JOURNAL OF CARDIO THORACIC MEDICINE
Year:2019 | Volume:7 | Issue:4|Papers Count:8

Introduction: The forced expiratory 'low at 25 and 75% of the pulmonary volume/forced vital capacity ratio (FEF25-75/FVC) as a spirometry parameter has been successful in the early diagnosis of chronic obstructive pulmonary disease (COPD) and the methacholine challenge test for assessing airway responsiveness. To determine the accuracy of FEF25-75/FVC for the classification of spirometry lung disease. Materials and Methods: Eighty subjects with clinical diagnosis of COPD and idiopathic pulmonary fibrosis (IPF) were entered into this casecontrol study. Forty normal volunteers in the control group with a PC20 of more than 8 mg/dl were also enrolled in this study. Spirometry, lung volumes, and diffusing capacity (DLCO) were measured for all the subjects by the body plethysmograph. Final diagnosis of COPD and IPF was confirmed according to patient's history, pulmonary function test, computed tomography of the lungs, and histopathology (in IPF subjects). The FEF25-75/FVC ratio was determined in each group, and test accuracy was compared with lung volumes and DLCO as the gold standard. Results: FEF25-75/FVC was able to divide the subjects into four categories and its agreement with the clinical diagnosis (kappa= 0. 486) was more than the ratio of forced expiratory volume in one second per forced vital capacity (FEV1/FVC) and residual volume (RV). Accuracy assessment showed that FEF25-75/FVC had the highest likelihood ratio (133) followed by FEV1/FVC. Mid-expiratory flow parameters including FEF25-75 and FEF25-75/FVC displayed the highest sensitivity, positive predicted value, negative predicted value, and accuracy. Conclusion: FEF25-75/FVC is helpful in diagnosing difficult cases such as mixed-type spirometry or spirometry results that are not matched with clinical findings and require lung volume measurement.

Introduction: Primary percutaneous coronary intervention (PPCI) is used for the treatment of ST segment elevation myocardial infarction (STEMI). Anterior STEMI is associated with adverse outcomes, and it is possible that the presence of ramus intermedius (RI) would inversely affect the outcome. This research involved the evaluation of the influence of RI presence on clinical outcomes in patients with anterior STEMI and culprit lesion in the left anterior descending artery (LAD). Materials and Methods: This study was conducted on 105 patients with acute anterior STEMI undergoing PPCI in Shahid Madani Hospital, Tabriz, Iran, from April 2016 to March 2018. The recorded data included the patients’ demographic and baseline data, angiographic features, presence of RI, the occurrence of heart failure (HF), cardiogenic shock, and in-hospital and one-year mortality. All data were analyzed, using SPSS software (version 23; SPSS Inc., Chicago, IL). Chisquare test, Fischer’ s exact test, independent t-test, or Mann-Whitney U test were employed to compare data between the two groups. A p-value less than 0. 05 were considered statistically signi8icant. Results: In this research, RI was present in 53 patients (50. 5%). The RI presence was mostly detected in male patinas than in their female counterparts (88. 7% vs. 69. 2%; P=0. 01). In addition, those with RI presence had a lower rate of single-vessel disease (60. 4% vs. 80. 8%; P=0. 01) and higher proximal LAD involvement (71. 7% vs. 32. 7%; P<0. 001). After the intervention, ST segment decreased more than 50% and was significantly higher in patients with RI, compared to those without it (52. 8% vs. 25. 5%; P=0. 004). Furthermore, there were no significant differences between the groups regarding cardiac enzymes, ejection fraction, HF, cardiogenic shock, and in-hospital and one-year mortality rates. Conclusion: The presence of RI was associated with more proximal LAD lesions and less frequent single-vessel disease. However, RI did not seem to influence in-hospital and one-year outcomes.

Introduction: The physiological process of sternum surgical fracture consolidation in patients undergoing cardiac surgery could be prolonged by the invasion of gram-positive saprophytic bacteria which perpetuates the local inflammatory process despite the standardized aseptic and antiseptic measures in cardiac surgery. In this regard, the topical application of Vancomycin can exert a positive effect and prevent the perpetuation of the local inflammatory process by the elimination of these bacteria which in turn reduces bone consolidation time. The purpose of the current study was to determine the effect of topical Vancomycin on sternum surgical fracture consolidation in patients undergoing to openheart surgery. Materials and Methods: Patients who underwent open heart surgery were assigned into groups receiving the topical application of bone wax or Vancomycin mass in the spongy tissue exposed by surgical sternotomy, prior to sternal closure. The bone consolidation processes were assessed by two expert radiologists with simple chest computed tomography (CT) in the postoperative period (4, 8, and 12 weeks). Results: The study was conducted on 55 patients in Vancomycin (n=33) and bone wax group (n=19). The computerized axial tomography (CAT) scan revealed a higher number of patients with early bone consolidation (Medullar and bone continuity, and callus bone) in Vancomycin group, as compared to bone wax group (p values between 0. 004-0. 02 at 4 weeks and 0. 01-0. 06 at 8 weeks). However, no difference was observed at 12 weeks (P=0. 09-0. 11). Moreover, The magnitude effect of topical Vancomycin was high (>90%) at 3, 8, and 12 weeks of follow up, compared to the patients who received bone wax (<90%). Conclusion: The topical Vancomycin application had a positive effect on sternal surgical fracture and promotes an early bone consolidation in patients undergoing open-heart surgery.

Introduction: Hypertensive heart disease (HHD) is the constellation of abnormalities characterized by cardiac complications. Despite advancements in the management of hypertension and access to medical care, the incidence of HHD is an alarmingly increasing through time. However, there is a dearth of information on the determinants of HHD in Ethiopia. Therefore, this study aimed to assess the determinants of HHD among adult hypertensive patients at Gondar University Referral Hospital, Gondar, Ethiopia. Materials and Methods: This case-control study was conducted from April 1st to 26th in 2018. The cases were adult hypertensive outpatients with cardiac complications who were diagnosed within the last two years and were on follow-up and care in Gondar University Referral Hospital Gondar, Ethiopia, during the study period. On the other hand, the controls were adult hypertensive outpatients without a history of any of the cardiac complications who were diagnosed within the last two years and were on follow-up and care in Gondar University Referral Hospital, Gondar, Ethiopia, during the study period. A total of 159 participants included 53 cases and 106 controls were selected using a simple random sampling method. Data were collected using a checklist, and an interviewer administered a structured questionnaire. Moreover, multivariate logistic regression analysis was used to identify the predictors of hypertensive heart disease. In addition, a p-value of less than 0. 05 was considered statistically significant. Results: According to the results of this study, the majority of the cases (70. 9%) and controls (54. 5%) were in the age group of ≥ 60 years. Furthermore, hypertensive patients who had a family history of cardiovascular disease (Adjusted odds ratio (AOR)=4. 7, 95% CI: 1. 8-11. 9), sedentary lifestyle (AOR=3. 2, 95% CI: 1. 3-7. 8), uncontrolled blood pressure (AOR=4, 95% CI: 1. 8-9. 0), and hypertension duration ≥ 10 years (AOR=3, 95% CI: 1. 1-8. 7) were more likely to develop hypertensive heart disease than their counterparts. Conclusion: Multiple factors predicted HHD; accordingly, it is highly recommended to consider the early management guidelines and provide professional advice regarding physical exercise, especially for older individuals.

Introduction: It is well-documented that right-sided heart dysfunction and significant tricuspid valve regurgitation (TVR) have adverse effects on patient outcomes after left-sided heart valve surgery. Therefore, the evaluation of right ventriclular (RV) function and TR severity in patients who had undergone mitral valve replacement (MVR), associated with/without concomitant surgery on tricuspid valve, could be helpful for deciding on the necessity of concomitant tricuspid valve intervention before surgery. Materials and Methods: A total of 222 patients with MVR for rheumatic disease were evaluated in our Echocardiography Lab in Ghaem Hospital, Mashhad, Iran, within 2013-2018. The patients were divided into four groups, according to their type of concomitant TV. The subjects (n=11) with concomitant indications for coronary artery bypass grafting (CABG) or history of coronary artery disease were excluded from the study. Results: Signi5icant (at least moderate) TVR was found in 60% of the patients. All patients with rheumatic tricuspid valve had significant TVR. After excluding the patients with significant pulmonary hypertension, there was no difference in the prevalence of significant TR, between the patients with tricuspid valve repair and those without any intervention on tricuspid valve (P=0. 178). Furthermore, no difference was observed between the patients with/without any intervention on tricuspid valve considering RV size and function. Conclusion: In patients with left valve surgery concomitant with TR, tricuspid valve repair and replacement could preserve RV size and function, for a long time. During the correction of the left-side valvulopathy, it seems rational to adopt more interventional consideration for patients with tricuspid valve regurgitation, especially those with rheumatic tricuspid valve involvement.

We reported the case of a 78-year old woman with the inadvertent superior vena cava injury resulting from hemodialysis catheter placement. The catheter was placed through the left internal jugular vein. Hemodynamics were stable. The initial chest film illustrated an extraluminal catheter and mediastinal widening. The patient did not have hemothorax. Computed tomography venography also confirmed the extraluminal position. The catheter was removed at the operating room, and the case was conservatively managed.

Pulmonary thromboembolism (PTE) is a fatal condition that may rarely occur due to complications of coronary catheter insertion. In this case report, a 41-year-old male was presented 48 hours after radiofrequency catheter ablation (RFCA) for the management of Wolf-Parkinson-White syndrome with acute onset of dyspnea, hemoptysis, and chest pain. The physical examination revealed coarse crackles in the base of left hemithorax and laboratory tests were normal. The patient was suspicious for PTE based on clinical symptoms and the history of RFCA. Diagnosis was confirmed by computed tomography angiography of lungs. Patient symptoms improved after 3 months of treatment with warfarin.

Mycotic aneurysms are localized and irreversible dilatations of the arteries caused by weakening and damaging the arterial wall by an invasive organism establishing infective arteritis. Mycotic aneurysm of the thoracic aorta is a rare event; however, it can be fatal if not diagnosed early or not treated appropriately. Clinical findings are usually nonspecific; however, contrast-enhanced computed tomography (CT) is a common imaging modality of choice for the detection of mycotic aneurysms. Current management consists of antibiotic therapy and surgical treatment or endovascular interventions as early as possible. Herein, we present a case report of mycotic aneurysm of the thoracic aorta as a postoperative complication in a 60-year-old female with a clinical history of the cardia and esophageal carcinoma who underwent thoracic surgery. The presence of mycotic aneurysm was detected after performing a contrast-enhanced thoracic CT scan.