{"title":"Post-operative Outcome during Off-Pump Coronary Artery Bypass Surgery – A Comparison between Combined High Thoracic Epidural Anaesthesia with General Anaesthesia and General Anaesthesia Alone","authors":"Saiful Islam Azad, S. Alam, Abdul Khaleque Beg","doi":"10.3329/cardio.v15i1.61912","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61912","url":null,"abstract":"Background: In the postoperative period inadequate analgesia may increase morbidity by causing adverse haemodynamic, metabolic, immunologic and haemostatic attentions and prolong mechanical ventilation with more ICU stay. This study has been undertaken to compare postoperative outcome in off-pump coronary artery bypass surgery (OPCAB) between high thoracic epidural anaesthesia (HTEA) as an adjunct to general anaesthesia (GA) vs. GA alone.\u0000Methods : This prospective, randomized case control comparative study was carried out in sixty patients without having left main coronary artery disease, left ventricular ejection fraction <30% or contraindication of regional anaesthesia scheduled for OPCAB. They were divided into two groups, thirty in each group. Group A received GA alone and group B received high thoracic epidural anaesthesia with GA. Requirement of postoperative analgesics, pain score, sedation score, and post-operative complications were evaluated. Results: Rescue analgesics was needed in 16 (53.3%) and 6 (20.0%) patients in group A and group B respectively (p<0.05). Post-operative pain score (VAS) during maintenance with ventilator with awareness at first fourth hour and after extubation during movement & cough were significantly different between two groups. Post-operative sedation score was significantly different between two groups except in 1st hour. No post-operative complication was observed in both groups.\u0000Conclusion: High thoracic epidural anaesthesia with GA appeared to be most reliable postoperative pain reliever with better post-operative outcome in OPCAB surgery.\u0000Cardiovasc j 2022; 15(1): 63-68","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80908530","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":"Renal Cell Carcinoma with Inferior Vena Cava Thrombus: A Case Report","authors":"M. Anisuzzaman, N. Hosain, Zulfiqar Rashid","doi":"10.3329/cardio.v15i1.61921","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61921","url":null,"abstract":"The incidence of venous extension to the inferior vena cava (IVC) of renal cell carcinoma (RCC) is markedly increased recently mostly due to the advances in diagnostic modalities. Such vascular invasion implies a heightened biologic behavior and a surgical challenge during the course of treatment. Here we discussed a case with study of the classification guidelines, recent diagnostic tools and up-to-date therapeutic modalities for RCC with IVC tumor thrombi. Also added to the discussion are the prognostic significance regarding the pathologic nature of vascular invasion, cephalad extent of thrombi and any associated distant metastasis.\u0000Cardiovasc j 2022; 15(1): 111-115","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86083588","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}
Sultan Sarwar Parvez, M. R. Amin, Reazul Haque, Jalal Uddin
{"title":"Delayed Surgical Repair of Ventricular Septal Rupture with CABG following Acute Myocardial Infraction- A Case Report","authors":"Sultan Sarwar Parvez, M. R. Amin, Reazul Haque, Jalal Uddin","doi":"10.3329/cardio.v15i1.61919","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61919","url":null,"abstract":"Ventricular septal rupture (VSR) is a rare but often life-threatening mechanical complication after acute myocardial infarction. Although surgical intervention is challenging and associated with high mortality and morbidity, but it is still now the gold standard treatment. Percutaneous device closure of VSR is an option in selected patients with suitable anatomy and when surgery is contraindicated. Optimally medically managed patients who survive at least 4 weeks before elective surgery to generate scar formation at the edges of the defect in a viable infarcted tissue have the greatest outcomes. Here we report a case of VSR following acute myocardial infarction. About 3 weeks after the occurrence of ventricular septal rupture following acute myocardial infraction, surgery was successfully performed with good outcome.\u0000Cardiovasc j 2022; 15(1): 100-105","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"43 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77566489","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}
M. A. K. Akanda, M. Ullah, M. Rahman, Md Sarwar Alam, Amiruzzaman Khan
{"title":"A Case of Giant Right Coronary Artery Aneurysm after DES Implantation","authors":"M. A. K. Akanda, M. Ullah, M. Rahman, Md Sarwar Alam, Amiruzzaman Khan","doi":"10.3329/cardio.v15i1.61917","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61917","url":null,"abstract":"Coronary artery aneurysms (CAAs) are not very uncommon but giant coronary artery aneurysms are rare with a reported prevalence of 0.02% to 0.2%. Recently, with the advent of implantation of drugeluting stents, there are increasing reports suggesting stents causing coronary aneurysms, months or years after the procedure. Though most of the CAAs are asymptomatic, they may present with various clinical presentations like angina pectoris, fistula formation, pericardial tamponade, compression of surrounding structures, congestive cardiac failure or sudden death. The natural history and prognosis remain unclear. Despite the important anatomical abnormality of the coronary artery, the treatment options of CAAs are still poorly defined and present a therapeutic challenge. We report a case of iatrogenic giant CAA following percutaneous transluminal coronary angioplasty (PTCA) with its relevant management strategy.\u0000Cardiovasc j 2022; 15(1): 88-94","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86953500","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}
A. S. Islam, Aym Shahidullah, M. Mostofa, Md Daud Hossain
{"title":"Replantation of an Amputated Hand- A Landmark surgery with Multidisciplinary Team Approach","authors":"A. S. Islam, Aym Shahidullah, M. Mostofa, Md Daud Hossain","doi":"10.3329/cardio.v15i1.61920","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61920","url":null,"abstract":"An amputation of the hand is a disastrous traumatic injury especially for advanced machinery workers which adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities. It also produces great psychological impact. In the following case report, we described a middleaged male with an amputation at the level of the distal forearm who underwent replantation. The transfer of the amputated hand, operative technique and postoperative status are described. Awareness of the possibility of salvage should be spread among healthcare providers and the need for immediate attention by a multispecialty team is advocated. This report reviews the literature related to the operative technique, contraindications and long-term results.\u0000Cardiovasc j 2022; 15(1): 106-110","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77505995","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}
Md Shariful Islam, Abdul Kader Akanda, M. Ullah, Md Gulam Mostafa, Md Zillur Rahman, Mohammad Mamoon Islam
{"title":"Association of Troponin-I Level with Left Ventricular Systolic Dysfunction after First Episode of Non- ST Elevation Myocardial Infarction","authors":"Md Shariful Islam, Abdul Kader Akanda, M. Ullah, Md Gulam Mostafa, Md Zillur Rahman, Mohammad Mamoon Islam","doi":"10.3329/cardio.v15i1.61909","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61909","url":null,"abstract":"Background: Serum troponin is an exquisitely sensitive marker of myocardial injury and is necessary for establishing the diagnosis of Myocardial Infarction particularly non-ST elevation myocardial infarction (NSTEMI). However, the relation of troponin-I level with left ventricular systolic dysfunction following first episode of NSTEMI are still not examined in our population. Therefore, to determine the relationship of serum troponin I with left ventricular ejection fraction after first episode of NSTEMI was set as an objective of the study.\u0000Methods: This cross sectional analytical study was conducted on 160 patients. They were divided into the two groups (80 patients in each group): Group-A (Troponin I level e” 0.4 ng/ml) high risk group and Group-B (Troponin I level < 0.4 ng/ml) low risk group. Left ventricular systolic dysfunction was defined as ejection fraction (EF%) < 50% calculated by modified Simpson’s method on transthoracic echocardiography. Association of troponin-I level with left ventricular systolic function was determined.\u0000Results: Among a total 160 patients, no significant variation across the group A and B in terms of age, gender and occupation (p>0.05 in all cases). Median serum troponin I of group A was 7.24 (range: 0.41- 58.25) and group B was 0.21(range: 0.12-0.39). Left ventricular EF was significantly lower in higher troponin I group (Group A-45.95±10.28 vs. Group B-56.30±7.78; p<0.05) and it was associated with higher proportion of left ventricular dysfunction (p<0.05).\u0000Conclusion: Serum troponin-I can be considered as a predictor of the left ventricular systolic dysfunction in first episode of Non-ST elevation myocardial infarction patients.\u0000Cardiovasc j 2022; 15(1): 42-48","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"86 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84123743","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":"Revascularization Failure: Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting","authors":"A. Islam, A. Reza, S. Munwar, S. Talukder","doi":"10.3329/cardio.v15i1.61915","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61915","url":null,"abstract":"Coronary artery disease (CAD) is one of the leading causes of mortality and morbidity in our Bangladeshi patient population. Percutaneous coronary intervention (PCI) or Coronary artery bypass grafting (CABG) are the gold standard of revascularization to treat these group of patients. Both treatment modalities may contribute to both short term and long-term excellent benefit with the relief of symptoms and improves quality of life. Beside the availability of modern techniques along with 3rd generation Drug eluting stents (DES) for PCI and uses of arterial conduit in bypass surgery, in long-term follow-up, many of the patient needs repeat revascularization. In Bangladesh, many of the centers are doing state of the art treatment with the available of most of interventional aids in treating complex PCI as well as primary PCI. Similarly, CABG with the advent and available expertise, minimal invasive bypass surgery or beating heart surgery, facilitate CABG more convenient for patient and surgeons as well. Exact data on stent occlusion or graft failure that may leads to repeat revascularization is not well understood in our circumstances. We need to form a common consensus, if needed, to form a national registry or database to follow up PCI or CABG patients who develop subsequent revascularization failure and address the reason behind. Thus, to reduce the needs of repeat revascularization and improve long term quality of life.\u0000Cardiovasc j 2022; 15(1): 81-85","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"35 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81073973","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}
Md Saiduzzaman, Md. Shahriar Kabir, Asmg Rabbani, Md Abdul Matin, Md. Rezaul Alam, Khandaker Abu Rubaiyat, Md Mamun Reza
{"title":"Analysis of Risk Factors among the Hypertensive Patients in a Tertiary Care Hospital of a Northern District in Bangladesh","authors":"Md Saiduzzaman, Md. Shahriar Kabir, Asmg Rabbani, Md Abdul Matin, Md. Rezaul Alam, Khandaker Abu Rubaiyat, Md Mamun Reza","doi":"10.3329/cardio.v15i1.61913","DOIUrl":"https://doi.org/10.3329/cardio.v15i1.61913","url":null,"abstract":"Background: Hypertension is the leading cause of cardiovascular morbidity and mortality all over the world. Although some epidemiological studies on hypertension have been conducted in Bangladesh, the factors associated with hypertension in this nation remain unclear. The objective of this study was to determine the factors associated with hypertension among the adult population in a northern district in Bangladesh.\u0000Methods: This cross- sectional study was conducted at the Department of Cardiology, M. Abdur Rahim Medical College Hospital, Dinajpur from March 2021 to February 2022. Out of total of 500 participants from OPD and indoor Cardiology Department of this hospital, 250 hypertensive patients were recruited as cases and another 250 normotensive participants were taken as control.\u0000Results: Majority of the hypertensive patients in the study population were in 46-55 years of age group [male 48(32.4%) and female 40(39.2%)]; whereas normotensive participants less in number in the same age group [male 20(16.1%) and female 24(19.0%)]. Hypertension was more common in males (59.2% of cases). Moreover, hypertensive participants had strong family history (66%) of hypertension, urban residential area (68%), habits of smoking (67.2%), diabetes mellitus (64%), and excess salt consumption (70%). Raised levels of total cholesterol, triglycerides, and LDL were more common among hypertensive participants than that of the normotensive control group and which was found to be statistically significant.\u0000Conclusion: Our study shows that the risk of hypertension was significantly associated with older age, male sex, family history of hypertension, urban residence, smoking, excess salt consumption, higher BMI and waist circumference, dyslipidemia and diabetes mellitus. More studies and area-specific longitudinal research is needed in this field which would help adopt national policies to limit incidence as well as consequences of hypertension in our country.\u0000Cardiovasc j 2022; 15(1): 69-74","PeriodicalId":9438,"journal":{"name":"Cardiovascular Journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88331122","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}