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Minimally Invasive Mitral Valve Surgery: An Update
Issue:
Volume 3, Issue 5, September 2017
Pages:
32-40
Received:
16 June 2017
Accepted:
27 September 2017
Published:
17 October 2017
Abstract: Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects of MIMVS are discussed in relation to its approaches (right parasternal incision, lower ministernotomy, right anterolateral minithoracotomy and left posterior minithoracotomy) as well as strategies (mini-incisions, video-assistance, video direction with robotic assistance and telemanipulation) passing through more than 2 decades of continuous evolution. In the current practice MIMVS shows similar outcome to conventional surgery with even more superior results regarding blood loss, ICU and hospital stay, as well as functional recovery. The accumulating experience with MIMVS encouraged surgeons to extend the application of these techniques to high-risk patients, redo surgeries, concomitant double or triple valve procedures as well as combined coronary artery and mitral valve diseases in a hybrid approach, reducing the need for full median sternotomy. In addition there is an emerging trend of transcatheter valve implantation in the mitral position with small reports of valve-in valve or valve-in- ring implantation as well as valve replacement in case of severe MAC. This new trend may establish itself in the future as a modality in treating native mitral valve diseases in high risk patients. Therefore it is recommended for cardiac centers to build up a program for MIMVS in order to fulfill the recent requirements of cardiac surgery.
Abstract: Minimally invasive mitral valve surgery (MIMVS) was introduced in the mid-1990s to refer to a variety of surgical techniques that avoid full sternotomy through smaller or alternative chest wall incisions, as an attempt to reduce complications, but at the same time preserve outcomes of the full sternotomy approach. In this review, different aspects ...
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3D A Retrospective Cohort Study Examining 3D Reconstruction to 2D Radiology in Identifying Rib Fractures
Gordon McCauley,
Sanjeet Singh,
Sudeep Das De,
Alan Kirk
Issue:
Volume 3, Issue 5, September 2017
Pages:
41-52
Received:
22 February 2017
Accepted:
22 March 2017
Published:
23 October 2017
Abstract: Introduction: Rib fractures are common presentations at emergency departments across the UK. 21% of emergency admissions are related to rib fractures, resulting from up to 39% of all blunt-trauma to the chest. Imaging is essential for identification of rib fractures but also for planning potential surgical intervention. The introduction of 3D imaging has enhanced the pre-surgical planning in many fields of medicine. We compared 3D CT in the identification of rib fractures to conventional 2D radiology. Methods: A retrospective cohort study of 22 patients was conducted at a district general hospital between Novembers 2014-2016. Chest X-ray, 2D CT and 3D CT findings were compared for the number of rib fractures and identification of displacement of rib fractures. Statistical analysis was performed using a 3-way ANOVA, with Cohen’s kappa statistic (κ) to identify agreement. There were 22 patients (20M: 2F) patients in this study. The mean age of patients was 50.2 ±21.7 (range 10-94). Chest X-rays had the poorest identification rate with slight agreement with 3D CT (κ=0.018). There was also a slight agreement for identification of displacement between 2D and 3D CT imaging (κ=0.127) Conclusion: Chest X-ray on its own is inferior to 2D and 3D CT. 3D CT adds to the value of 2D imaging as it gives an enhanced view of any possible fracture displacement.
Abstract: Introduction: Rib fractures are common presentations at emergency departments across the UK. 21% of emergency admissions are related to rib fractures, resulting from up to 39% of all blunt-trauma to the chest. Imaging is essential for identification of rib fractures but also for planning potential surgical intervention. The introduction of 3D imagi...
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Mitral Valve Rupture Following CABG and PDA Endarterectomy: A Rare and Potentially Lethal Complication
Kawkabani Nadine,
Darwish Rula,
Bejjani Simon,
Boustros Omar,
Abou Khalil Bassam
Issue:
Volume 3, Issue 5, September 2017
Pages:
53-56
Received:
14 March 2017
Accepted:
10 April 2017
Published:
23 October 2017
Abstract: Mitral valve rupture is a very rare and lethal complication following coronary artery bypass grafting (CABG). We report in this paper a case of mitral valve rupture ninety hours following CABG and coronary endarterectomy and we review the literature for similar cases in order to determine the different etiologies and mechanisms that may precipitate such serious adverse event and to define the measures that will help us diagnosing and treating promptly this complication.
Abstract: Mitral valve rupture is a very rare and lethal complication following coronary artery bypass grafting (CABG). We report in this paper a case of mitral valve rupture ninety hours following CABG and coronary endarterectomy and we review the literature for similar cases in order to determine the different etiologies and mechanisms that may precipitate...
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Comparison of Outcome in Male and Female Indian Patients Undergoing Cabg, Activity Levels and Quality of Life: One Year Follow-Up Study
Rakesh Kumar,
Milind Padmakar Hote,
Gautam Sharma,
Bhaskar Thakur,
Balram Airan
Issue:
Volume 3, Issue 5, September 2017
Pages:
57-62
Received:
16 February 2017
Accepted:
23 March 2017
Published:
24 October 2017
Abstract: This study intended to find out the outcome (in terms of quality of life and activity levels) of coronary artery bypass graft surgery (CABG) in Indian population; and whether there are differences associated with gender of the patient. Standard SF 36 questionnaire was utilized to access patient’s general health, emotional status, and social activity following surgery. It has been noted that, there is significant apprehension amongst Indian population related to open heart surgery and that patients are hesitant to return back to their normal preoperative routine following heart surgery especially CABG. The socioeconomic and educational background of the Indian patient population is commonly such that it precludes them from returning to full activity status following surgery. Hence this study is conceptualized to objectivise the outcome following CABG surgery in Indian patients and also assess any gender differences noted in the outcome following this surgery. Material and Methods: Prospective analysis was done at one year follow up of patients undergoing coronary artery bypass grafting between 1st July 2015 – 31st October 2016, without having other cardiac complications like mitral regurgitation, ventricular dysfunction, ventricular aneurysm/rupture or other complications. Patients who were operated on pump/off pump, having pre-op diabetes or hypertension at AIIMS New Delhi, coming for follow up at routine intervals, were included in this study. Using SF 36 questionnaire here we recorded the patients’ detailed activity levels and quality of life in post-operative period, also we correlated the impact of CABG surgery with gender of patients. We compared the outcome in 168 male and female patients, who underwent CABG surgery during the study period. Follow-up was completed at intervals of 1 week, 1 month, 3 months, 6 months and 12 months following surgery. This follow-up was done both telephonically and during their office visits. Results: After 4 weeks following CABG (average 30 days), both men and women had less anxiety and symptoms related to depression than before surgery. After 6 months (average 184 days), both men and women improved in their physical and social functioning. Although changes in scale scores were similar for men and women at each time point, women scored lower than men on these domains, and had more symptoms related to depression through 1 year after CABG. Conclusions: Both male and female patients improve in physical, social, and emotional functioning after CABG, and recovery over time is similar in men and women. However women’s health-related quality-of-life scale scores remained less favourable than men’s through 1 year after surgery.
Abstract: This study intended to find out the outcome (in terms of quality of life and activity levels) of coronary artery bypass graft surgery (CABG) in Indian population; and whether there are differences associated with gender of the patient. Standard SF 36 questionnaire was utilized to access patient’s general health, emotional status, and social activit...
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Mediastinal Pseudo-Tumor Tuberculosis Associated with Systemic Lupus Erythematosus
Nassima Dekdouk,
Djennette Hakem,
Karima Abbaci,
Nassima Djami,
Rabah Amrane,
Rafika Boughrarou,
Brahim Mansouri,
Abdelkrim Berrah
Issue:
Volume 3, Issue 5, September 2017
Pages:
63-66
Received:
27 May 2017
Accepted:
16 June 2017
Published:
24 October 2017
Abstract: We report the singular association of mediastinal pseudo-tumoral tuberculosis [TB] with systemic lupus erythematosus [SLE]. D. I, 22 years old woman, is followed for a SLE since 2006 controlled by hydrochloroquine ‘HCQ’200mg twice/day and a thyroiditis of Hashimoto under levothyrox 125 mg/d. It does not relate to tuberculosis. She is hospitalized in pneumology for progressive dyspnea and chest pain. Objective clinical examination shows a conserved general condition, apyrexia T° to 37, BMI to 21.1 (without notion of loss of weight), heart beat 94 / min, respiratory rate at 24 cycle/min and blood pressure at 110/60 mmHg. The pleuropulmonary and cardiovascular examination were without abnormality and thus the remainder of the clinical examination. The image of the thoracic face fails with a right para-cardiac opacity erasing the right edge of the cortex and the CT concludes to a mediastinal tumoral process, filling the gutter vertebral and extending from T6 to T10, with tissue density presenting areas of necrosis within it. Bronchial fibroscopy finds a thickening of inter-lobar spurs and bronchial biopsies identifies a bronchial mucosa site of chronic inflammatory remodeling with presence of multi-nucleated giant cells suggesting a tuberculoid process. The parameters of the hemogram were normal and the inflammatory syndrome was attested by both the increase ERS at 54 mm and the level of CRP at 12 mg/l. The smears, negative on direct examination, will prove positive for culture on Lowenstein medium. Antituberculosis treatment has been prescribed with good clinical, bacteriological and radiological progress. Long-term asymptomatic mediastinal pseudo-tumoral tuberculosis can be revealed at the compressive stage by dyspnea and chest pain. The fear of lymphoma requires biopsies with pathological examinations which sometimes reveal benign affections (tuberculosis, sarcoidosis in their tumor forms) which can enamel the autoimmune disorders characterizing a SLE.
Abstract: We report the singular association of mediastinal pseudo-tumoral tuberculosis [TB] with systemic lupus erythematosus [SLE]. D. I, 22 years old woman, is followed for a SLE since 2006 controlled by hydrochloroquine ‘HCQ’200mg twice/day and a thyroiditis of Hashimoto under levothyrox 125 mg/d. It does not relate to tuberculosis. She is hospitalized i...
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