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Bangladesh Heart Journal

This prospective study was designed to determine the incidence of pulmonary complications after o... more This prospective study was designed to determine the incidence of pulmonary complications after open cardiac surgery as well as to identity predisposing factors of these complications at NICVD, Dhaka, Bangladesh. The cumulative incidence of pulmonary complications after open heart surgery was 16.85% (15of 89) with a mortality rate of 33.33% (5 of 15) and the overall mortality among all patients was 5.62% (5 of 89). Pulmonary complications occurred in 15.9% of patients with coronary artery revascularization, 11.53% in patients with valvular replacement and 26.31% in patients with congenital heart disease. ARDS occurred in 2.25% of patients with a mortality rate of about 100%,, pneumonia in 5.62%, atelectasis in 2.25%, pleural effusion in 5.62% and pneumothorax in 3.37%. The most predisposing factors were massive blood transfusion, re-exploration for control of post-operative bleeding, cardiopulmonary resuscitation and prolonged length stay in the intensive care unit. Bangladesh Heart...

Cardiovascular Journal

An amputation of the hand is a disastrous traumatic injury especially for advanced machinery work... more An amputation of the hand is a disastrous traumatic injury especially for advanced machinery workers which adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities. It also produces great psychological impact. In the following case report, we described a middleaged male with an amputation at the level of the distal forearm who underwent replantation. The transfer of the amputated hand, operative technique and postoperative status are described. Awareness of the possibility of salvage should be spread among healthcare providers and the need for immediate attention by a multispecialty team is advocated. This report reviews the literature related to the operative technique, contraindications and long-term results. Cardiovasc j 2022; 15(1): 106-110

Cardiovascular Journal

Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it ad... more Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it adversely affects the postoperative outcome after CABG surgery. Adequate control of diabetes for a longer period, which can be assessed by HbA1c, before OPCAB may reduce development of postoperative atrial fibrillation and thus improve outcome. Methods: This was an observational study included sixty diabetic patients purposively who underwent isolated off pump coronary artery bypass procedure in NICVD. Total sample contained 60 diabetic patients, which were divided in two equal groups. Grouping was Group I – 30 Diabetic patients with preoperative HbA1c <7% and Group II – 30 Diabetic patients with preoperative HbA1c ≥7% and all of whom underwent isolated OPCAB. Postoperative atrial fibrillation and other complications were recorded and compared in two groups of patients. Results: Most postoperative atrial fibrillation (AF) developed in higher age group 61-70 years (61.5%). Postoperative ...

Cardiovascular Journal

Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surger... more Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery and its peak incidence is between second or third postoperative day. It occurs in 40% to 50% of patients after valve surgery alone or combined valve and CABG surgery respectively. Among all the anti-arrhythmic drugs evaluated for AF, amiodarone has shown the most promising results with successful conversion and maintenance of normal sinus rhythm achieved in 50%–70% of patients. Methods: Sixty diabetic patients purposively selected who underwent isolated off pump coronary artery bypass procedure in NICVD. Group A – 30 patients receiving loading dose of amiodarone intra-operatively before establishment of CPB during valve replacement surgery and Group B- 30 patients without receiving loading dose of amiodarone intra-operatively during valve replacement surgery. Incidence of atrial fibrillation in postoperative period was evaluated. Results: Atrial fibrillation was observed in 8 (26.7%) p...

Cardiovascular Journal

Background: Identification of predictors of morbidity and mortality is an important issue for the... more Background: Identification of predictors of morbidity and mortality is an important issue for the management of cardiac surgical patients. Elevated lactate concentrations in the immediate postoperative period reflect unmet metabolic demand and may be associated with outcome. Methods: A prospective observational study was carried out in the department of cardiac surgery, at National Heart Foundation Hospital& Research Institute(NHFH&RI), Dhaka. commencing from July 2016 to March 2018. In all Adult patients irrespective of sex undergoing elective off-pump coronary artery bypass grafting (OPCABG). Purposive sampling was applied with patient with blood lactate level < 3 mmol/L 6hours after shifting from OT to ICU in Group-A and blood lactate level ≥3mmol/l, 6hours after shifting to the ICU in Group-B.Postoperative early adverse outcomes were analyzed in both the patient groups. Results: Blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanica...

Cardiovascular Journal

Background: Current cardioplegic technique during conventional coronary artery bypass grafting (C... more Background: Current cardioplegic technique during conventional coronary artery bypass grafting (CABG) does not consistently avoid myocardial ischemic damage in high risk patients. Alternatively revascularization without CPB is not always technically feasible. The on-pump beating technique eliminates global myocardial ischemia and thus reduce the mortality and morbidity in high risk patients. This study evaluates the early surgical outcomes of on-pump beating-heart CABG in comparison to conventional CABG. Methods: In this prospective study 60 high risk patients with EURO-SCORE of 6 and above were prospectively allocated into two groups in non-randomized way. Among them 30 patients underwent on-pump beating-heart CABG and 30 patients underwent conventional CABG. The early surgical clinical outcomes were compared between the groups. Results: On-pump beating heart CABG significantly reduced the duration of operation time, cardiopulmonary bypass time, postoperative ventilation time and i...

Cardiovascular Journal

Background: One of the main causes of post-operative morbidity in cardiac surgical patient is exc... more Background: One of the main causes of post-operative morbidity in cardiac surgical patient is excessive bleeding requiring transfusion of blood component after CPB. Re-exploration due to bleeding occurs in 2% to 7% of post bypass patient and 50% to 80% of these patients not having any identifiable surgical bleeding source. Tranexamic acid is competitive inhibitor of plasminogen activator and at higher concentration a non-competitive inhibitor of plasmin. It is 10 times more potent than Epsilone Aminocaproic Acid in preventing post-operative haemorrhage following CPB. Methods: This study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh between January 2009 and December 2010. The Study population was divided into two groups. Group A comprised of 35 patients, who had received Tranexamic Acid 10 mg /kg after induction and then 1 mg/kg/hour till time of protamin infusion and Group B comprised of 35 patients who h...

Bangladesh Heart Journal

Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome aft... more Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients. Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative ...

Bangladesh Heart Journal

This prospective study was designed to determine the incidence of pulmonary complications after o... more This prospective study was designed to determine the incidence of pulmonary complications after open cardiac surgery as well as to identity predisposing factors of these complications at NICVD, Dhaka, Bangladesh. The cumulative incidence of pulmonary complications after open heart surgery was 16.85% (15of 89) with a mortality rate of 33.33% (5 of 15) and the overall mortality among all patients was 5.62% (5 of 89). Pulmonary complications occurred in 15.9% of patients with coronary artery revascularization, 11.53% in patients with valvular replacement and 26.31% in patients with congenital heart disease. ARDS occurred in 2.25% of patients with a mortality rate of about 100%,, pneumonia in 5.62%, atelectasis in 2.25%, pleural effusion in 5.62% and pneumothorax in 3.37%. The most predisposing factors were massive blood transfusion, re-exploration for control of post-operative bleeding, cardiopulmonary resuscitation and prolonged length stay in the intensive care unit. Bangladesh Heart...

Cardiovascular Journal

An amputation of the hand is a disastrous traumatic injury especially for advanced machinery work... more An amputation of the hand is a disastrous traumatic injury especially for advanced machinery workers which adversely affects the victim’s ability to earn a livelihood, support a family, and carry out daily activities. It also produces great psychological impact. In the following case report, we described a middleaged male with an amputation at the level of the distal forearm who underwent replantation. The transfer of the amputated hand, operative technique and postoperative status are described. Awareness of the possibility of salvage should be spread among healthcare providers and the need for immediate attention by a multispecialty team is advocated. This report reviews the literature related to the operative technique, contraindications and long-term results. Cardiovasc j 2022; 15(1): 106-110

Cardiovascular Journal

Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it ad... more Background: Diabetes mellitus is an independent risk factor for coronary artery disease and it adversely affects the postoperative outcome after CABG surgery. Adequate control of diabetes for a longer period, which can be assessed by HbA1c, before OPCAB may reduce development of postoperative atrial fibrillation and thus improve outcome. Methods: This was an observational study included sixty diabetic patients purposively who underwent isolated off pump coronary artery bypass procedure in NICVD. Total sample contained 60 diabetic patients, which were divided in two equal groups. Grouping was Group I – 30 Diabetic patients with preoperative HbA1c <7% and Group II – 30 Diabetic patients with preoperative HbA1c ≥7% and all of whom underwent isolated OPCAB. Postoperative atrial fibrillation and other complications were recorded and compared in two groups of patients. Results: Most postoperative atrial fibrillation (AF) developed in higher age group 61-70 years (61.5%). Postoperative ...

Cardiovascular Journal

Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surger... more Background: Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery and its peak incidence is between second or third postoperative day. It occurs in 40% to 50% of patients after valve surgery alone or combined valve and CABG surgery respectively. Among all the anti-arrhythmic drugs evaluated for AF, amiodarone has shown the most promising results with successful conversion and maintenance of normal sinus rhythm achieved in 50%–70% of patients. Methods: Sixty diabetic patients purposively selected who underwent isolated off pump coronary artery bypass procedure in NICVD. Group A – 30 patients receiving loading dose of amiodarone intra-operatively before establishment of CPB during valve replacement surgery and Group B- 30 patients without receiving loading dose of amiodarone intra-operatively during valve replacement surgery. Incidence of atrial fibrillation in postoperative period was evaluated. Results: Atrial fibrillation was observed in 8 (26.7%) p...

Cardiovascular Journal

Background: Identification of predictors of morbidity and mortality is an important issue for the... more Background: Identification of predictors of morbidity and mortality is an important issue for the management of cardiac surgical patients. Elevated lactate concentrations in the immediate postoperative period reflect unmet metabolic demand and may be associated with outcome. Methods: A prospective observational study was carried out in the department of cardiac surgery, at National Heart Foundation Hospital& Research Institute(NHFH&RI), Dhaka. commencing from July 2016 to March 2018. In all Adult patients irrespective of sex undergoing elective off-pump coronary artery bypass grafting (OPCABG). Purposive sampling was applied with patient with blood lactate level < 3 mmol/L 6hours after shifting from OT to ICU in Group-A and blood lactate level ≥3mmol/l, 6hours after shifting to the ICU in Group-B.Postoperative early adverse outcomes were analyzed in both the patient groups. Results: Blood lactate level 6 hours after ICU transfer is an independent predictor for prolonged mechanica...

Cardiovascular Journal

Background: Current cardioplegic technique during conventional coronary artery bypass grafting (C... more Background: Current cardioplegic technique during conventional coronary artery bypass grafting (CABG) does not consistently avoid myocardial ischemic damage in high risk patients. Alternatively revascularization without CPB is not always technically feasible. The on-pump beating technique eliminates global myocardial ischemia and thus reduce the mortality and morbidity in high risk patients. This study evaluates the early surgical outcomes of on-pump beating-heart CABG in comparison to conventional CABG. Methods: In this prospective study 60 high risk patients with EURO-SCORE of 6 and above were prospectively allocated into two groups in non-randomized way. Among them 30 patients underwent on-pump beating-heart CABG and 30 patients underwent conventional CABG. The early surgical clinical outcomes were compared between the groups. Results: On-pump beating heart CABG significantly reduced the duration of operation time, cardiopulmonary bypass time, postoperative ventilation time and i...

Cardiovascular Journal

Background: One of the main causes of post-operative morbidity in cardiac surgical patient is exc... more Background: One of the main causes of post-operative morbidity in cardiac surgical patient is excessive bleeding requiring transfusion of blood component after CPB. Re-exploration due to bleeding occurs in 2% to 7% of post bypass patient and 50% to 80% of these patients not having any identifiable surgical bleeding source. Tranexamic acid is competitive inhibitor of plasminogen activator and at higher concentration a non-competitive inhibitor of plasmin. It is 10 times more potent than Epsilone Aminocaproic Acid in preventing post-operative haemorrhage following CPB. Methods: This study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh between January 2009 and December 2010. The Study population was divided into two groups. Group A comprised of 35 patients, who had received Tranexamic Acid 10 mg /kg after induction and then 1 mg/kg/hour till time of protamin infusion and Group B comprised of 35 patients who h...

Bangladesh Heart Journal

Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome aft... more Introduction: Diabetes mellitus has been associated with an increased risk of adverse outcome after coronary artery bypass graft surgery. HbA1c is a reliable measure of long-term glucose control. It is unknown whether adequacy of diabetic control, measured by hemoglobin A1c, is a predictor of adverse outcomes after coronary artery bypass grafting. The predictive role of HbA1c on short term outcomes after coronary artery bypass graft surgery has not been evaluated. Diabetes mellitus has become a major health issue and contributes to morbidity and mortality from coronary artery disease. The purpose of this study is to determine the predictive role of preoperative elevated HbA1c on post-operative outcome in CABG patients. Objectives: This study evaluates the early postoperative outcomes of CABG in terms of mortality and major postoperative morbidities like deep sternal wound infection, sepsis, stroke, renal failure, bleeding, arrhythmia, and mediastinitis in patients with preoperative ...