JOURNAL OF CARDIO THORACIC MEDICINE
Year:2017 | Volume:5 | Issue:2|Papers Count:8

Introduction: Noninvasive positive pressure ventilation (NIPPV) hasbecome an integral tool in the management of acute hypercapnicrespiratory failure (AHRF) in chronic obstructive pulmonary disease(COPD). This study was performed to evaluate the early effects of NIPPVon pulmonary artery pressure (PAP), serum N-terminal pro BNP(NT-proBNP), and ventilatory parameters in the COPD patients withAHRF.Materials & Methods: This quasi-experimental study was conducted on20 COPD patients with AHRF. The participants received the standardtreatment in addition to NIPPV. There was no contraindication for NIPPV.Arterial blood gas analysis, Doppler echocardiography (for measuringPAP), and plasma NT-proBNP measurements were performed before andafter NIPPV.Results: According to the results, the mean age of the participants was54.57±15.43 years. Furthermore, the mean pressures of carbon dioxide(PCO2), NT-proBNP levels, and PAP were 72.33±13.96 mmHg, 4333.90±6542.20 pg/ml, and 47.5±6.38 mmHg, respectively. After oneweek of NIPPV, there were statistically significant differences among themean pH, PaCO2, PAP, and NT-proBNP (P<0.001, P=0.003, P<0.001, andP<0.001, respectively).Conclusion: As the findings of the present study indicated, the applicationof NIPPV in the COPD patients with AHRF can not only improve arterialblood pH and carbon dioxide tension, but also instantly decreaseNT-proBNP levels and PAP.

Introduction: More than 90% of the deaths caused by chronic obstructivepulmonary disease (COPD) occur in the low- and middle -incomecountries. The main aim of this study was to investigate the lipid profilelevels in COPD patients and examine the correlation of total cholesterol, triglycerides, low-density lipoproteins, high density lipoproteins, andLDL/HDL risk ratio with COPD stages that are developed by the globalinitiative for chronic obstructive lung disease (GOLD)Materials & Methods: A total of 100 COPD patients including 25 COPDnon-smokers were enrolled in this study. The diagnosis of COPD wascarried out by using the spirometry following the GOLD guidelines (postbronchodilator forced expiratory volume (FEV1) /forced vital capacity(FVC) ratio<70% predicted). Accordingly, the patients were dividedinto four groups based on the severity of their disease in accordancewith the GOLD guidelines, including mild COPD (stage I, FEV1 ≥ 80%predicted), moderate COPD (stage II, 50% ≤ FEV1<80% predicted), severe COPD (stage III, 30% ≤ FEV1<50% predicted), and very severeCOPD (stage IV, FEV1<30% predicted). The fasting blood samples oflipid profile were collected. The four COPD groups were compared usingthe ANOVA test.Results: According to the results, the majority 53 patients (53%) were inage group 40 to 60 years with mean age of 60.46+/-11.56. Most of thepatients had moderate to severe airflow obstruction (GOLD stages II andIII). The severity of COPD had no significant correlation with thetriglycerides, LDL, HDL, and LDL/HDL risk ratio. The mean totalcholesterol levels in the stages I and IV were 151.92±32.82 and 128.50±21.46 mg/dL, respectively, which was statistically significant (P=0.04).Conclusion: The present study indicates that there was no significantcorrelation between various lipid profile parameters and severity ofCOPD.

Introduction: Surgery is the first therapeutic option for esophagealcancer. There is controversy over the selection of the best surgicalapproach. Regarding this, the present study aimed to compare theminimally invasive and open esophagectomy in terms of their short-termoutcomes and preoperative complications.Materials & Methods: This randomized clinical trial was conducted on 61patients in Ghaem Hospital, Mashhad, Iran, within 2011-2013. Thepatients were assigned into two groups based on the type of therapeuticapproach they received. The minimally invasive esophagectomy (MIE) andopen esophagectomy (OE) groups consisted of 31 and 30 patients, respectively. For the purpose of the study, we collected such data as age, gender, site of lesion, bleeding, duration of surgery, rate of switch to openapproach, post-operative morbidity, duration of hospital stay, andmortality rate.Results: According to the results of the study, 60.7% of the participantswere male. The mean age of the patients was 62.39±11.91 years. Therewas no significant difference between the two groups regarding the site oflesion (P=0.014) and stage of tumor (P=0.108). No significant differencewas observed between the MIE and OE groups in terms of the bloodtransfusion (P=0.981). Considering the complications, there was one caseof fistula in the MIE group; furthermore, one and two cases of woundinfection and pleural effusions were observed in the OE group, respectively. There were no significant differences between the twogroups in terms of the post-operative complications, namely fistula, pleural effusions, and wound infection (P=0.492, P=0.238, and P=0.492, respectively). The MIE group had longer operation time (P≤0.001). Therewas one patient in the MIE group converted to open approach. Theduration of hospitalization was significantly longer in the OE group, andthere was no mortality.Conclusion: As the findings of the present study demonstrated, the MIEoutcomes were comparable with those of the OE with improved shortterm outcomes.

Introduction: In this study, we sought to illustrate our experience inurgent surgical management for embolized cardiac septal occlude devicesresulting from trans-catheter closure of atrial septal defect and ventricularseptal defect.Mathrials and Methods: We retrospectively reviewed four patients aged2–10 years who underwent urgent surgery due to cardiac septal occluderembolization between December 2015 and December 2016. Congenitaldefects were atrial septal defect (n=2) and ventricular septal defect (VSD) (n=2). Risk factors for device embolization and the need for urgentsurgical retrieval/definitive management techniques for embolized deviceremoval are discussed.Results: Removal of embolized devices was performed in all the cases.Inevitably, in three patients the primary defect was closed, while in onecase of VSD the device was removed without closing the defect. All theoperations were completed successfully and no hospital mortality ormorbidity was encountered.Conclusions: Although closure of left to right shunting defects bypercutaneous occluder devices has several advantages, device embolizationis still a major complication. If embolized device retrieval fails withpercutaneous intervention attempts, surgical management is the onlymethod to remove embolized devices. In this circumstance, to provide anuneventful perioperative course, urgent management strategies should bewell planned.

Rheumatic fever (RF) is a prevalent healthcare problem in the developingcountries. Recurrence of this disorder is often observed in childhood andadolescence. RF can mimic the presentations of infective endocarditis, andclinicians are not really familiar with this issue. Herein, we present a caseof recurrent acute rheumatic fever in a patient suspicious of acutebacterial endocarditis due to her previous RF. Finally, she was definitivelydiagnosed and underwent valvular replacement surgery and receivedprophylaxis antibiotics besides regular follow-up.

Certain subsets of high-risk mitral valve patients are not suitablecandidates for transcatheter therapies. The objective of this report is topresent a young patient with combined mitral valve and coronary arterydisease to illustrate these challenges.In this report, we present a 47-yearold man with longstanding HIV infection who was referred with severemitral regurgitation (MR) and profound cardiomyopathy to highlight theimportance of decision-making and perioperative management.A 47-yearold HIV positive man with New York Heart Association class IV congestiveheart failure was found to have severe MR (mixed Carpentier Type I andIIIB pathologies). The last viral load titer of the patient was undetectable.Cardiac catheterization revealed a chronic total occlusion of the middle ofleft anterior descending artery, ostial obtuse marginal and 70% posteriordescending artery lesion, as well as severe pulmonary hypertension (PAPof 70/30 (mean: 43)), and a pulmonary vascular resistance of 4.6 Woodsunits. Preoperative cardiac magnetic resonance imaging showed leftventricular ejection fraction of 20%, right ventricular ejection fraction of30%, nonviable circumflex distribution and scattered viability in theanterior and inferior cardiac walls. He underwent a high-risk coronaryartery blood grafting plus mitral valve (MV) replacement (with intra-aorticballoon pump support). The postoperative course was complicated bygastrointestinal bleeding requiring transfusion, aspiration pneumonitis, atrial flutter and difficile colitis. However, the patient recoveredappropriately, and remained asymptomatic and healthy in three monthsfollow-up postoperatively. Application of transcatheter MV or deviceassisted therapies for high-risk patients with severe MR might be limiteddue to financial, medical or social situations. In these instances, high-riskmitral valve surgery may still be the choice treatment in the selectedpatients.

Unlike the primary tracheal tumors, squamous cell carcinoma of tracheais common, especially in smokers. This type of tumor has a low rate ofsurvival and it is diagnosed too late on account of late presentation of itssigns. The treatment of choice is surgical removal followed by adjuvantradiotherapy; Primary radiotherapy is the appropriate treatment ininoperable cases. In this study, we present the case with a long history ofsmoking, who was suffering from cough and dyspnea for a long time.During diagnostic evaluations a vegetated tumor was observed about 5centimeters below the vocal cords. Pathologists reported the tumor as asquamous cell carcinoma, and the patient underwent an operation forresection of involved trachea.Through presenting this patient, we aimed to draw attention to thisuncommon malignancy and recommend considering it as a probablediagnosis when evaluating a patient with treatment-resistant respiratorysymptoms.

Dear EditorCardiovascular diseases (CVDs) are debilitatingconditions with long-term physical and psychological consequences (1). After a cardiac event orprocedure, the patient encounters severalproblems, two of the most important of which arepsychosexual dysfunction and difficulty inresuming sexual activity (2-4).