Papers by Aliasghar Moeinipour
Background: Malnutrition is a considerable problem after major surgeries in hospitalized patients... more Background: Malnutrition is a considerable problem after major surgeries in hospitalized patients. Moreover, increasing prevalence of cardiovascular diseases leads to an augmentation in number of cardiovascular surgeries. Ghrelin is an appetite-stimulating hormone that can prevent malnutrition. This study aimed to evaluate ghrelin levels in coronary artery bypass graft patients in two methods, on-and off-pump. Method: In this prospective cohort study, 40 patients who underwent off-and on-pump operation were designated during September 2011 through March 2012 at Imam Reza hospital, Mashhad, Iran. Written informed consents were obtained from patients before entering the study. Patients with HIV, HCV, HBS, malignancy, and weight loss of >50% in last three month were excluded. Nutritional status and ghrelin level were evaluated for three times: (0, 5th and 40th day after surgery). SPSS 11.5 software was used for data analysis by t-test and Mann-Whitney test. Results: Thirty-four patients were divided into two groups: off-pump (17 patients, mean age 64±1) and on-pump (17 patients, mean age 65±2). Mean value for ghrelin after 40 days was 62.00 (pmol/dl) and 44.00 (pmol/dl) in off and on-pump groups, respectively, with no significant difference (p>0.05). Conclusions: Ghrelin levels were not remarkably changed in off and on-pump methods after the surgery.
Wedescribea72-year-oldwomanwhosufferedfromoldinferiorposteriortransmuralmyocardial infarctioncomp... more Wedescribea72-year-oldwomanwhosufferedfromoldinferiorposteriortransmuralmyocardial infarctioncomplicatedbyatrueposteriorleftventricularaneurysm.Wedescribetheclinicalcourse, diagnosis,andsurgicalmanagementofthistypeofcomplicationofmyocardialinfarctionandalso illustratetheearlyclinicalfollow-upandoutcome.
Endovascular intervention is an interesting alternative to conventional open surgical repair for ... more Endovascular intervention is an interesting alternative to conventional open surgical repair for a penetrated peripheral artery that has suitable anatomic criteria for percutaneous device treatment. Carotid and subclavian artery injury, especially at the base of the artery in proximity to the aortic arch, is a challenging anatomic position for surgical exposure. This is a situation where the use of endovascular intervention seems to be a good option. Endovascular treatment decreases the time of surgery, estimated bleeding, and iatrogenic complications, especially peripheral nerve injury, when compared with similar surgical modalities by limiting surgical dissection in the traumatized operative field. We describe a young man with a traumatic stab wound injury to the junction of the left subclavian artery and the carotid artery that was successfully managed with a covered stent.
A severe aortic calcification (porcelain aorta) carries a high risk of atheroembolism and bleedin... more A severe aortic calcification (porcelain aorta) carries a high risk of atheroembolism and bleeding during cardiac surgery, with an incidence range of 14% to 29%. Proximal anastomosis of conduits to the ascending aorta in patients undergoing coronary artery bypass grafting may be hazardous or impossible in the presence of complex aortic pathology. Various techniques have been introduced in order to avoid cannulation and clamping of the aorta. Herein, we present a technique in a high-risk group of such patients (Iranian Heart Journal 2014; 15 (1): 29-31)..
We describe a 67-year-old man with a primary diagnosis of left atrial myxoma. Preoperativ... more We describe a 67-year-old man with a primary diagnosis of left atrial myxoma. Preoperative coronary angiography revealed a significant three-vessel disease. The patient underwent surgery, comprising the complete resection of the left atrial mass concomitant with coronary artery bypass grafting. He had good recovery without any complications in the early and late follow-up. There was no residual tumor or recurrence. The histopathological examination of the mass confirmed the diagnosis of the left atrial myxoma. (Iranian Heart Journal 2015; 16(3): 54-56)
Background: It is common practice for patients with prosthetic cardiac devices, especially hear... more Background: It is common practice for patients with prosthetic cardiac devices, especially heart valve prosthesis, arterial stents, defibrillators, and pacemaker devices, to use anticoagulation treatment. When these patients suffer from multiple trauma after motor vehicle accidents, the best medi- cal management for this challenging position is mandatory. This strategy should include a rapid diagnosis of all possible multiple organ injuries, with special attention to anticoagula- tion therapy so as to minimize the risk of thromboembolism complication in prosthetic devices. In this review, we describe the best medical management for patients with multiple trauma who use anticoagulants after heart valve replacement.
Methods: We searched electronic databases PubMed/ Medline, Scopus, Embase, and Google Scholar using the fol- lowing terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
Results: For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anes- thesiologists, and cardiologists is essential. For optimal medi- cal management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is impor- tant to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
Conclusion: The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
Background: Median sternotomy and resternotomy is the standard technique for coronary artery bypa... more Background: Median sternotomy and resternotomy is the standard technique for coronary artery bypass grafting (CABG), valvular heart disease, and congenital heart disease. Despite ad-vances in many areas of cardiac surgical procedures, there is a lack of innovation in sternal closure techniques. Several studies have examined sternal closure techniques including wiring, interlocking, plate and screw, and bone cementation. However, none of them achieved widespread acceptability. On one hand, serious post-operative complications are associated with the use of wiring and plating techniques in high-risk patients. The aim of this study is showing challenges and difficulties with resternotomy in patient with a history of previous cardiac surgery and usage of biologic bone cements. Case Report: The case was a 56-year-old woman with a history of previous sternotomy for mitral and aortic valve replacement (mechanical sj. No. 29 and mechanical sj. No. 21, respectively) using biologic bone cement (Kryptonite TM, Doctors Research Group Inc.) for her osteopenic sternum. Four years after the mitral valve replacement (MVR), she was referred to emergency department with a thrombosis at the mitral valve. She under-went emergent cardiac surgery with a very difficult resternotomy under femoral cannulation support. Conclusion: Resternotomy in patients with previous sternotomy with Kryptonite bone cements or calcium phosphate cements (CPC) is safe and can be done similar to other cardiac reoperations. It seems that reoperation in this patients does not increase the risk of bleeding, morbidity, and mortality.
Introduction: Aortic Valve Papillary Fibroelastoma (AVPF) is the most common benign tumor of card... more Introduction: Aortic Valve Papillary Fibroelastoma (AVPF) is the most common benign tumor of cardiac valves. Most cases of AVPF are completely asymptomatic and the diagnosis is made incidentally. However, ischemic heart attack, atrial and ventricular arrhythmia, and also thromboembolism complication especially in CNS system, are the most common presentations in symptomatic cases. Herein, we report a very rare case of AVPF in an old age patient presented with stable angina.
Case presentation: A 60-year old woman was referred to our clinic with symptoms of stable angina. Transesophageal echocardiography showed a tumor suspected mass (1 X 1 cm) on aortic valve. Angiography was reported normal. Considering the presence of the symptomatic mass, patient underwent open cardiac surgery and tumor resected. Report of biopsy revealed the AVPF.
Conclusion: Although treatment of asymptomatic AVPF is controversial; but, for symptomatic masses, surgical resection for avoidance of its complication is recommended. Result of surgical resection of AVPF usually is excellent and mortality, morbidity, and recurrence rate are almost low
Introduction: The adult patients' population with congenital heart disease (CHD) is rapidly growi... more Introduction: The adult patients' population with congenital heart disease (CHD) is rapidly growing due to progress in cardiologic and surgical interventions. Almost a million adult with CHD are living in western world. The present study was performed with aim to evaluate the newest studies to determine the cardiac assessment before pregnancy, best diagnostic methods, and determining the cases of pregnancy contraindication in congenital heart disease.
Methods: In this narrative review article, the most recent researches, reviews, guideline articles, gynecology and cardiovascular surgery reference books were selected and evaluated by the keywords of pregnancy, congenital disease and their equivalents; then, the most important and strongest diagnostic and therapeutic recommendations were provided. 20 articles were used in this study consisted of the related articles in the PubMed, Scopus, Google scholar databases during 1997 to 2014.
Results: Cardiac contraindications to pregnancy in CHD included severe pulmonary hypertension, severe obstructive lesions, class III/IV congestive heart failure and Mar fan syndrome with aortic root >40 mm and sever PI and right ventricle failure. Echocardiography is the preferred imaging modality for guiding the treatment care of these patients.
Conclusion: Preconception evaluation is essential for genetic consultation, identifying/optimizing medical and surgical ideals before pregnancy in order to improve outcomes. A multidisciplinary approach with collaboration between gynecology, anesthesiology, cardiology and cardiac surgery at a specialized center is required for treatment management of these patients.
Nonsurgical bleeding after complex thoracic aortic procedures (such as aortic dissection and aort... more Nonsurgical bleeding after complex thoracic aortic procedures (such as aortic dissection and aortic aneurysm) is a great challenge for cardiac surgeons because of severe coagulopathy, exsanguinous bleeding, and inevitable death. Temporary mediastinal packing (with sponge) in such cases is the only life-saving technique with good result in most cases. Herein, we presented three cases with acute aortic dissection with intractable bleeding that was successfully managed with mediastinal packing.
Brucellosis is an infectious disease that can involve the cardiovascular system. Brucella aortic ... more Brucellosis is an infectious disease that can involve the cardiovascular system. Brucella aortic valve endocarditis is an uncommon presentation of it with aortic valve regurgitation and heart failure. Diagnosis of brucella endocarditis of aortic valve is done in most cases with echocardiography. Successful management of this disease requires a combination of appropriate antibiotic treatment and surgical valve replacement, followed by a long duration of antibiotic therapy postoperatively (Doxycycline and Rifampicin). We describe a 36-year-old man, with brucella endocarditis of aortic valve and paravalvular abscess, who was managed via aortic valve replacement using a mechanical prosthesis with good results. (Iranian Heart Journal 2015; 16(1): 38-41)
Endovascular intervention is an interesting alternative to conventional open surgical repair for ... more Endovascular intervention is an interesting alternative to conventional open surgical repair for a penetrated peripheral artery that has suitable anatomic criteria for percutaneous device treatment. Carotid and subclavian artery injury, especially at the base of the artery in proximity to the aortic arch, is a challenging anatomic position for surgical exposure. This is a situation where the use of endovascular intervention seems to be a good option. Endovascular treatment decreases the time of surgery, estimated bleeding, and iatrogenic complications, especially peripheral nerve injury, when compared with similar surgical modalities by limiting surgical dissection in the traumatized operative field. We describe a young man with a traumatic stab wound injury to the junction of the left subclavian artery and the carotid artery that was successfully managed with a covered stent.
Abstract:
Background: Intraoperative trans-esophageal echocardiography (TEE) and Saline inje... more Abstract:
Background: Intraoperative trans-esophageal echocardiography (TEE) and Saline injection pressurization of the left ventricle are the most popular methods to evaluate the repaired mitral valve during mitral valve repair surgery. We describe a simple and reliable intraoperative saline injection leak test method for mitral valve repair which has multiple benefits over the conventional method. Materials and methods: Twenty patients with mitral regurgitation who met the inclusion criteria for mitral valve repair were enrolled in the study. When the repair procedure is done, a balloon catheter (12 Fr Foley catheter) is inserted into the left ventricle through the site of cardioplegia cannula on ascending aorta and inflated at the level of left ventricular outflow tract inferior to the aortic valve. The valve’s competency is then evaluated by saline injection into the left ventricle through the balloon catheter.
Results: Intra operative TEE revealed trivial and mild MR in 12 and 7 patients and moderate MR in one patient. No significant discrepancy was found between the intra-operative TEE findings and the described intra-operative leak test results (p value>0.05).
Conclusion: The intraoperative saline leak test described here is a simple, safe and reliable method to assess the efficacy of mitral valve repair before chest closure.
Keyword(s): MITRAL VALVE, INTRAOPERATIVE PERIOD, TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Abstract:
Objective: Postoperative atrial fibrillation (POAF) is the most common complication a... more Abstract:
Objective: Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass graft surgery (CABG) and a major cause of increased hospital costs. Dispersed atrial refractoriness is thought to be the primary mechanism, whereas myocardial inflammation has an important role in altering atrial conduction. We evaluated the preventive effect of an intravenous combination of Digoxin, Hydrocortisone, and Amiodarone as anti-inflammatory and anti-arrhythmic agents on AF after off-pump CABG.
Material and Methods: One hundred fifty patients who underwent off-pump CABG between March 2010 and April 2011 and met our inclusion criteria were enrolled. The patients were randomized into two groups: the study group received 300 mg Amiodarone, 0.5 mg Digoxin, and 200 mg Hydrocortisone before the induction of anesthesia, but the control group did not. Surgical and anesthetic techniques were identical in both groups.
Results: Patient characteristics and surgical variables were similar in both groups (p value<0.05).
POAF was observed in 6 (8%) patients in the case group and in 18 (24%) of the controls.
There was a significant difference between the two groups in the prevalence of new-onset POAF (p value=0.03).
Conclusion: A preoperative dose of a combination of Digoxin, Hydrocortisone, and Amiodarone is a safe and feasible method to reduce POAF prevalence, produce a better outcome, and reduce the duration of hospital stay and hospital costs.
Abstract:
We present the case of an advanced and large cardiac angiosarcoma in the right atriu... more Abstract:
We present the case of an advanced and large cardiac angiosarcoma in the right atrium and right ventricle, which occupied the most part of the right heart and created a significant stenosis in the pulmonary circulation. Our patient was in very bad general condition with severe respiratory distress and had very unstable hemodynamic. Also, he experienced two episodes of CPR (cardiopulmonary resuscitation) before he was transferred to the operating room. Given the patient’s poor condition and limited life expectancy, we performed a palliative bypass procedure, consisting of cavopulmonary anastomosis
Abstract: Atrial fibrillation (AF) is the most frequent (arrhythmia) complication following coron... more Abstract: Atrial fibrillation (AF) is the most frequent (arrhythmia) complication following coronary arterygrafting surgery (CABG). The present study is designed to evaluate the efficacy of temporary atrial pacing prevention of AF after off pump coronary artery bypass graft surgery. The patients who had first-time ofCABG were enrolled in the study. The exclusion criteria were that the patients had valve dysfunctions. The group (n = 39) were paced electively and the control group (n = 40) were not paced, and both were monitored hours postoperative for the occurrence of AF. The end points of the study were occurrence of AF, death postoperative period, and discharge from hospital. The data analyzed by t-test and chi-squared test for variabltotal of 120 patients enrolled in the study. Forty-one patients were excluded from the study because of intraopdysrhythmia, tachycardia or failure of pacing, so the final study subjects consist of 79 patients. AF occurred in 13paced group (33.33%) and 13 of 40 non-paced group (32.5%). No statically significant difference in the proportiopatients developing atrial fibrillation was observed between the study and the control group for incidence of AFage (P=0.007), history of myocardial infarction (P=0.001), systolic dysfunction (P=0.003), ejection fraction (P=0and atrial enlargement (P=0.001) were identified as AF predictors. The result of this study shows that prophylacticright atrial pacing had no significant effect on reducing the incidence of AF following off-pump CABG.
[Abbasi Tashnizi Mohammad, Moeinipour Ali Asghar, Mirzai Asadollah, Asadollah Jalal, Sadraee Javad, SepehShamloo Alirez, Zirak Nahid, Khameneh Bagheri Ramin, Amouzeshi Ahmad. The Evaluation of Right AtriaTemporary Pacing for Preventing Postoperative Atrial Fibrillation Following Coronary Artery Bypass
Grafting Surgery: prospective observational study.
Life Sci J 2012;9(3):2283-2287] (ISSN:1097-8135).
CABG in pocelain AORTA
A severe aortic calcification (porcelain aorta) carries a high risk of atheroembolism and bleedin... more A severe aortic calcification (porcelain aorta) carries a high risk of atheroembolism and bleeding during cardiac surgery, with an incidence range of 14% to 29%. Proximal anastomosis of conduits to the ascending aorta in patients undergoing coronary artery bypass grafting may be hazardous or impossible in the presence of complex aortic pathology. Various techniques have been introduced in order to avoid cannulation and clamping of the aorta. Herein, we present a technique in a high-risk group of such patients (Iranian Heart Journal 2014; 15 (1): 29-31)..
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Papers by Aliasghar Moeinipour
Methods: We searched electronic databases PubMed/ Medline, Scopus, Embase, and Google Scholar using the fol- lowing terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
Results: For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anes- thesiologists, and cardiologists is essential. For optimal medi- cal management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is impor- tant to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
Conclusion: The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
Case presentation: A 60-year old woman was referred to our clinic with symptoms of stable angina. Transesophageal echocardiography showed a tumor suspected mass (1 X 1 cm) on aortic valve. Angiography was reported normal. Considering the presence of the symptomatic mass, patient underwent open cardiac surgery and tumor resected. Report of biopsy revealed the AVPF.
Conclusion: Although treatment of asymptomatic AVPF is controversial; but, for symptomatic masses, surgical resection for avoidance of its complication is recommended. Result of surgical resection of AVPF usually is excellent and mortality, morbidity, and recurrence rate are almost low
Methods: In this narrative review article, the most recent researches, reviews, guideline articles, gynecology and cardiovascular surgery reference books were selected and evaluated by the keywords of pregnancy, congenital disease and their equivalents; then, the most important and strongest diagnostic and therapeutic recommendations were provided. 20 articles were used in this study consisted of the related articles in the PubMed, Scopus, Google scholar databases during 1997 to 2014.
Results: Cardiac contraindications to pregnancy in CHD included severe pulmonary hypertension, severe obstructive lesions, class III/IV congestive heart failure and Mar fan syndrome with aortic root >40 mm and sever PI and right ventricle failure. Echocardiography is the preferred imaging modality for guiding the treatment care of these patients.
Conclusion: Preconception evaluation is essential for genetic consultation, identifying/optimizing medical and surgical ideals before pregnancy in order to improve outcomes. A multidisciplinary approach with collaboration between gynecology, anesthesiology, cardiology and cardiac surgery at a specialized center is required for treatment management of these patients.
Background: Intraoperative trans-esophageal echocardiography (TEE) and Saline injection pressurization of the left ventricle are the most popular methods to evaluate the repaired mitral valve during mitral valve repair surgery. We describe a simple and reliable intraoperative saline injection leak test method for mitral valve repair which has multiple benefits over the conventional method. Materials and methods: Twenty patients with mitral regurgitation who met the inclusion criteria for mitral valve repair were enrolled in the study. When the repair procedure is done, a balloon catheter (12 Fr Foley catheter) is inserted into the left ventricle through the site of cardioplegia cannula on ascending aorta and inflated at the level of left ventricular outflow tract inferior to the aortic valve. The valve’s competency is then evaluated by saline injection into the left ventricle through the balloon catheter.
Results: Intra operative TEE revealed trivial and mild MR in 12 and 7 patients and moderate MR in one patient. No significant discrepancy was found between the intra-operative TEE findings and the described intra-operative leak test results (p value>0.05).
Conclusion: The intraoperative saline leak test described here is a simple, safe and reliable method to assess the efficacy of mitral valve repair before chest closure.
Keyword(s): MITRAL VALVE, INTRAOPERATIVE PERIOD, TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Objective: Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass graft surgery (CABG) and a major cause of increased hospital costs. Dispersed atrial refractoriness is thought to be the primary mechanism, whereas myocardial inflammation has an important role in altering atrial conduction. We evaluated the preventive effect of an intravenous combination of Digoxin, Hydrocortisone, and Amiodarone as anti-inflammatory and anti-arrhythmic agents on AF after off-pump CABG.
Material and Methods: One hundred fifty patients who underwent off-pump CABG between March 2010 and April 2011 and met our inclusion criteria were enrolled. The patients were randomized into two groups: the study group received 300 mg Amiodarone, 0.5 mg Digoxin, and 200 mg Hydrocortisone before the induction of anesthesia, but the control group did not. Surgical and anesthetic techniques were identical in both groups.
Results: Patient characteristics and surgical variables were similar in both groups (p value<0.05).
POAF was observed in 6 (8%) patients in the case group and in 18 (24%) of the controls.
There was a significant difference between the two groups in the prevalence of new-onset POAF (p value=0.03).
Conclusion: A preoperative dose of a combination of Digoxin, Hydrocortisone, and Amiodarone is a safe and feasible method to reduce POAF prevalence, produce a better outcome, and reduce the duration of hospital stay and hospital costs.
We present the case of an advanced and large cardiac angiosarcoma in the right atrium and right ventricle, which occupied the most part of the right heart and created a significant stenosis in the pulmonary circulation. Our patient was in very bad general condition with severe respiratory distress and had very unstable hemodynamic. Also, he experienced two episodes of CPR (cardiopulmonary resuscitation) before he was transferred to the operating room. Given the patient’s poor condition and limited life expectancy, we performed a palliative bypass procedure, consisting of cavopulmonary anastomosis
[Abbasi Tashnizi Mohammad, Moeinipour Ali Asghar, Mirzai Asadollah, Asadollah Jalal, Sadraee Javad, SepehShamloo Alirez, Zirak Nahid, Khameneh Bagheri Ramin, Amouzeshi Ahmad. The Evaluation of Right AtriaTemporary Pacing for Preventing Postoperative Atrial Fibrillation Following Coronary Artery Bypass
Grafting Surgery: prospective observational study.
Life Sci J 2012;9(3):2283-2287] (ISSN:1097-8135).
Methods: We searched electronic databases PubMed/ Medline, Scopus, Embase, and Google Scholar using the fol- lowing terms: anticoagulant, warfarin, heparin, and multiple trauma. Also, similar studies suggested by the databases were included. Non-English articles were excluded from the review.
Results: For patients who use anticoagulation therapy, teamwork between cardiac surgeons, general surgeons, anes- thesiologists, and cardiologists is essential. For optimal medi- cal management, multiple consults between members of this team is mandatory for rapid diagnosis of all possible damaged organs, with special attention to the central nervous system, chest, and abdominal traumas. With this strategy, it is impor- tant to take note of anticoagulation drugs to minimize the risk of thromboembolism complications in cardiac devices.
Conclusion: The best anticoagulant agents for emergency operations in patients with multiple trauma who are using an anticoagulant after heart valve replacement are fresh frozen plasma (FFP) and prothrombin complex concentrates (PCC).
Case presentation: A 60-year old woman was referred to our clinic with symptoms of stable angina. Transesophageal echocardiography showed a tumor suspected mass (1 X 1 cm) on aortic valve. Angiography was reported normal. Considering the presence of the symptomatic mass, patient underwent open cardiac surgery and tumor resected. Report of biopsy revealed the AVPF.
Conclusion: Although treatment of asymptomatic AVPF is controversial; but, for symptomatic masses, surgical resection for avoidance of its complication is recommended. Result of surgical resection of AVPF usually is excellent and mortality, morbidity, and recurrence rate are almost low
Methods: In this narrative review article, the most recent researches, reviews, guideline articles, gynecology and cardiovascular surgery reference books were selected and evaluated by the keywords of pregnancy, congenital disease and their equivalents; then, the most important and strongest diagnostic and therapeutic recommendations were provided. 20 articles were used in this study consisted of the related articles in the PubMed, Scopus, Google scholar databases during 1997 to 2014.
Results: Cardiac contraindications to pregnancy in CHD included severe pulmonary hypertension, severe obstructive lesions, class III/IV congestive heart failure and Mar fan syndrome with aortic root >40 mm and sever PI and right ventricle failure. Echocardiography is the preferred imaging modality for guiding the treatment care of these patients.
Conclusion: Preconception evaluation is essential for genetic consultation, identifying/optimizing medical and surgical ideals before pregnancy in order to improve outcomes. A multidisciplinary approach with collaboration between gynecology, anesthesiology, cardiology and cardiac surgery at a specialized center is required for treatment management of these patients.
Background: Intraoperative trans-esophageal echocardiography (TEE) and Saline injection pressurization of the left ventricle are the most popular methods to evaluate the repaired mitral valve during mitral valve repair surgery. We describe a simple and reliable intraoperative saline injection leak test method for mitral valve repair which has multiple benefits over the conventional method. Materials and methods: Twenty patients with mitral regurgitation who met the inclusion criteria for mitral valve repair were enrolled in the study. When the repair procedure is done, a balloon catheter (12 Fr Foley catheter) is inserted into the left ventricle through the site of cardioplegia cannula on ascending aorta and inflated at the level of left ventricular outflow tract inferior to the aortic valve. The valve’s competency is then evaluated by saline injection into the left ventricle through the balloon catheter.
Results: Intra operative TEE revealed trivial and mild MR in 12 and 7 patients and moderate MR in one patient. No significant discrepancy was found between the intra-operative TEE findings and the described intra-operative leak test results (p value>0.05).
Conclusion: The intraoperative saline leak test described here is a simple, safe and reliable method to assess the efficacy of mitral valve repair before chest closure.
Keyword(s): MITRAL VALVE, INTRAOPERATIVE PERIOD, TRANSESOPHAGEAL ECHOCARDIOGRAPHY
Objective: Postoperative atrial fibrillation (POAF) is the most common complication after coronary artery bypass graft surgery (CABG) and a major cause of increased hospital costs. Dispersed atrial refractoriness is thought to be the primary mechanism, whereas myocardial inflammation has an important role in altering atrial conduction. We evaluated the preventive effect of an intravenous combination of Digoxin, Hydrocortisone, and Amiodarone as anti-inflammatory and anti-arrhythmic agents on AF after off-pump CABG.
Material and Methods: One hundred fifty patients who underwent off-pump CABG between March 2010 and April 2011 and met our inclusion criteria were enrolled. The patients were randomized into two groups: the study group received 300 mg Amiodarone, 0.5 mg Digoxin, and 200 mg Hydrocortisone before the induction of anesthesia, but the control group did not. Surgical and anesthetic techniques were identical in both groups.
Results: Patient characteristics and surgical variables were similar in both groups (p value<0.05).
POAF was observed in 6 (8%) patients in the case group and in 18 (24%) of the controls.
There was a significant difference between the two groups in the prevalence of new-onset POAF (p value=0.03).
Conclusion: A preoperative dose of a combination of Digoxin, Hydrocortisone, and Amiodarone is a safe and feasible method to reduce POAF prevalence, produce a better outcome, and reduce the duration of hospital stay and hospital costs.
We present the case of an advanced and large cardiac angiosarcoma in the right atrium and right ventricle, which occupied the most part of the right heart and created a significant stenosis in the pulmonary circulation. Our patient was in very bad general condition with severe respiratory distress and had very unstable hemodynamic. Also, he experienced two episodes of CPR (cardiopulmonary resuscitation) before he was transferred to the operating room. Given the patient’s poor condition and limited life expectancy, we performed a palliative bypass procedure, consisting of cavopulmonary anastomosis
[Abbasi Tashnizi Mohammad, Moeinipour Ali Asghar, Mirzai Asadollah, Asadollah Jalal, Sadraee Javad, SepehShamloo Alirez, Zirak Nahid, Khameneh Bagheri Ramin, Amouzeshi Ahmad. The Evaluation of Right AtriaTemporary Pacing for Preventing Postoperative Atrial Fibrillation Following Coronary Artery Bypass
Grafting Surgery: prospective observational study.
Life Sci J 2012;9(3):2283-2287] (ISSN:1097-8135).