records of Cairo University Hospitals. Forty-two (70%) patients were males, and 18 (30%) were females with a mean age of 29.3 ± 10.6 years. Eleven patients had an underlying cardiac lesion, and 27 patients were intravenous (IV)-drug addicts. Results TV repair could be done in nine (15%) patients, and the rest received TV replacement with biological valves. Twenty-four (40%) patients experienced postoperative complications. On multivariate analysis, a vegetation size >2.2 cm...
BackgroundTracheal stenosis following prolonged intubation is a relatively rare but serious probl... more BackgroundTracheal stenosis following prolonged intubation is a relatively rare but serious problem. This condition is usually managed by surgical or endoscopic interventions. Bronchoscopic balloon dilatation for tracheal stenosis is considered a valuable tool used for the management of tracheal stenosis. In this article, we try to evaluate the role of balloon tracheoplasty in the management of tracheal stenosis and to assess the number of dilatation sessions usually needed as well as the short to midterm outcome.ResultsThis study involved 40 patients with tracheal stenosis diagnosed by computed tomography (neck and chest) and bronchoscopy at the Security Force Hospital in Riyadh, KSA, between January 2013 and August 2018. Patients’ data were retrospectively reviewed and analyzed. Patients’ age ranged between 18 and 60 years. Thirty patients were males (75%); those patients underwent balloon tracheoplasty via dilatation of areas of narrowing using catheter balloon insufflation guide...
Journal of Clinical and Medical Images, Case Reports
Due to the rarity of retained intra-cardiac sewing needles, no clear guidelines exist regarding t... more Due to the rarity of retained intra-cardiac sewing needles, no clear guidelines exist regarding the indication for their extraction. In this study we report a case of a sewing needle extracted from the right atrium of an adult female presenting with recurrent pericardial effusion after one year of accidental penetration.
Background: Among the complications noted after debanding is those related to residual pulmonary ... more Background: Among the complications noted after debanding is those related to residual pulmonary stenosis. Removal of band without repairing pulmonary artery could be enough. Others recommend patching pulmonary artery at the site of band during debanding because of possibility of residual gradient caused by a residual shelf or narrowing and distortion of the arterial wall. This may necessitate re-operation especially if it leads to pressure overload on the right ventricle. Objective: To compare between simple band removal and band removal with pulmonary artery repair using pericardial patch, at time of debanding; concerning early postoperative pressure gradients across the main pulmonary artery. Patients and methods: This retrospective observational study included 40 patients who underwent pulmonary artery debanding in the period between January 2016 and January 2020 at the Cardiothoracic Surgery Department, Cairo University hospitals and Atfal Masr Hospital. Patients were divided into two groups; group A, which included 20 patients who underwent simple band removal and group B, which included 20 patients who underwent pulmonary artery debanding with pericardial patch repair. Results: The median pressure gradient across the main pulmonary artery postoperatively was 15 mm Hg for group A (mean 22.58±18.0) and 10 mm Hg for group B (mean 11.3±8.0) with statistically significant value (p=0.020). 40.0% of cases in Group A had significant residual pressure gradient compared to only 10.0% of cases in Group B, and that difference was statistically significant (p=0.028). The median pressure gradient across the band immediate preoperatively was 60mmHg for group A (mean 62.0±9.8) and 70mmHg (mean 64.2±10.6) with statistically insignificant value (p=0.065). Conclusion: Pulmonary artery repair with pericardial patch showed the advantage of reducing the risk of significant residual pressure gradient across the band site over simple band removal in pulmonary artery debanding.
Article information Background: Surgical glue [synthetic cyanoacrylic glue] is a sealant material... more Article information Background: Surgical glue [synthetic cyanoacrylic glue] is a sealant material used in treatment of persistent air leak in primary, secondary and recurrent spontaneous pneumothorax after repair of bronco pleural fistula by synthetic sutures as polypropylene or polydioxanone materials. The aim of the work: We aimed to evaluate the effect of surgical glue in treatment of cases of persistent air leak after surgical repair in comparison to surgical repair only. Patients and Methods: A retrospective analysis was performed of 21 patients who underwent surgery for persistent air leak at our department in Al Zahra and Dar Elhekma hospital from May 2015 to December 2018 where age ranges from 32 to 55 and they were 4 females and 17 males, surgical glue used in a group of patients [group A] and another patients as a comparison group without using the glue [group B].11 patients were treated by excision of blebs or bullae with closure of feeding bronchus by synthetic sutures with application of surgical glue and 10 patients were treated by excision only without application of glue. Results: Thoracotomy done in all patients via posterolateral thoracotomy. Operative time, chest tube removal, and hospital stay were significant in group A versus group B. Superficial wound infection in one case in group A without mortality in both groups, one case of persistent air leak and 4 cases of recurrent pneumothorax within two years of follow up in group B. Conclusion: Use of surgical glue [sealant] applied in reducing air leak associated with spontaneous pneumothorax and in recurrent pneumothorax was safe and effective.
Background There is now extension of minimally invasive techniques to involve concomitantly aorti... more Background There is now extension of minimally invasive techniques to involve concomitantly aortic and mitral valves through a single small incision. We share our experience in such surgeries through upper partial sternotomy with approaching the mitral valve through the dome of the left atrium. Methods Two matched groups of cases receiving concomitant aortic and mitral valve surgeries are compared regarding the surgical outcomes: the minimally invasive group (group A) including 72 patients and the conventional group (group B) including 78 patients. Results The mean age was 52 ± 8 years in group A and 53 ± 7 years in group B. Males represented (42%) in group A and (49%) in group B. The mean mechanical ventilation time was significantly shorter in group A (4.3 ± 1.2 hours) than in group B (6.1 ± 0.8 hours) with a p-value of 0.001. In addition, the amount of chest tube drainage and the need for blood transfusion units were significantly less in group A (250 ± 160 cm3 and 1.3 ± 0.8 unit...
Introduction:In this study, we share our experience in the Warden procedure for the repair of par... more Introduction:In this study, we share our experience in the Warden procedure for the repair of partial anomalous pulmonary venous connections (PAPVCs) draining high in the superior caval vein in 65 cases of the paediatric age group over a period of 10 years.Patients and methods:In total, 65 patients receiving the Warden procedure for the repair of high PAPVCs (draining above the cavoatrial junction) over a period of 10 years starting from January, 2010 to January, 2020 were included in this study.Results:In total, 34 were males (52.3%) and 31 were females (47.7%). The mean age was 3.47 ± 1.4 years, while the mean weight was 17.3 ± 5.3 kilograms. The mean bypass time was 84.2 ± 13.9 minutes and the mean cross clamp time was 54.8 ± 12.9 minutes. The mean intensive care unit stay was 2.14 ± 0.89 days, while the mean hospital stay was 5.9 ± 1.4 days. There was no in-hospital mortality or persistent sinus node dysfunction necessitating permanent pacemaker. In total, 62 patients (95%) coul...
Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be assoc... more Background Mitral valve stenosis in adults especially due to rheumatic heart disease may be associated with a smaller than normal left ventricular cavity. Mitral valve replacement in such cases may lead to hemodynamic instability either during weaning from cardiopulmonary bypass or in the early postoperative period manifested by the need for inotropic support and even mortality due to low cardiac output syndrome. Patients and methods 184 patients with predominately severe stenotic mitral valves who underwent elective isolated mitral valve replacement in the period between January 2012 and January 2018 at our hospital were included in this study. Patients were divided into 2 matched groups; (small LV group) consisting of 86 cases and (normal or dilated LV group) consisting of 98 cases. Results There were no statistically significant differences in operative details among both groups apart from the need for inotropic support and intra-aortic balloon pump due to low cardiac output whic...
Background Functional tricuspid valve regurgitation due to left sided valve lesions remains a com... more Background Functional tricuspid valve regurgitation due to left sided valve lesions remains a common finding. Nowadays, different types of three-dimensional rings and flexible bands are considered to be the gold standard techniques for repair of such functional regurgitation. Our study aimed for long-term comparison of the durability and effectiveness of those techniques. Results The data of 170 adult patients with moderate or more functional tricuspid regurgitation secondary to mitral stenosis or regurgitation receiving tricuspid valve repair using either rigid 3D rings (contour 3D or MC3 ring) or prosthetic fashioned bands (Dacron or PTFE) and mitral valve surgery between March 2013 and September 2018 were collected and analysed. Patients were classified in two matched groups: ring group (group A) consisting of 90 cases and band group (group B) consisting of 80 cases. follow-up period ranged from 55.2 to 78 months (mean 67.2 ± 10.8), during this period New York heart association f...
Background: Dilated left ventricle occurs in chronic aortic and mitral regurgitations. We describ... more Background: Dilated left ventricle occurs in chronic aortic and mitral regurgitations. We describe the early outcome of mitral and aortic valve replacement for patients with severely dilated left ventricle in different surgical interventions. Methods: From March 2014 to December 2018, 620 patients with left ventricular end-diastolic diameter (LVEDD) of ≥ 70 mm underwent valve replacement procedures in 8 cardiac surgery centers in Egypt. One hundred ninety four cases (31.3%) underwent aortic valve replacement, 173 cases (27.9%) underwent mitral valve replacement, 123 cases (19.9%) underwent double valve replacement, 59 cases (9.5%) underwent double valve replacement with either tricuspid valve repair or replacement, 33 cases (5.3%) underwent mitral valve replacement with either tricuspid valve repair or replacement, 20 cases (3.2%) underwent mitral valve replacement with CABG, 10 cases (1.6%) underwent aortic valve replacement with CABG, while 8 cases (1.3%) underwent aortic valve re...
Background: Ventricular septal defect (VSD) is the most common congenital heart disease, and cond... more Background: Ventricular septal defect (VSD) is the most common congenital heart disease, and conduction disorder is one of the frequent complications after VSD closure. Suturing technique used for VSD closure may affect the occurrence of this complication. The aim of this study was to compare the outcome of VSD surgical patch closure using continuous versus interrupted suture techniques. Methods: The study included 150 VSD patients who had surgical patch closure between December 2014 and March 2017. They were subclassified into two groups according to the suture technique; continuous suture technique (n= 75) and interrupted suture technique (n= 75). Preoperative, operative, and postoperative variables were reviewed and analyzed. The postoperative rhythm was recorded using contіnuous electrocardiogram during intensive care unit stay. 12-leads electrocardiogram and echocardiography were performed immediately after surgery and repeated before discharge and after 3, 6, 12 months then ye...
Background: In this study, we evaluate different annuloplasty modalities to repair functional tri... more Background: In this study, we evaluate different annuloplasty modalities to repair functional tricuspid regurgitation. Patients and methods: Between January 2011 and January 2017, 200 patients with moderate or greater functional tricuspid regurgitation received tricuspid valve repair as part of primary surgeries on the left side of their cardiac valves. Of these, 39 patients received rings (Group A), 84 patients received bands (Group B), and 77 patients received suture annuloplasty (Group C). Results: Two patients from Group C were operated on again, during the primary hospital stay due to severe symptomatic tricuspid regurgitation. The degrees of early postoperative tricuspid regurgitation – mean vena contracta and mean jet area – significantly were higher in Group C. During a mean follow-up period of 26 ± 12.6 months, 5 patients within Group C (6.85%) and one patient in Group B (1.3%) were operated on again with tricuspid valve replacement due to severe symptomatic tricuspid incom...
World Journal for Pediatric and Congenital Heart Surgery, 2019
Background: Catheter-based interventions for treating congenital cardiac defects have gained wide... more Background: Catheter-based interventions for treating congenital cardiac defects have gained wide acceptance as they reduce the risks associated with surgery. However, these procedures are associated with some complications, such as the embolization of devices or stents and the injury of surrounding structures, which might need a rescue surgical intervention. Methods: Data from 25 patients who needed rescue surgery following interventional catheterization between January 2008 and January 2018 were retrospectively collected and statistically analyzed to review the decision and timing of surgery as well as the surgical techniques and results. Results: There were 24 cases of rescue surgery after device embolization, including 9 cases of atrial septal defect closure, 8 cases of patent ductus arteriosus closure, 4 cases of pulmonary artery balloon dilatation with stenting, 3 cases of muscular ventricular septal defect closure, and 1 case of right ventricular outflow tract injury during b...
Objectives: The optimal management of rheumatic moderate mitral regurgitation in cases with sever... more Objectives: The optimal management of rheumatic moderate mitral regurgitation in cases with severe aortic stenosis remains not well defined and it is frequently not corrected as it is claimed to improve after AVR and prompt myocardial remodeling. We evaluated the effectiveness and outcome impact of repaired mitral valve on clinical and echocardiographic parameters of the patient over follow-up of six-month duration. Methods: This prospective comparable study was conducted between January 2016 and June 2018 in Egypt (Department of Cardiothoracic Surgery, Cairo University, and other open heart surgery centers). One hundred and thirty patients diagnosed with severe aortic stenosis and moderate rheumatic mitral regurgitation was involved in the study. Half of them (Group A) were offered aortic valve replacement and mitral valve repair with a remodeling ring annuloplasy, and the other half were offered aortic valve replacement only. Preoperative, intraoperative, postoperative, and at six-month post-surgery follow-up echocardiography was done as well as clinical correlation assessment. We excluded patients with echocardiographic evidence of mitral valve apparatus pathology (rheumatic or non-rheumatic) necessitating its replacement. Also patients with associated moderate-to-severe tricuspid valve regurgitation requiring concomitant repair or replacement were excluded. We also did not involve patients with concomitant coronary artery disease as well as those having aortic aneurysms or dissections necessitating intervention. Results: Patients of both groups had properly-matching preoperative demographic data. Mean age was 40.34 ± 6.81 years in group A and 43.60 ± 6.53 in group B. Male patients represented 61.53% in group A and 53.84% for group B. Group A involved 48 (73.84%) patients in NYHA class III classification; versus 51 (78.46%) patients in group B. Mean preoperative LVEF% was 60.2 ± 5.1% for group A patients; versus 61.6 ± 7.5% for group B patients. Echocardiographic data obtained in the early postoperative and at 6-months follow-up were compared with the preoperative profile. We had the sum of 5 patients (3.84%) mortality in both groups. All patients expressed improvement of clinical symptoms of mitral regurgitation at time of hospital discharge. And at 6-months evaluation, clear statistical significance emerged where patients of group A had significant improvement of mitral regurgitation degree (improved in 75.38% compared to 50.77% of group B patients), significant improvement of MR jet area (3.91 ± 0.8 cm 2 compared to 4.78 ±0.9 cm 2 in group B patients), and significant improvement of NYHA class (21.53% of group A in NYHA class I compared to none in group B, 78.46 % of group A compared to 46.15 % of group B in NYHA class II and 53.84% of group B remained in NYHA class III compared to none in group A). Conclusion: The presence of moderate rheumatic mitral regurgitation in patients who undergo aortic valve replacement for severe aortic stenosis does not affect the immediate postoperative or early (6-months) follow-up outcome. However, statistically significant differences were found between both groups concerning the regression of the Moderate Rheumatic MR and improvement of the MR jet area; which reflects the effect of concomitant mitral valve repair on improving both the outcome of Moderate Rheumatic MR and the clinical status of the patients. However, operative parameters were statistically significant i.e. total operative time, total bypass time and total cross clamp time between both groups. Thus, patients with LV dysfunction should be considered carefully for this option selection. We recommend considering a procedure addressing the rheumatic mitral valve with moderate regurgitation in the setting of AVR for severe AS with great concern to those with a worse preoperative left ventricular profile.
International Journal of Cardiovascular and Thoracic Surgery, 2019
Background: Due to their unfavorable outcome, patients with impaired left ventricular function un... more Background: Due to their unfavorable outcome, patients with impaired left ventricular function undergoing CABG surgery (LVEF ≤ 35%) are in a real need for optimization of their preoperative status in order to achieve the best possible results. In this retrospective comparative study we analysis our results in patients with impaired LV function after using Levosimendan as a continuous infusion 24 hours prior to CABG surgery regarding the need for postoperative IABP. Patients and methods: We included in this study 103 patients with LVEF ≤ 35% that underwent coronary artery bypass grafting with or without repair of ischemic mitral regurgitation and received Levosimendan infusion 24 hours before surgery in the period between January 2016 and January 2019 in 2 hospitals (Group A). These data were compared to another matched control group of 98 patients with similar conditions that were operated in the same hospitals over a previous period of 3 years but received no Levosimendan infusion preoperatively (Group B). Results: There was a statistically significant difference in the postoperative results in favor of group A regarding the need for IABP application (P-value = 0.013). However there were no statistically significant differences between both groups in concern of duration of inotropic support (P-value = 0.40), duration of mechanical ventilation (P-value = 0.30), total ICU (P-value = 0.20) and hospital stays (P-value = 0.40), incidence of postoperative atrial fibrillation (P-value = 0.50), incidence of major adverse effects, and in-hospital mortality (P-value = 0.20). There was only one in-hospital mortality in each group. Conclusion: According to our study, infusion of Levosimendan 24 hours prior to CABG surgery in patients with impaired left ventricular contractility is safe and effective in reducing the need of IABP application. However Levosimendan infusion did not affect significantly postoperative coarse, incidence of major adverse effects, and in-hospital mortality.
Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary ve... more Background: We assessed risk factors for early mortality in isolated total anomalous pulmonary venous connection over a modern era excluding emergent cases to eliminate the influence of associated factors on surgical outcome. Methods: 70 patients with isolated total anomalous pulmonary venous connection who were repaired electively between January 2013 and February 2018 were included. Results: In-hospital mortality was encountered in 4 patients (5.7%). Upon univariate analysis, low age (P = .003) and weight (P = .001) at surgery, preoperative pulmonary venous obstruction (P = .010), preoperative low oxygen saturation (P = .031), long cardiopulmonary bypass (P = .001) and aortic cross clamp (P = .003) times, long duration of mechanical ventilation (P = .001), chest infection (P = 0.041), postoperative low CO syndrome (P < .001) and long postoperative inotropic support (P = .015) were significant predictors of in-hospital mortality. In multivariate analysis postoperative low cardi...
Indian Journal of Thoracic and Cardiovascular Surgery, 2018
Diaphragmatic hernias following cardiac surgeries in general are being reported after coronary ar... more Diaphragmatic hernias following cardiac surgeries in general are being reported after coronary artery bypass grafting using the right gastro-epiploic artery as a conduit as well as in patients with ventricular assist devices, orthotopic heart transplants, or subxiphoid epicardial pacemakers. We report a case of an iatrogenic diaphragmatic hernia following pulmonary artery banding operation through median sternotomy which was discovered 4 years later during the debanding and ventricular septal defect closure operation. The diaphragm was most likely injured during insertion of the retro-sternal tube during the first operation.
Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve ... more Background Most previous studies dealing with predictors of surgical outcome in prosthetic valve endocarditis included patients with aortic and/or mitral valve prostheses. Here, we concentrate on isolated prosthetic mitral endocarditis due to heterogeneity of epidemiological data, anatomical factors, and surgical techniques between mitral, prosthetic mitral, and aortic endocarditis between prosthetic mitral and prosthetic aortic endocarditis. Methods Data of 40 patients reoperated upon due to isolated prosthetic mitral endocarditis between July 2015 and March 2017 were retrospectively collected and analyzed. Results Independent predictors of major postoperative complications on multivariate analysis were: no blood cultures before referral (odds ratio 6.36, 95% confidence interval: 1.44-28.15), inadequate response to medical treatment (odds ratio 11.38, 95% confidence interval: 1.29-100.25), and serum creatinine ≥2.0 mg·dL (odds ratio 4.56, 95% confidence interval: 1.07-19.36). Indep...
General thoracic and cardiovascular surgery, Jan 27, 2018
Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a... more Entometrioid stromal sarcomas are seen in extra-uterine as well as extra-gonadal sites and have a strong association with endometriosis. Although having better prognosis than other sarcomas, yet these tumors may relapse (whether local or distant) in up to 56% of cases, even as late as 20 years after surgery. We report a case of a 30-year-old female patient with a mass in the inferior vena cava and right atrium which was surgically removed using cardiopulmonary bypass and deep hypothermic circulatory arrest and turned to be an entometrioid stromal sarcoma. The patient gave a history of endometriosis followed by the appearance of a low-grade ovarian endometrioid stromal sarcoma 4 years before the development of the mass in the IVC and right atrium.
We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a ... more We report a case of Morgagni hernia occupying the anterior mediastinum and right hemithorax in a male infant with Down syndrome, who also had a perimembranous ventricular septal defect. Through a median sternotomy, the hernia sac was freed from the right pleura, and the pericardium was opened to reduce its contents (colon) into the abdomen. The diaphragmatic defect was closed with Prolene mesh and the hernia sac was used to reinforce the diaphragmatic defect. Finally, the pericardium was opened and the ventricular septal defect was closed with a polytetrafluoroethylene patch through a right atriotomy after instituting cardiopulmonary bypass.
Background Tricuspid valve (TV) endocarditis may be associated with serious complications, and 25... more Background Tricuspid valve (TV) endocarditis may be associated with serious complications, and 25% of patients require surgical intervention. However, indications and outcomes of surgery are not clearly identified. In this study, 60 patients are retrospectively reviewed to determine preoperative predictors of surgical outcome. Patients and Methods Sixty patients with isolated TV endocarditis who underwent surgery in the period between January 2012 and December 2016 are reviewed retrospectively from the medical records of Cairo University Hospitals. Forty-two (70%) patients were males, and 18 (30%) were females with a mean age of 29.3 ± 10.6 years. Eleven patients had an underlying cardiac lesion, and 27 patients were intravenous (IV)-drug addicts. Results TV repair could be done in nine (15%) patients, and the rest received TV replacement with biological valves. Twenty-four (40%) patients experienced postoperative complications. On multivariate analysis, a vegetation size >2.2 cm...
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Papers by Hesham Alkady