Background: The cardiac operative procedure has a significant relationship with acute onset of pain. After cardiac surgery, pain has been managed with the help of opiate analgesics. Objective: To analyze the adverse effects of postoperative multimodal analgesia after cardiac surgery concerning the physical and specific biochemical parameters of undergoing surgery patients. Materials & Methods: It was a single-center, prospective study where patients were approached on the day before their cardiac surgery. A total of 120 post-cardiac operative surgery patients at Khwaja Yunus Ali Medical College Hospital, Sirajganj were included for this study purpose. Results: In first group, three types of analgesia were used in 60 patients and in second group, five types of analgesia were used in another 60 patients. About 76.7% were male and mean age was 45.73 (± 11.3) years. Fentanyl was used for all patients followed by paracetamol (96.7%), diclofenac (83.3%), tramadol (16.7%), and pethidine (3.3%). Drug-induced nausea and vomiting were found in 76.7%and 66.7% patients respectively followed by drowsiness (36.7%) and vertigo (20.0%). Conclusion: In patients undergoing cardiac surgery, a multimodal regimen offered better analgesia. Furthermore, nausea and vomiting complaints were reduced significantly in the multimodal group. KYAMC Journal Vol. 13, No. 02, July 2022: 94-97

Total anomalous pulmonary venous connection (TAPVC) is a congenital cyanotic heart disease where all 4 pulmonary veins do not open directly to left atrium. There are 4 types of TAPVC. Supra cardiac type forms a confluence and may open to Innominate vein or SVC. Cardiac type usually opens to coronary sinus. Infracardiac type opens to hepatic veins or other veins. Mixed type is the combination of others. Of these 4 types infracardiac type is most vulnerable and presents with early features of cyanosis, pulmonary hypertension, pulmonary vein obstruction. We present the case of an 18 year old lady with atrial septal defect (ASD) with cyanosis. Pre operative echo showed ASD with 3rd chamber behind LA, CT angiogram revealed large ASD, with tongue like extended chamber in posteromedial aspect of RA. Preoperative angiogram report was inconclusive. Despite the diagnostic dilemma, we took the challenge and the patient went for open heart surgery. The patient recovered well and discharged on 10 th post operative day. Post operative echocardiogram is encouraging and she is doing fine. KYAMC Journal.2021;12(02): 107-110

Nitrogen (N) is the prime nutrient for crop production and carbon-based functions associated with soil quality. The objective of our study (2012 to 2019) was to evaluate the impact of variable rates of N fertilization on soil organic carbon (C) pools and their stocks, stratification, and lability in subtropical wheat (Triticum aestivum)-mungbean (Vigna radiata)-rice (Oryza sativa L) agroecosystems. The field experiment was conducted in a randomized complete block design (RCB) with N fertilization at 60, 80, 100, 120, and 140% of the recommended rates of wheat (100 kg/ha), mungbean (20 kg/ha), and rice (80 kg/ha), respectively. Composite soils were collected at 0-15 and 15-30 cm depths from each replicated plot and analyzed for microbial biomass (MBC), basal respiration (BR), total organic C (TOC), particulate organic C (POC), permanganate oxidizable C (POXC), carbon lability indices, and stratification. N fertilization (120 and 140%) significantly increased the POC at both depths; however, the effect was more pronounced in the surface layer. Moreover, N fertilization (at 120% and 140%) significantly increased the TOC and labile C pools when compared to the control (100%) and the lower rates (60 and 80%). N fertilization significantly increased MBC, C pool (CPI), lability (CLI), and management indices (CMI), indicating improved and efficient soil biological activities in such systems. The MBC and POC stocks were significantly higher with higher rates of N fertilization (120% and 140%) than the control. Likewise, higher rates of N fertilization significantly increased the stocks of labile C pools. Equally, the stratification values for POC, MBC, and POXC show evidence of improved soil quality because of optimum N fertilization (120-140%) to maintain and/or improve soil quality under rice-based systems in subtropical climates.

Rheumatic valvular heart disease is quite common in Bangladesh. It affects most commonly mitral and aortic valve. As a result of annular fibrosis, aortic root become smaller in some patients. So, if smaller prosthesis is implanted, there is gross patient prosthesis mismatch (PPM), poor LV regression, increase overload, and ultimately low survival rate. Its' to report our experience in aortic root enlargement in case of double valve replacement where a patient of severe mitral stenosis and aortic regurgitation with small aortic annulus requiring aortic root enlargement (ARE).Weaning from Cardiopulmonary bypass (CPB) was uneventful, perioperative and post operative period was satisfactory. Post-operative echocardiography revealed normally functioning prosthesis. In case of small aortic root, aortic root enlargement (ARE) can be safely done by double valve replacement to overcome the prosthetic patient mismatch (PPM). KYAMC Journal Vol. 11, No.-2, July 2020, Page 108-110

Background: There is significant difference between the survival of patient with and without post-operative pulmonary arterial hypertension (PAH). This study was designed to see the early post-operative outcomes of PAH after preoperative oral administration of ambrisentan. Objective: Evaluation of role of preoperative oral ambrisentan for the management of PAH following cardiac surgery for ventricular septal defect (VSD) with moderate to severe PAH. Materials and Methods: A total of 54 patients were stratified into two equal groups (n=27) depeding upon receiving of orala mbisentan. Ambrisentan group received dose of 2.5mg and 5mg in two divided doses for weight <20kg and > 20 kg respectively at least two weeks before surgery. Results: PASP was measured peroperatively before establishment of CPB, immediately after VSD closure and after weaning from CPB which were 59.55±11.16 mm of Hg, 45.49±9.46 mm of Hg and 40.49 ±10.33 mm of Hg respectively in the ambrisentan group (Group-A) and was 71.92 ±10.62 mm of Hg, 66.34±10.22 mm of Hg and 62.14 ±9.46 mm of Hg respectively in the control group (Group-B) with a p value of 0.002, 0.001 and 0.001 respectively. Considering PASP on echocardiogram at 7th post-operative day was 33.55 ± 1.23 in ambrisentan group and 41.70 ± 5.60 in control group. At one month PASP on echocardiogram was 30.55±2.26 in ambrisentan group and 39.11 ±3.28 in control group. Conclusion: Preoperative oral administration of ambrisentan is more effective in control of postoperative PAH and may be advised in every patients with VSD with moderate to severe PAH. KYAMC Journal Vol. 11, No.-1, April 2020, Page 36-41

Sinus of Valsalva Aneurysms are extremely rare cardiac anomalies.The sinus of Valsalva aneurysm (SVA) is a small dilatation caused by a separation between the aortic media and annulus fibrosus. Its may be either acquired or congenital. The right coronary sinus is most frequently affected. The most common complication being rupture.We present the case of a 12-year old girl with ruptured non-coronary sinus of valsalva aneurysm associated with ventricular septal defect , mitral regurgitation grade II and severe pulmonary hypertension. Echocardiography is sufficient to diagnose SVA, its complications, repercussions, and surgical options. SVA, even if asymptomatic, has potential risks of expansion,rupture, cardiac failure, endocarditis, embolism and sudden death. This justifies surgical correction, with a low mortality rate in both the short- and long-term. KYAMC Journal Vol. 10, No.-4, January 2020, Page 211-213

Mediastinal tumors are slow growing tumors of rare entity. They usually affect middle aged people ranging from 30-50 years. When they grow, may compress surrounding structures and produce symptoms such as cough, chest pain, chest tightness and respiratory distress. The most common anterior mediastinal masses are thymoma and lymphoma. Posterior mediastinal tumors are mainly neuroendocrine tumors. Diagnosis depends upon proper clinical history, X-ray chest, CT scan and if necessary CT guided FNAC. Sometimes hormonal tests such as -hCG and AFP may be needed for Germ cell tumors. Treatment is usually by wide surgical excision and biopsy followed by chemo or radiotherapy. Hodgkin's and Non-Hodgkin's Lymphoma are usually treated by chemotherapy. For proper management, widespread suspicion and diagnostic facilities should be available before the start of treatment. KYAMC Journal Vol. 11, No.-3, October 2020, Page 161-163

Two sets of experiments were conducted in Bangladesh for 10 successive growing seasons of transplanted aman and boro rice during 2010-2015 to assess the effects of tillage and organic amendments on properties and carbon sequestration index (CSI) of terrace soil. The experiment 1 comprised of two tillage practices (minimum and traditional) and three rice straw management (zero, incorporation, and mulch). The experiment 2 consisted of five treatments viz. control, poultry manure (PM), cowdung (CD), rice straw (RS), and soil test-based fertilizers. A fixed carbon (C) rate of 2 t ha(-1) was ensured from organic amendments in each crop season. Data were collected after harvesting of the 10(th) crop in 2015. Traditional tillage and RS mulch were found immensely positive for microbial population and biomass C and nitrogen (N) in soils. Minimum tillage tied with RS incorporation was appeared positive in holding C and nutrients and increasing CSI. Poultry manure contributed to higher quantities of bacteria, fungi, and actinomycetes and attributed to maximum biomass C and N compared to other organic treatments. Organic amendments increased soil aggregate stability, nutrients, and moisture contents. The CSI of RS (0.21-0.29), PM (0.25), and CD (0.22) can be used to predict soil C sequestration.

Total anomalous pulmonary venous connection (TAPVC) is a rare congenital heart disease in which there is developmental absence of connection of all four pulmonary veins with the left atrium. To report a rare case and share our experience in surgery and post-operative management for supracardiac TAPVC. Patient with supracardiac TAPVC with atrial septal defect (ASD) secundum variety with rudimentary patent ductus arteriosus (PDA) underwent rechanneling of pulmonary veins to left atrium (LA) with gluteryldehye treated autologous pericardial patch closure of ASD with ligation of ascending vertical vein and ligation of rudimentary PDA.Post operatively there were no events of pulmonary hypertensive crisis, low cardiac output syndrome, right heart failure or conduction defect were observed and echocardiogram showed adequate pulmonary venous drainage with no residual shunt across the interatrial septum. Marked development in surgical results of TAPVC has been observed in recent years with declining mortality rate from 65% in early sixties to 5% in current surgical scenerio. KYAMC Journal Vol. 10, No.-2, July 2019, Page 118-121

Background: Coronary artery bypass surgery (CABG) with cardioplegia has been considered the gold standard operation for coronary revascularization. Activation of compliments system after CABG surgery involves C-reactive protein (CRP). Patients with preoperative increased CRP levels have significantly higher CRP levels on postoperative days and are at increased risk of developing postoperative complications. High sensitivity CRP ( hs-CRP ) is lower concentration of CRP measured by the hs-CRP test. It is more sensitive and more useful in predicting the potential risk level for cardiovascular disease, heart attacks and strokes. Objective: To assess the association of preoperative hs-CRP level with the incidence of postoperative arrhythmia, low output syndrome and sternal wound infection following on pump CABG surgery. Materials & Methods: The study was cross sectional analytical study. A total of 70 patients were selected. For the purpose of analysis the study subjects were divided into two group; Group A patients with preoperative hs-CRP level <3mg/l (n=35) and Group B patients with preoperative hs-CRP level >3mg/l (n=35). The incidence of early outcome- arrhythmia, low output syndrome and sternal wound infection were observed within 30 days of surgical procedure. Results: The incidence of arrhythmia, low output syndrome and sternal wound infection were significantly less in group A than those in group B. Logistic regression analysis showing significant correlation of hs-CRP with arrhythmia, p value is 0.005; with low output syndrome, p value is 0.003 and with sternal wound infection, p value is 0.004. Conclusion: Preoperative hs- CRP is an important determinant of post operative outcome after CABG surgery and might be useful as predictive marker in risk stratification for postoperative complications in patients scheduled for on pump CABG surgery. KYAMC Journal Vol. 9, No.-4, January 2019, Page 153-158

Single atrium is a rare congenital heart disease in which there is developmental absence of both septum primum and secondum part of atrial septum. this report of rare case is to share our experience in surgery for Single atrium. Patient with single atrium with persistant left superior venacava (PLSVC) and left sided Inferior venacava (IVC) underwent gluteryldehye treated autologous pericardial patch closure, separating the two atria and leaving the coronary sinus, both PLSVC and Left IVC in the right atrial side and drainage of all four pulmonary vein into Left atrium. Post operatively there was no conduction defects in electrocardiogram and echocardiogram showed no residual shunt across the neoatrial septum. The long-term survival of surgical correction of single atrium is good. To avoid injury to the conduction system one has to be utmost careful by keeping the sutures remote and superficial from the bundle. KYAMC Journal Vol. 10, No.-1, April 2019, Page 54-56

Malignant pleural effusions (MPE) are a common clinical problem in patients with neoplastic disease. In adults, 95% of neoplastic pleural effusions arise from a metastatic source, with lung and breast carcinoma accounting for 75% of all cases. Median survival following diagnosis ranges from 3 to 12 months and is dependent on the stage and type of the underlying malignancy. Most pleural metastases arise from tumor emboli to the visceral pleural surface, with secondary seeding to the parietal pleura. Other possible mechanisms include direct tumor invasion, hematogenous spread to parietal pleura, and lymphatic involvement. Dyspnoea is the most common presenting symptom and is occasionally accompanied by chest pain and cough. Chest radiographs confirm the size and location of the pleural collection. Thoracocentesis is usually diagnostic and also therapeutic. Exudative and hemorrhagic collections should be considered metastatic until proved otherwise. Various modalities are available in the management of MPE. Careful consideration of the patient's expected survival and quality of life is needed when deciding the optimum treatment modality in such patients. KYAMC Journal Vol. 9, No.-4, January 2019, Page 182-189

Background: Marfan syndrome is an autosomal-dominant hereditary connective tissue disorder with the clinical manifestations involving the ocular, skeletal, and cardiovascular systems. The cardiovascular manifestations include aortic root dilatation, aortic valvular insufficiency, mitral valve prolapse, mitral regurgitation, aortic dissection and aortic rupture. Acute aortic dissection is one of the most common catastrophes involving the aorta. A high index of suspicion is important in patients who have predisposing risk factors. Classification is based on the location of dissection and its duration. Stanford type A (De bakey type I /type II) dissection should be treated surgically in essentially all cases.Objective: To report our experience in Bentall surgery in Acute aortic dissection (type A ). The efficacy of right axillary artery cannulation was investigated.Materials & Methods: Patient with acute type A aortic dissection involving coronary sinuses with 3 vessels of the arch free of lesions underwent aortic valve with ascending aorta and hemiarch replacement with composite valve graft (Bentall procedure) and reimplantation of coronary arteries under moderate hypothermia. The axillary artery was used for arterial cannulation.Results: Weaning from CPB was smooth. Perioperative period was eventless. Follow-up Echo revealed normal cardiac parameters.Conclusion: Prompt establishment of the diagnosis, through focused physical examination and noninvasive imaging, followed by rapid medical and surgical therapy, are the only effective methods to alter survival in patients with acute aortic dissection.KYAMC Journal Vol. 9, No.-2, July 2018, Page 95-100

Lutembacher's Syndrome is a rare heart disease first described by Lutembacher, is a combination of a congenital atrial septal defect (ASD) and acquired mitral stenosis (MS). Traditionally Lutembacher syndrome has been corrected by surgical treatment. If diagnosis could be done earlier, surgical closure of ASD with replacement of mitral valve bears a good prognostic value. Cases were reported where patients treated percutaneouly with a combined Inoue balloon valvuloplasty and septal defect closure using the Amplatzer septal occlusion device. Our patient Mrs. Kohinoor Begum, 26 years old, non diabetic, non hypertensive, admitted in khwaja Yunus Ali Medical College & Hospital (KYAMCH) on 03.04.2013 with the complaints of respiratory distress and chest pain for 3 years. There was history of recurrent attack of fever in childhood. Subsequently she developed MS from Rheumatic carditis. ASD was congenital in origin. After thorough perioperative evaluation pericardial patch closure of ASD with open mitral commissurotomy was done. Postoperative followup 6 months after operation showed no residual shunt with adequately functioning mitral valve.KYAMC Journal Vol. 5, No.-1, Jul 2014, Page 484-487

Lung hydatid cyst may be primary or secondary. In our case, the cyst was a single one locating in right middle lobe. Hydatidosis locating in different sites, particularly the liver may be associated. Initial growth of primary hydatidosis is asymptomatic. The evolution of the cyst may produce bronchial fistulization and intrapleural rupture. Breaking of primary visceral hydatid cyst in a vein or heart producing hydatidosis is rare. Progressive respiratory deficiency and right ventricular failure due to multiple malignant primary hydatidosis is a special form. The recognition of certain details of the lesion and discoverothers are not visible by conventional radiography, can be done by ultrasonography, computed tomography and magnetic resistance imaging. Surgery is the treatment of choice. Chemotherapy is used in general as a complement to surgical treatment to prevent recurrence. The goal of surgery is to remove the parasite and to treat the bronchialpericyst pathology with other associated lesions. The results are now commonly satisfactory. Prolonged air leakage and pleural infection are most frequent complication. KYAMC Journal Vol. 4, No.-2, Jan 2014, Page 427-430

It is very much problematic to plan the overall therapeutic strategy in patients with coronary artery diseases (CAD) and peripheral arterial diseases (PAD) affecting several arterial segment at the same time. The great saphenous vein (GSV) is usually used as a gold standard conduit. The symptom of the CAD and PAD vary with the site of involvement. Some sorts of the symptom of CAD may be obscured in patient with both CAD and PAD due to lack of ambulation for lower limb claudication, rest pain, ulceration and gangreen. To give maximum benefit to this patient, both the CAD and PAD should be dealt simultaneously or in the same settings. In our perspective if possible and adequate facilities is available the both operations better to be done on the same table. Because it has a better compliance to the patient both for financial savings and avoidance of harassment of 2nd. operation. Our present patient who was followed for 2 months has an excellent postoperative results with disappearance of rest pain and claudication. KYAMC Journal Vol. 3, No.-2, January 2013, Page 312-314 DOI: http://dx.doi.org/10.3329/kyamcj.v3i2.15175

DOI: http://dx.doi.org/10.3329/kyamcj.v1i2.13320KYAMC Journal Vol.1(2) January 2011, 82-83