There are many factors that determine the best neurocognitive outcome following cardiac surgery. Optimum oxygen delivery to the tissues has always been the goal to optimum perfusion. Some patients may exhibit neurocognitive impairments in the early postoperative period; that could be easily missed clinically as they are not associated with radiographic evidence of structural brain damage. At this study we aimed to correlate the lowest oxygen delivery levels with incidence of neurocognitive impairment in the early postoperative period by Folstein test. A non-randomized, prospective pilot study was designed to correlate the nadir oxygen delivery (DO2) during CPB with post-operative cognitive impairment. The study included 271 patients of both sexes, an age group of 50–60 years with university level of education, scheduled for elective, isolated CABG for three vessel disease. All patients underwent pre-and post-operative neurocognitive test by a specialized neuropsychiatric doctor. with a mean nadir DO2 of 291 mL/min/m2, the majority of the patients exhibited "normal" results, with a mean nadir DO2 of 266 mL/min/m2 92 patients showed mild impairment in their cognitive behavior, while the worst results "moderate" and "severe" were associate with means of 244,200 mL/min/m2 successively. The nadir oxygen delivery is a risk factor for development of post-operative neurocognitive impairment. A level below 260 mL/min/m2 is generally associated with higher risk while a level below 220 mL/min/m2 carries the worst prognosis.
Social media browsing became a daily activity of most people including physicians. The use of social media in healthcare can help patients, healthcare professionals, and researchers to keep more updated. However, there are concerns about the risks of using social media for healthcare providers including high rates of false information, and the opportunity cost of using physician time. This study aims to define how cardiothoracic surgeons used social media and the effect of its use on surgical practice and patients' management progress. The present study was a cross-sectional pilot study based on online questionnaire. The convenient sample was recruited through announcement at cardiothoracic surgeons' Facebook groups and also by email invitations for members of cardiothoracic societies. The number of respondents was 83 physicians. About the half of the sample were Egyptians (50.6%). There was a statistically significant different between Egyptian and non- Egyptian cardiothoracic surgeons as regards time spent while using social media as Egyptians spent more time. Most of respondents used social media for official purposes as advertisement and patients' education. Thirty percent of surgeons thought that, the social media were sometimes relevant and helpful for their jobs and this was mainly by increasing communication with other colleagues. Social media is modifying the nature of interaction between healthcare workers and patients. There is a significant need and a great opportunity for healthcare professionals to provide extra support for patients and their careers beyond the hospital walls using social media.
Current surgical technique to fix the tricuspid valve regurgitation carry a high percentage (up to 37%) of recurrence of severe tricuspid valve regurgitation in mid-term follow up. There is a need for anatomically and physiologically correct Tricuspid annulus device. Our ring is developed in the way that mimics the normal anatomy & physiology of Tricuspid annulus. The aim of this study is to test three prototypes and choose the proper prototype that is tested and suitable to conform well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle. We used an acute open heart model in sheep as an animal model to test three prototypes. We used adult sheep (6 males and 6 females), body weight 60–70 Kg, age: 1–3 years old. We followed the protocol of open heart model in animals. Post Prototype implantation, Tricuspid valve leaflet coaptation was verified with no induced tricuspid regurgitation. On the other hand, there was no ring distortion or ring material fracture. All the three prototypes conformed well to the normal shape of the tricuspid annulus with no distortion of the movement during the different phases of the cardiac cycle (both in systole and diastole). All the three tested prototypes seemed to be effective and reproducible.
Atrial fibrillation (AF) is the most common sustained arrhythmia. It increases the risk of thromboembolic stroke, anticoagulation induced bleeding, and the overall mortality. Restoration of the sinus rhythm may improve the quality of life and reduce the mortality. The classic ‘cut and sew’ cox maze procedure is the gold standard; however, it is complex. Bipolar radiofrequency ablation is faster and simpler. This study included 129 patients. They underwent bipolar radiofrequency ablation for their AF in concomitant with their cardiac surgery from 2008 throughout 2016 in Morriston hospital in UK. Patients were followed up for 6 months and divided according to their rhythm at 6 months into sinus group and AF group. Peri-operative data were collected. Comparison between the two groups was done to determine the predicting factors for the restoration of the sinus rhythm. 42 patients were in AF in 6 months, while 87 patients restored their sinus rhythm. The two groups were compared according to different parameters. The results were tabulated and analysed using different tests. The significant predicting factors were left atrial diameter (P=0.004), type of AF (P=0.005), duration of AF (P<0.001), and the rhythm at discharge (P=0.020). The predicting factors for the restoration of the sinus rhythm after AF ablation were: smaller left atrial diameter, paroxysmal atrial fibrillation, short duration of atrial fibrillation, and sinus rhythm at discharge.
Right ventricle outflow tract myocardium in tetralogy of Fallot reflects the effect of hemodynamic stresses on right ventricle muscle and correlates with clinical right ventricle dysfunction. It may be a useful adjunct in determining the time for intracardiac repair and predicting the clinical outcome. Septal and parietal bands of infundibular septum and obstructing muscle bands were excised in 48 patients undergoing intracardiac repair for tetralogy of Fallot. Microscopic study of histopathological changes in resected muscle bands was done. Post operative 2D echocardiography and tissue doppler imaging were done at the end of first and third month evaluating the right ventricular function. Moderate myocardial fibrosis was seen in 42.9% (12/28) patients with age >5 years compared to 37.5% (6/16) patients with age between 1-5 years and 0% patients with age < 1 year (P >0.05). Right ventricular dysfunction was seen in 41.9% (18/43) patients who had no myocardial ischemia compared to 60% (3/5) patients with myocardial ischemia. Right ventricular dysfunction was noted in 13.33% (4/30) patients having mild myocardial fibrosis compared to 33.33% (6/18) patients with moderate myocardial fibrosis (P >0.05). Early postoperative right ventricular dysfunction was seen in more number of patients with increasing age as calculated by fractional area changes and Tei index. Myocardial fibrosis was seen in more number of patients as age progresses. Early postoperative right ventricular dysfunction was more frequent in patients with higher grade of myocardial fibrosis and higher age group.
