Journal of the Egyptian Society of Cardio-Thoracic Surgery最新文献

{"title":"Short term outcome of coronary artery bypass graft surgery: Evaluation of recently established cardiac center","authors":"Yusuf S.E. Khalifa ,&nbsp;Karam M. Eisa ,&nbsp;Mohamed Abdel Bary ,&nbsp;Hossam Eldin M.M. Ismail ,&nbsp;Abdallah M. Taha","doi":"10.1016/j.jescts.2017.12.003","DOIUrl":"10.1016/j.jescts.2017.12.003","url":null,"abstract":"<div><h3>Background</h3><p>Overall, coronary artery bypass graft (CABG) surgery achieves excellent outcomes regarding anginal relief and resumption of normal activities. In general, completeness and stability of revascularization are superior with surgical revascularization versus percutaneous interventions.</p><p>This study aimed at assessment of the early postoperative outcome of the first 100 CABG cases grafted in the cardiothoracic surgery department, Qena university hospital, Qena, Egypt.</p></div><div><h3>Results</h3><p>This study was conducted on 100 patients with coronary artery disease. Only 5 patients had single vessel disease and 95 patients had multi-vessel disease, two or more. No one had left main disease. There was a great prevalence of diabetes mellitus (55%), hypertension (69%), dyslipidaemia (55%) and smoking (58%). Operatively, we used left internal mammary artery to left anterior descending coronary artery anastomosis in the majority of cases. In only two cases, right internal mammary artery was used, and great saphenous vein graft was used in anastomosis of remaining diseased vessels. Most cases underwent elective CABG. An intra-aortic balloon pump was used only in 2% of cases. Septicaemia was a significant complication. After 6 months, 97% of the patients were alive.</p></div><div><h3>Conclusions</h3><p>Institutional results are essential to enable surgeons and interventionists to decide if international data is keeping with local findings or not. However, the likenesses between international data and our results confer confidence in our findings.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"26 1","pages":"Pages 24-29"},"PeriodicalIF":0.0,"publicationDate":"2018-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.12.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80766009","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intra-operative removal of chest tube in video-assisted thoracoscopic procedures","authors":"Moustafa M. El-Badry ,&nbsp;Hussein Elkhayat ,&nbsp;Gamal. A. Makhlouf ,&nbsp;Ahmed Ghoneim","doi":"10.1016/j.jescts.2017.09.002","DOIUrl":"https://doi.org/10.1016/j.jescts.2017.09.002","url":null,"abstract":"<div><h3>Objective</h3><p>Thoracic Surgery has witnessed a massive revolution in the last 25 years with the standardization of video-assisted thoracoscopic surgery as the best approach of the thoracic operations. Earlier, when thoracic surgery was done through the huge thoracotomy incisions and rib spreading retractors with their excruciating pain, the chest tube pain was masked, but using VATS, has caused surgeons seeking early removal of chest tubes. With advances of the instruments and stapling devices, the amount of air-leak was significantly reduced, diminishing the time needed for chest tube drainage.</p></div><div><h3>Methods</h3><p>A prospective study, from May 2014 to December 2016, included 29 patients admitted to the service in Faculty of Medicine, Assiut University. Patients had different clinical presentations. Undergoing VATS procedures (uni-portal VATS in all except one), they were then divided into two groups: study group, those with intra-operative removal of chest tube, (16 patients) and control group (13 patients). Patients would undergo an air-leak test.</p></div><div><h3>Results</h3><p>The two groups had a significant difference in the post-operative mean pain score (study group 4.9 &amp; control group 7.8), and hospital stay (study group 1.4 &amp; control group 4). Both groups were similar in occurrence of post-operative pneumothorax (study group 25% &amp; control group 23.1%), with only 2 patients (12.5%) in the study group requiring re-insertion of chest tube.</p></div><div><h3>Conclusions</h3><p>Intra-operative removal of chest tube during VATS procedures was a safe technique in well selected patients with an intra-operative successful air-leak test with radiological and clinical follow-up. This technique provided lesser post-operative pain with shorter hospital stay.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 362-368"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.09.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759036","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Role of intra-aortic morphine in post conditioning during valvular surgery with low ejection fraction","authors":"Ahmed Mostafa Omran MD, EFCTS, MRCS(ENG)","doi":"10.1016/j.jescts.2017.09.001","DOIUrl":"10.1016/j.jescts.2017.09.001","url":null,"abstract":"<div><h3>Background</h3><p>The application of cardioplegia does not completely eradicate myocardial ischemia in cardiac/reperfusion injury due to cardiac arrest. Post conditioning is novel strategy of attaining cardioprotection. Pharmacological post conditioning using a drug as morphine administered before reperfusion would protect the heart against ischemia-reperfusion injury. We investigated whether intra-aortic morphine administration has a post conditioning effect on patients with low ejection fraction (EF) undergoing valve surgery.</p></div><div><h3>Methods</h3><p>This prospective randomized controlled trial in a single center involved one hundred patients scheduled for elective valve surgery were divided into two groups: the Post conditioning group and the Control group. The Post conditioning group (n = 50) received a dose of morphine (0.1 mg/kg) diluted in 20 ml normal saline, injected via a cardioplegia needle into the aortic root with warm hotshot before aortic cross-clamp removal while the control group (n = 50) received the same volume of saline without morphine. Both groups received antegrade warm blood cardioplegia. To assess results EF, fractional shortening (FS), troponin level, ABG, inotropes, postoperative ventilation time, and length of ICU stay were assessed.</p></div><div><h3>Results</h3><p>Postoperative EF and FS revealed a statistically significant higher readings in the Post conditioning group. A significant reduction in the troponin levels was recorded in the study group than the control group. Duration of postoperative ventilation and length of ICU stay were statistically lesser in the Post conditioning group.</p></div><div><h3>Conclusions</h3><p>Morphine administration immediately with warm hotshot was related to improvement in the cardiopulmonary function, less inotropic drug use, and higher left ventricular EF.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 301-305"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.09.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83383146","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The history of introducing the fiberoptic bronchoscopy in Iraq","authors":"Abdulsalam Yaseen Taha","doi":"10.1016/j.jescts.2017.11.003","DOIUrl":"10.1016/j.jescts.2017.11.003","url":null,"abstract":"<div><p>Fiberoptic bronchoscopy is considered the best means of evaluating the bronchial tree and the adjacent lung parenchyma. The wide range of indications of fiberoptic bronchoscopy in thoracic surgery makes it an indispensable component of the diagnostic and therapeutic armamentarium of the chest surgeon. Dr. Azhar K. Kassab (FRCS), a cardiothoracic and vascular surgeon is credited for introducing fiberoptic bronchoscopy in Iraq in 1976. The story of the very beginning and later spread of this technique in our country is described in this short communication.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 373-376"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.11.003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85949959","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plating versus wiring for fixation of traumatic rib and sternal fractures","authors":"Mostafa Kamel Abd-Elnaim,&nbsp;Ahmed El-Minshawy,&nbsp;Mohamed Abd-Elkader Osman,&nbsp;Mohamed Mahmoud Ahmed","doi":"10.1016/j.jescts.2017.08.005","DOIUrl":"https://doi.org/10.1016/j.jescts.2017.08.005","url":null,"abstract":"<div><h3>Background</h3><p>The fracture of ribs is a common injury presenting to trauma centers and hospitals. Along the years, a lot of methods have been introduced to stabilize the rib and sternal fractures, as most of studies reported that the treatment of these cases is warranted. In spite of the large number of methods for fixation introduced; no definitive method has been presented yet.</p></div><div><h3>Methods</h3><p>From July 2015 to November 2016, the data of 30 patients with rib or sternal fractures or both who fulfilled the inclusion criteria were collected prospectively. Those patients were assigned into two groups; (group A) the fractures were fixed by plates and (group B) were fixed by stainless steel wires. The choice of method of fixation depended on surgeon's experience. The variables evaluated included stability of chest wall, intensive care unit stay, hospital stay and ventilator days.</p></div><div><h3>Results</h3><p>The chest wall stability in (group A) was achieved in 100% of the patients, while in (group B) it was achieved in 60% of patients. Intensive care unit stay for group A was 9 ± 4.37 days and for group B 13.8 ± 7.61 (p = 0.031). Hospital stay for group A was 11.6 ± 5.27 days and for group B 17.1 ± 6.77 (p = 0.021). Ventilator days for (group A) were 6.38 ± 3.83 days, while in (group B) 10.3 ± 8.82days, however this difference was statistically insignificant (p = 0.129).</p></div><div><h3>Conclusions</h3><p>Plating of rib and sternal fractures had better outcome than wiring, regarding better chest wall stability and restoration of chest contour; also it had shorter intensive care unit, hospital and ventilator days.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 356-361"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.08.005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrosternal goiter and thymic carcinoid: A rare co-existence","authors":"Abdulsalam Yaseen Taha ,&nbsp;Nezar A. Almahfooz ,&nbsp;Hassanain H. Khudair","doi":"10.1016/j.jescts.2017.11.004","DOIUrl":"https://doi.org/10.1016/j.jescts.2017.11.004","url":null,"abstract":"<div><p>Retrosternal goiter is diagnosed when more than 50% of the thyroid gland extends below the thoracic inlet. Surgery is the treatment of choice. Carcinoid tumor of thymus gland is very rare. Although both conditions develop in the anterior mediastinum, literature search revealed no patient having both lesions at the same time. Reported herein, is a 55-year old Iraqi man with retrosternal multinodular goiter and a localized solitary primary thymic carcinoid. Thymic tumor was simultaneously removed along right thyroid lobectomy via median sternotomy extended to the neck. Early outcome was good. The patient had no evidence of recurrence after surgery.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 369-372"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.11.004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91723681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular rings and slings: A challenging diagnostic and therapeutic rare disease entity","authors":"Yasser Mohamed Menaissy ,&nbsp;Mohamed –Adel Fetouh Elgamal ,&nbsp;Samy Amin ,&nbsp;Ahmed Fayez Zaki","doi":"10.1016/j.jescts.2017.10.002","DOIUrl":"https://doi.org/10.1016/j.jescts.2017.10.002","url":null,"abstract":"<div><h3>Background</h3><p>Vascular rings (VRs) are classified as true rings or partial rings. The complete VRs include double aortic arch (DAA) and right aortic arch (RAA) with aberrant left subclavian artery and left ligamentum. The incomplete (VRs) include innominate artery compression and pulmonary artery sling.</p></div><div><h3>Methods</h3><p>We retrospectively analyzed the data from 90 patients with VRs and pulmonary artery slings diagnosed at Mansoura University Children’s Hospital between 2004 to 2016. The initial diagnostic clue might be a right sided aortic arch on a plain x-ray chest. Lateral views were evaluated for retro tracheal opacity, anterior tracheal bowing, and posterior indentation. In our series, bronchoscopy was used for patients with respiratory tract symptoms. Bronchoscopy was performed in 21 patients (23.3%), with finding of external tracheal wall pulsatile compression. Echocardiography was used initially in most cases as the first diagnostic tool followed by Multislice CT scan (MSCT).</p></div><div><h3>Results</h3><p>The age of operation was significantly earlier in patients with complete VRs versus incomplete vascular rings. By far the commonest variant was the DAA which constituted in our series 57.8%. The second common type was RAA with aberrant left subclavian and left ligamentum which constituted 30%. The third most common type was pulmonary artery sling constituting 6.7%. In our series, Echocardiography was done in 78 cases (85.6%). It was useful not only in initially diagnosing VR anomaly but also it detected associated cardiac anomalies in 4 cases. MSCT was an excellent noninvasive diagnostic modality that was used in 75 cases (83.3%). We operated 90 cases; 79 via left thoracotomy, 10 cases via median sternotomy and one case via right thoracotomy. Among the 90 cases that were operated, there was a single mortality, no cases were complicated by recurrent laryngeal nerve injury and five cases had postoperative chylothorax.</p></div><div><h3>Conclusions</h3><p>In our series, Echocardiography and MSCT were essential for proper diagnosis and planing for surgery. Left thoracotomy or median sternotomy provided good exposure in the operated cases. Surgery was done with low mortality and morbidity.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 349-355"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.10.002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91759037","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanical mitral valve prosthesis: Should the INR be above 2 when aspirin is added to the oral anticoagulant?","authors":"Ashraf Fawzy,&nbsp;Hosam Fathy Ali,&nbsp;Mohamed Elanwar","doi":"10.1016/j.jescts.2017.06.001","DOIUrl":"10.1016/j.jescts.2017.06.001","url":null,"abstract":"<div><h3>Background</h3><p>Our aim is to avoid thrombo-embolic and bleeding events in mechanical mitral valve prostheses and find a solution for the difficult adjustment of the INR with the given Vitamin K Antagonists/Oral anticoagulants (VKA) by adding small dose of Aspirin (75 or 81 mg/day)to the oral anticoagulants.</p></div><div><h3>Methods</h3><p>We revised the data of 183 patients who had been submitted for mechanical mitral valve replacement between January 2007 and January 2011 and followed for 2–3 years post operative. All of them had been replaced with St.Jude prostheses. 104 of them received Aspirin with the VKA, referred to as group A; group B patients (79 patients) received only VKA. We followed both groups clinically, by coagulation profile and by echocardiography for 2–3 years to assess the INR and the state of the valve in response to the added Aspirin to the VKA.</p></div><div><h3>Results</h3><p>In the cases receiving Aspirin added to the oral anticoagulants we found less incidence of malfunctioning valves, less thrombo-embolism and less bleeding events. There were lower doses of oral anticoagulants taken, lower figures of INR in group A than in group B.</p></div><div><h3>Conclusions</h3><p>Aspirin added to oral anticoagulants post MVR had the advantages of being safe, convenient and reliable with no need to frequently adjust the oral anticoagulants doses or fear of thrombo-embolic events.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 285-288"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.06.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83598817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Retrosternal goiter and thymic carcinoid: A rare co-existence","authors":"A. Taha, Nezar A. Almahfooz, H. H. Khudair","doi":"10.1016/J.JESCTS.2017.11.004","DOIUrl":"https://doi.org/10.1016/J.JESCTS.2017.11.004","url":null,"abstract":"","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"75 1","pages":"369-372"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82357063","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Multiple arterial grafts in coronary artery bypass grafting, Sohag University Hospital's initial experience","authors":"A.A.A. Elsayed ,&nbsp;A.M. Boghdady ,&nbsp;Khaled M. Abdelaal ,&nbsp;E.A. Mokhtar ,&nbsp;Ahmed Gaafar","doi":"10.1016/j.jescts.2017.10.001","DOIUrl":"10.1016/j.jescts.2017.10.001","url":null,"abstract":"<div><h3>Background</h3><p>Left internal mammary artery (LIMA) grafting to the left anterior descending artery (LAD) is the most crucial step in any surgical coronary revascularization. It has been proved that using LIMA during coronary artery bypass grafting (CABG) resulted in better long term results in comparison to other conduits. With accumulation of data about failure and lower patency rates of vein grafts, the concept of total arterial revascularization (TAR) and multiple arterial revascularization (MAR) has developed to offer more physiological and durable conduits for CABG patients.</p></div><div><h3>Methods</h3><p>This study was conducted in the <u>D</u>epartment of <u>C</u>ardiothoracic <u>S</u>urgery, Sohag University Hospital, Egypt, between January 2012 and January 2017. 104 patients who underwent CABG during the initial experience were involved. They were divided into 2 groups, group A (MAR) 46 patients, and Group B (Conventional CABG) 58 patients. Demographic data, <u>p</u>reoperative risk factors, operative and post operative details were compared.</p></div><div><h3>Results</h3><p>With almost comparable preoperative demographic distribution and risk factors, results were comparable regarding post operative MI, incidence of deep sternal wound infection, number of distal anastomoses, postoperative bleeding, and the need for blood transfusion. Cross clamp time and total bypass time were slightly longer in group A than in group B with statistically significant difference.</p></div><div><h3>Conclusions</h3><p>Using multiple arterial grafts did not add a significant risk or time to the classic CABG. With accumulating evidence about better patency rate in arterial grafts, MAR is recommended especially in younger patients undergoing CABG.</p></div>","PeriodicalId":100843,"journal":{"name":"Journal of the Egyptian Society of Cardio-Thoracic Surgery","volume":"25 4","pages":"Pages 306-310"},"PeriodicalIF":0.0,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.jescts.2017.10.001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88162577","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}