Introduction: Cardiopathy still remains a prominent cause of maternal and fetal morbidity and mortality. Pregnancy increases cardiovascular stress and can cause an asymptomatic woman with heart disease to become symptomatic. Definite data in heart surgery with extracorporeal circulation during pregnancy are limited. This report analyzes our experience in this area.Methods: Thirteen women who underwent open-heart surgery during pregnancy at our center in Tehran from 1985 to 2002 were studied. The patients were in New York Heart Association functional class III to IV and were operated upon urgently.Results: The mean age of the women at the time of surgery was 25.3±5.41 years (range: 17- 36 years). Their gestational age was 4-32 weeks. Surgical procedures performed were mitral valve replacement for mitral stenosis in 4 (30.76%) patients, declotting or redo valve replacement for prosthetic valve malfunction in 7 (53.83%), excision of subvalvular aortic stenosis in 1 (7.69%) and resection of atrial myxoma in 1 (7.69%) patient. Surgery was performed at normothermic cardiopulmonary bypass in 8 patients and mild hypothermia in 5 patients. There was one maternal death and as a result, fetal loss. Fetal deaths occurred in 5 of the 12 pregnancies (41.6%) in the women who survived the surgical procedure.Conclusion: Cardiopulmonary bypass during pregnancy carries a high risk of fetal morbidity and mortality and should be advised only in extreme emergencies. If possible, surgery should be carried out in the second trimester of pregnancy.

Background. Children undergoing cardiopulmonary bypass (CPB) often demonstrate increased capillary-permeability and accumulation of excess total-body water (TBW), which can lead to multiple~organ failure and death. The management consists of efforts to diminish the circulating inflammatory mediators from CPB include preemptive -therapies to diminish the inflammatory response and Temovals trategies to eliminate. the inflammatory mediators. It has been demonstrated that .peritoneal dialysis is an effective and safe procedure that not only removes excess ototal-body water and pro-inflammatory factors but also improves hemodynamics, pulmonary and renal function. We studied the role of peritoneal dialysis in infants and children undergoingopen-heart surgery at our department. Methods. Among 1258 pediatric open-heart surgery cases from January 1996 to September 2000 at our center, 64 patients demonstrated indication for peritoneal dialysis. Our criteria of performing peritoneal dialysis were presence of ascites or oliguria. We measured volume of peritoneal -fluid, as wen as negative balance, urine output and gastric fluid every 2 hours. Central venous pressure and other hemodynamic parameters (MAP, HR) were monitored during peritoneal dialysis Results. Criteria for performing peritoneal dialysis (ascites or oliguria) were found in 64 of 1258 (5.0 %) patients. Diagnosis for 23 patients was VSD with pulmonary hypertension, 14 patients had transposition of the great arteries (TGA), and 11 patients were candidates for total correction of tetralogy of Fallot. Nineteen of sixty-four patients died mostly due to cardiovascular problems (mortality rate 29.6%). The mean interval between the operation and peritoneal catheter insertion was 10.36±5.95 hours. In the first day the volume of negative balance was 69.51 ±11.80mI, which decreased to 19.41 ±5.81 ml on the fifth day. Urine output was 45.83±6.17(ml/kg/24h) on the first day or 3.31±0.6 (ml/kg/h) in the first hours of peritoneal dialysis and improved to 62.91±12.44 on the third day of peritoneal dialysis. CVP was 13.24±2.49 cmH20 and declined to 10.95 ±1.16 two hours following peritoneal catheter insertion. We found no grossly cloudy or bloody peritoneal fluid. Conclusion. We conclude that peritoneal dialysis is a safe procedure for infants and children after open heart surgery to reduce CPB complications and preventing multiple organ fai

Background- Atrial fibrillation (AF) is a common complication of heart surgery. This unwanted sequel leads to an increased risk of thromboembolism and necessitates further often costly health care. Advanced age, previous AF rhythm, and valvular heart disease are the most consistently identified risk factors for the development of this rhythm after cardiac surgical procedures. Dispersion of repolarization leading to reentry is believed to be the mechanism of postoperative AF. Treatment is aimed at controlling heart rate, preventing thromboembolic events, and converting to sinus rhythm. Material- 500 consecutive patients who were undergoing cardiac surgical procedures consisting of coronary artery bypass, valve procedures and combined coronary-valve procedures were prospectively evaluated to determine the predisposing factors relating to the development of postoperative AF rhythm.Results- In this series of 500 patients undergoing cardiac operations at our center, we found the incidence of AF to be 13% after coronary artery bypass grafting (CABG), 24% after mitral valve replacement, 23% after aortic valve replacement, and 32% after combined CABG and valve replacement procedures. Patient age, valvular heart disease, preoperative AF rhythm, and discontinuation of beta-blockers were shown to be statistically significant in determining the development of postoperative AF rhythm in our group of patients.Conclusion- The only firm conclusion that can be drawn concerning preventive measures is that beta-blocker withdrawal is to be avoided after heart operations and to consider beta-blocker therapy for other patients who may tolerate these drugs in order to reduce the chances of developing AF rhythm

Background: One of the most common surgical procedures performed today is open heart surgery, and with it comes complications. One of these complications is post-operative myocardial infarction (MI), and others are post-operative stroke, neurological problems, wound infection, respiratory complications, etc.Methods: This prospective study included 424 patients who underwent open heart surgery at our center between November 2005 and May 2006. All relevant clinical, electrocardiographic, echocardiographic, and laboratory data were gathered in all the patients, and the patients were observed for the development of MI after surgery.Results: Post-operative MI occurred in 45 (10.8%) patients. By the univariate analysis, systemic hypertension, on-pump surgery, and increased serum levels of LDL cholesterol and triglycerides (TG) were significantly associated with the occurrence of post-operative MI (all P-values<0.05).Conclusion: The results of the present study demonstrated that systemic hypertension, on-pump surgery, and serum levels of LDL and TG were related to post-operative MI. Therefore, clinical data, laboratory data, ECG, and echocardiography may be useful in the risk stratification of high-risk patients for the occurrence of post-operative MI.

Background- A number of publications has shown a relation between increased QT dispersion and death from a cardiac cause. However, there are no published data on the value of QT interval dispersion after open-heart surgery in the pediatric age group.Methods- Three electrocardiograms (pre-operation, on the day of operation and the second day post-operation) were obtained from 18 children (11 males, 7 females), three to 14years of age. Measurements were carried out from standard 12-lead ECGs recorded at a speed of 25 mmls at rest. The QT and preceding RR intervals of at least one sinus beat (range one to three) were measured in a range of nine to 12 leads, and the mean QT and RR intervals were calculated. The corrected QT interval was calculated by Bazetl's method (QTc = QT/√RR). QT intervals were measured from the onset of the QRS complex to the end of the T wave. Dispersion of the QT and QTc were defined by the difference between the maximum and minimum QT and QTc intervals occurring in any of the 12 leads.Results-The mean QT dispersion in patients before surgery was 53±22ms, 72±31ms on the day of operation and 65±27 one day after operation, and mean QTc dispersion before surgery was 62±22ms, 95±27ms on the day of operation and 97±41ms on the day after operation. There was a significant increase in mean QT and QTc immediately after surgery (p<0.001). Although it decreased on the first day after surgery, it remained significantly high as compared to before surgery (p<0.02).Conclusion- QT interval dispersion may increase after open-heart surgery, which may result in death following an arrhythmia. Open-heart surgery may have an independent role in the genesis of QT dispersion prolongation and should be considered as one of the mechanisms of arrhythmia after surgery.

Introduction: CLL occurs with malignant proliferation of lymphocytes. Proliferation of these cells causes decrease in other blood cells.As a result of decreased production of red blood cells, anemia can be occurred. The reduction in the number of platelets leads to blood coagulation disorder. Hematoma and bleeding easily occurs. Usually in people over age 60 occur. In the early stages of the disease is usually asymptomatic. Treatment is based on the establishment stage disease.Methods: Search in internetObjective: To prevent complications of open heart surgery in patients with CLLExpression problem: Experience of open heart surgery in patients with CLL is limited. Clinical course is unpredictable and Variable. Survivals of patients are different, from one to a few decades. Lifetime has direct relationship with the physical examination and laboratory findings. Diagnosis is often random and recognized by repeated counting blood cells (CBC).Assessment of patients by CBC, serum protein and bone marrow biopsy are necessary. Patients with a better prognosis have better open heart surgery tolerance and fewer side shows. However, in patients with fewer prognoses, mortality is higher and complications are more severe. These complications include sepsis, nosocomial infection, other malignancy, duration of hospitalization and blood products transfusion.Results: Before open heart surgery, hematology counseling and staging must be done, because this staging helps surgeon to make decision and also this staging characterizes expectation which will be obtained by result of surgery. Open heart surgery in patients with mild CLL is done. So complications are very low and are rarely troublesome. But in open heart surgery leads to worse complications and high mortality. The main cause of hospital mortality is infection which can be controlled and prevented by administration of intravenous Gama-globulin and antibiotics.