Mohamed Ismail | Mansoura University (original) (raw)

Papers by Mohamed Ismail

Journal of Cardiac Surgery, 2012

We present a rare case of a patient with a dilated unroofed coronary sinus mimicking cor triatria... more We present a rare case of a patient with a dilated unroofed coronary sinus mimicking cor triatriatum that altered mitral inflow in a cardiactype total anomalous pulmonary venous connection. The membranous tissue in the left atrium, thought to be cor triatriatum tissue preoperatively, was actually a remnant of a dilated coronary sinus tissue. Although this tissue did not create a significant pressure gradient and merely induced a turbulent mitral inflow, we resected it to avoid future problems with mitral leaflet function.

Indian journal of anaesthesia, 2017

Paediatric cardiac surgery with cardiopulmonary bypass (CPB) is associated with a marked inflamma... more Paediatric cardiac surgery with cardiopulmonary bypass (CPB) is associated with a marked inflammatory response and triggers release of inflammatory cytokines. The aim of this study was to study the effect of ketamine on the inflammatory response during correction of congenital cyanotic heart diseases. Sixty-six patients with congenital cyanotic heart diseases scheduled for cardiac surgery were randomised into three groups. Group A patients did not receive ketamine (control group), Group B patients received 2 mg/kg ketamine intravenous (IV) and Group C patients received ketamine 2 mg/kg IV and an IV infusion of ketamine (50 μg/kg/min). Interleukin (IL) levels for IL-6, IL-8, IL-10, C-reactive protein (CRP) and tumour necrosis factor-α (TNF-α) levels were examined in the three groups at four timings: pre-operative (baseline), intraoperative (after weaning off the CPB) and post-operative (6 and 24 h after weaning off CPB). Paired sample t-test and ANOVA test were used for statistical a...

Archivos de Bronconeumología, 2012

Los traumatismos son la primera causa de mortalidad en los niños de más de un año de edad en los ... more Los traumatismos son la primera causa de mortalidad en los niños de más de un año de edad en los países industrializados. En este estudio retrospectivo hemos revisado todos los traumatismos torácicos en pacientes pediátricos ingresados en el centro de urgencias del Mansoura University Emergency Hospital entre enero de 1997 y enero de 2007. Nuestro hospital recibió a 472 pacientes de menos de 18 años de edad. Hubo 374 pacientes varones, con una media de edad de 9,2 ± 4,9 años. Las causas fueron traumatismos penetrantes (2,1%) y traumatismos cerrados (97,9%). Consistieron en traumatismos sufridos por peatones (38,3%), accidentes de vehículos a motor (28,1%), choques de motocicletas (19,9%), caídas desde una altura (6,7%), traumatismos causados por animales (2,9%) y lesiones deportivas (1,2%). Los tipos de lesión fueron contusiones (27,1%) y laceraciones pulmonares (6,9%), fracturas costales (23,9%) y volet costal (2,5%), hemotórax (18%), hemoneumotórax (11,8%), neumotórax (23,7%), enfisema quirúrgico (6,1%), lesiones traumáticas traqueobronquiales (5,3%) y lesión traumática del diafragma (2,1%). Las lesiones asociadas consistieron en traumatismos craneales (38,9%), fracturas óseas (33,5%) y traumatismos abdominales (16,7%). El tratamiento consistió en un enfoque conservador (29,9%), un tubo de toracostomía (58,1%) o una toracotomía (12,1%). La tasa de mortalidad fue del 7,2%, y los politraumatismos fueron la principal causa de muerte (82,3%) (p < 0,001). Nuestra conclusión es que los traumatismos cerrados son la causa más frecuente de traumatismo torácico en los niños y que a menudo se producen en atropellos de peatones. Las fracturas costales y las contusiones pulmonares son los tipos de traumatismos más frecuentes. El retraso en el diagnóstico y los politraumatismos se asocian a una incidencia elevada de mortalidad.

Journal of the Egyptian Society of Cardio-Thoracic Surgery

Journal of cardiothoracic surgery, Jan 5, 2018

Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of ... more Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age. From 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET. JET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectivel...

The Thoracic and cardiovascular surgeon, Jan 12, 2017

Background The increasing complexity of congenital cardiac surgery has resulted in the increased ... more Background The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass. The purpose of this research was to assess the mortality and morbidity in children requiring ECMO support after the repair of congenital heart defects (CHDs). Methods The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016 were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Results A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was 3 months (range, 4 days–15 years) and median weight was 3.5 kg (range, 2.2–42.5). Forty-two (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology, it was 37.1% (23/62 patients). Univariate analysis revealed number of days on ECMO support, renal failure, and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically nonsignificant. Conclusion Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. Prolonged ECMO support, renal failure, and stroke are risk of mortality.

Background: As the age of the population increases with time, more elderly patients are considere... more Background: As the age of the population increases with time, more elderly patients are considered for cardiac surgery. This group of patients has the highest prevalence of cardiac disease and is more likely to have medically refractory symptoms, but they are less likely to be suitable for less invasive procedures such as coronary angioplasty. Patients and methods: Over a period of two years, from September 2008 to September 2010, 304 consecutive patients underwent isolated coronary bypass surgery (CABG) , 48 patients were 70 years of age or older (Group I) which is referred to as elderly group and 256 were below 70 years (Group II) which is referred to as younger group. Results: The mean age of 72.2 ± 2 years, their ages ranged from 70 to 85 years, 70.8% of them were males. Diabetes mellitus, hyper-tension, dyslipidemia, old cerebral infarction and renal dysfunction were more prevalent in the elderly group preoperatively. Postoperative mechanical ventilation time was significantly longer in the elderly group 34.1±8.2 hours and intensive care unit and total hospital stay were statistically significant longer in the elderly group (mean 9.3±4.6 and 15.3±6.1 days respectively). 31.3% had atrial fibrillation and 16.7% had serious ventricular arrhythmias postoperatively in elderly group that is significantly different between the two groups. Transient renal dysfunc-tion occurred in 25.0% in the elderly group with statistical significance. Cerebral stroke occurred in 1.9% with no significance. Sternal wound infection occurred in 8.3% in the elderly group without statistical significance. Overall hospital mortality occurred in 4.2% in the elderly group due to multi organ failure. There was no statistical significance between the two groups. Conclusions: Coronary artery bypass surgery can be performed safely in elderly patients with acceptable results. Careful postoperative care is required to reduce the higher rate of immediate adverse effects in this age group. Elderly patients should not be denied coronary artery bypass surgery on the bases of advanced age alone.

Cardiovascular Mohamed Fouad Ismail, et al. Cardiovascular Objectives: In patients with depressed... more Cardiovascular Mohamed Fouad Ismail, et al. Cardiovascular Objectives: In patients with depressed left ventricular (LV) function (ejection fraction [EF] < 0.30), coronary artery bypass grafting (CABG) is the optimal therapeutic approach and remains superior to medical therapy. Patients and methods: 304 consecutive patients underwent isolated CABG, 57 patients had low ejection fraction (EF) < 30% (Group I) and 247 had EF > 30 % (Group II). Results: Mean age was 62 ± 2 years, 46 (79.7%) of them were males. Preoperative renal dysfunction and patients with history of prior myocardial infarction were statistically significant predominant in group I. Mean left ventricular ejection fraction was 25.3±4.3 in group I and 53.3±6.5 in group II. Left main trunk ste-nosis was significantly more (42.1%) in group I than group II (11.7%) (P<0.001). Preoperative intra-aortic balloon pump (IABP) to support the circulation was statistically significant. Aortic cross clamp time was longer in group II (mean = 112.8±14.1 min.) than group I (mean = 96.7±12.6 min.). Postoperative mechanical ventilation time was significantly longer in group I (mean = 29.1±8.2 hours). Intensive care unit and total hospital stay were statistically significant longer in group I (mean 8.3±4.6 and 12.6±6.1 days respectively). Arrhythmias were significantly more frequent in group I that had 8 patients (14.1%) while group II had only 11 patients (4.5%). Overall hospital mortality occurred in 3 patient (5.2%) died in group I, (P<0.001). Conclusion: Patients with ischemic heart disease and poor left ventricular function can be offered CABG with acceptable operative morbidity and mortality. Comprehensive assessment of the efficacy of the preoperative use of IABP requires a prospective randomized trial.

Methods: This retrospective study included 145 consecutive patients who underwent complete atriov... more Methods: This retrospective study included 145 consecutive patients who underwent complete atrioventricular (CAVSD) repair between January 2002 and January 2012. Peri-operative data were analyzed. Ninety-two patients had a two-patch technique (group A); 53 patients had a single-patch technique (group B). Results: Mean age was 13.17 ± 4.94 months (group A) versus 5.15 ± 1.52 months (group B), (p < 0.001). Mean weight was 9.87 ± 5.53 versus 5.23 ± 2.12 kg (p < 0.001). Down syndrome was present in 82 (90.2%) in group A and 48 (90.5%) in group B (p = 0.315). Aortic cross-clamp times in group A was 135.3 ± 19.6 min and group B 107.7 ± 21.4 min (p < 0.0001). Cardiopulmo-nary bypass times were shorter in group B (132.2 ± 24.3 min) than group A (159.42 ± 31.4 min) with p value <0.001. Chylothorax, post operative bleeding, ICU stay and hospital length were not significant. Reoperation for left atrioventricular valve insufficiency occurred in 5 patients (5.4%) in group A, one of them needed valve replacement and 3 patients (5.7%) in group B. Permanent pacemaker was required for postoperative heart block in 3 patients (3.3%) in group A and 2 patients (3.8%) in group B (p = 0.623). Hospital mortality was seen in 6 patients (6.5%) in group A and 3 patients (5.7%) in group B (p = 0.606). Conclusions: Single-patch technique can be performed with the same results like the two patch technique with a significantly shorter aortic cross clamp and bypass time.

Objective: To evaluate our experience in the Fontan procedure comparing those below and above 6 y... more Objective: To evaluate our experience in the Fontan procedure comparing those below and above 6 years of age. Methods: A review of our clinical database was conducted to identify the patients who received extracardiac Fontan between 2002 and 2010. All demographic, echocardiographic, surgical, haemo-dynamic and follow-up data were collected. The overall mortality was defined as death occurring from the time of surgery to the most recent follow-up. Early postoperative death was defined as death occurring during admission or within 30 days from the operation. Seventy-six patients with functionally univentricular hearts were included in the study. Patients were divided into two groups. Group A included patients who had received extracardiac Fontan at the age of 6 years or less, whereas group B included patients who had received extracardiac Fontan at an age of more than 6 years. Results: The overall hospital mortality was 7.9% (10.2% in group A and 5.9% in group B). No statistically significant difference was seen between the two groups regarding the postoperative

Your article is protected by copyright and all rights are held exclusively by Indian Association ... more Your article is protected by copyright and all rights are held exclusively by Indian Association of Cardiovascular-Thoracic Surgeons. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".

Background: chondrosarcoma is the most common primary tumor of the chest wall. We analyzed cases ... more Background: chondrosarcoma is the most common primary tumor of the chest wall. We analyzed cases of chest wall chondrosarcoma to establish the presentation, diagnostic tools, surgical treatment, and outcome. Methods: this was a retrospective observational analysis of 45 patients who underwent surgery for chondrosarcoma. Results: the mean age was 42.3 AE 8.5 years, and 57.8% patients were male. Symptoms were a painful chest wall mass in 91.1% of patients. Chest radiography and computed tomography, and biopsy were the diagnostic tools. The tumor was right-sided in 57.8% of patients. It was located in the lateral (71.1%), anterior (26.7%), or posterior (2.2%) chest wall. The mean tumor diameter was 7.6 AE 3.3 cm. Radical en-bloc excision was performed in all patients. Chest wall reconstruction was carried out using methylmethacrylate and Prolene mesh (42.2%), Prolene mesh alone (37.8%), and direct closure (20%). A muscle flap was used for soft tissue reconstruction in 11.1%. Complications were encountered in 6.7%. There was no operative mortality. Follow-up was complete in 66.7% of patients. The mean follow-up period was 3.7 AE 2.1 years. Local recurrences and late mortality occurred in 4.4%. Conclusion: surgery for chondrosarcoma can be performed with acceptable morbidity and mortality. Proper selection of patients and radical en-block excision of the tumor are the keys for successful treatment and better outcomes.

Background: The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhy... more Background: The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting. Methods: Our Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records. Results: This retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring reopening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.

Journal of Cardiac Surgery, 2012

We present a rare case of a patient with a dilated unroofed coronary sinus mimicking cor triatria... more We present a rare case of a patient with a dilated unroofed coronary sinus mimicking cor triatriatum that altered mitral inflow in a cardiactype total anomalous pulmonary venous connection. The membranous tissue in the left atrium, thought to be cor triatriatum tissue preoperatively, was actually a remnant of a dilated coronary sinus tissue. Although this tissue did not create a significant pressure gradient and merely induced a turbulent mitral inflow, we resected it to avoid future problems with mitral leaflet function.

Indian journal of anaesthesia, 2017

Paediatric cardiac surgery with cardiopulmonary bypass (CPB) is associated with a marked inflamma... more Paediatric cardiac surgery with cardiopulmonary bypass (CPB) is associated with a marked inflammatory response and triggers release of inflammatory cytokines. The aim of this study was to study the effect of ketamine on the inflammatory response during correction of congenital cyanotic heart diseases. Sixty-six patients with congenital cyanotic heart diseases scheduled for cardiac surgery were randomised into three groups. Group A patients did not receive ketamine (control group), Group B patients received 2 mg/kg ketamine intravenous (IV) and Group C patients received ketamine 2 mg/kg IV and an IV infusion of ketamine (50 μg/kg/min). Interleukin (IL) levels for IL-6, IL-8, IL-10, C-reactive protein (CRP) and tumour necrosis factor-α (TNF-α) levels were examined in the three groups at four timings: pre-operative (baseline), intraoperative (after weaning off the CPB) and post-operative (6 and 24 h after weaning off CPB). Paired sample t-test and ANOVA test were used for statistical a...

Archivos de Bronconeumología, 2012

Los traumatismos son la primera causa de mortalidad en los niños de más de un año de edad en los ... more Los traumatismos son la primera causa de mortalidad en los niños de más de un año de edad en los países industrializados. En este estudio retrospectivo hemos revisado todos los traumatismos torácicos en pacientes pediátricos ingresados en el centro de urgencias del Mansoura University Emergency Hospital entre enero de 1997 y enero de 2007. Nuestro hospital recibió a 472 pacientes de menos de 18 años de edad. Hubo 374 pacientes varones, con una media de edad de 9,2 ± 4,9 años. Las causas fueron traumatismos penetrantes (2,1%) y traumatismos cerrados (97,9%). Consistieron en traumatismos sufridos por peatones (38,3%), accidentes de vehículos a motor (28,1%), choques de motocicletas (19,9%), caídas desde una altura (6,7%), traumatismos causados por animales (2,9%) y lesiones deportivas (1,2%). Los tipos de lesión fueron contusiones (27,1%) y laceraciones pulmonares (6,9%), fracturas costales (23,9%) y volet costal (2,5%), hemotórax (18%), hemoneumotórax (11,8%), neumotórax (23,7%), enfisema quirúrgico (6,1%), lesiones traumáticas traqueobronquiales (5,3%) y lesión traumática del diafragma (2,1%). Las lesiones asociadas consistieron en traumatismos craneales (38,9%), fracturas óseas (33,5%) y traumatismos abdominales (16,7%). El tratamiento consistió en un enfoque conservador (29,9%), un tubo de toracostomía (58,1%) o una toracotomía (12,1%). La tasa de mortalidad fue del 7,2%, y los politraumatismos fueron la principal causa de muerte (82,3%) (p < 0,001). Nuestra conclusión es que los traumatismos cerrados son la causa más frecuente de traumatismo torácico en los niños y que a menudo se producen en atropellos de peatones. Las fracturas costales y las contusiones pulmonares son los tipos de traumatismos más frecuentes. El retraso en el diagnóstico y los politraumatismos se asocian a una incidencia elevada de mortalidad.

Journal of the Egyptian Society of Cardio-Thoracic Surgery

Journal of cardiothoracic surgery, Jan 5, 2018

Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of ... more Junctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age. From 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET. JET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectivel...

The Thoracic and cardiovascular surgeon, Jan 12, 2017

Background The increasing complexity of congenital cardiac surgery has resulted in the increased ... more Background The increasing complexity of congenital cardiac surgery has resulted in the increased use of extracorporeal membrane oxygenation (ECMO) support for children who cannot be weaned from cardiopulmonary bypass. The purpose of this research was to assess the mortality and morbidity in children requiring ECMO support after the repair of congenital heart defects (CHDs). Methods The hospital records of all patients with CHD who required ECMO after a cardiac surgical procedure between January 2001 and December 2016 were retrospectively reviewed. Various outcomes were reported and tested for any association with hospital death. Results A total of 113 children required ECMO for cardiopulmonary support after congenital cardiac surgery; 88 (77.9%) were placed on ECMO in the operating room. Median age of the patients was 3 months (range, 4 days–15 years) and median weight was 3.5 kg (range, 2.2–42.5). Forty-two (37.2%) survived to hospital discharge. In children with single-ventricle physiology, survival to discharge was 37.3% (19/51 patients) and for biventricular physiology, it was 37.1% (23/62 patients). Univariate analysis revealed number of days on ECMO support, renal failure, and stroke as risk factors for hospital mortality, while age and cross-clamp time were found to be statistically nonsignificant. Conclusion Satisfactory results can be achieved in pediatric patients by using ECMO support for postoperative cardiac and pulmonary failure refractory to medical management. Prolonged ECMO support, renal failure, and stroke are risk of mortality.

Background: As the age of the population increases with time, more elderly patients are considere... more Background: As the age of the population increases with time, more elderly patients are considered for cardiac surgery. This group of patients has the highest prevalence of cardiac disease and is more likely to have medically refractory symptoms, but they are less likely to be suitable for less invasive procedures such as coronary angioplasty. Patients and methods: Over a period of two years, from September 2008 to September 2010, 304 consecutive patients underwent isolated coronary bypass surgery (CABG) , 48 patients were 70 years of age or older (Group I) which is referred to as elderly group and 256 were below 70 years (Group II) which is referred to as younger group. Results: The mean age of 72.2 ± 2 years, their ages ranged from 70 to 85 years, 70.8% of them were males. Diabetes mellitus, hyper-tension, dyslipidemia, old cerebral infarction and renal dysfunction were more prevalent in the elderly group preoperatively. Postoperative mechanical ventilation time was significantly longer in the elderly group 34.1±8.2 hours and intensive care unit and total hospital stay were statistically significant longer in the elderly group (mean 9.3±4.6 and 15.3±6.1 days respectively). 31.3% had atrial fibrillation and 16.7% had serious ventricular arrhythmias postoperatively in elderly group that is significantly different between the two groups. Transient renal dysfunc-tion occurred in 25.0% in the elderly group with statistical significance. Cerebral stroke occurred in 1.9% with no significance. Sternal wound infection occurred in 8.3% in the elderly group without statistical significance. Overall hospital mortality occurred in 4.2% in the elderly group due to multi organ failure. There was no statistical significance between the two groups. Conclusions: Coronary artery bypass surgery can be performed safely in elderly patients with acceptable results. Careful postoperative care is required to reduce the higher rate of immediate adverse effects in this age group. Elderly patients should not be denied coronary artery bypass surgery on the bases of advanced age alone.

Cardiovascular Mohamed Fouad Ismail, et al. Cardiovascular Objectives: In patients with depressed... more Cardiovascular Mohamed Fouad Ismail, et al. Cardiovascular Objectives: In patients with depressed left ventricular (LV) function (ejection fraction [EF] < 0.30), coronary artery bypass grafting (CABG) is the optimal therapeutic approach and remains superior to medical therapy. Patients and methods: 304 consecutive patients underwent isolated CABG, 57 patients had low ejection fraction (EF) < 30% (Group I) and 247 had EF > 30 % (Group II). Results: Mean age was 62 ± 2 years, 46 (79.7%) of them were males. Preoperative renal dysfunction and patients with history of prior myocardial infarction were statistically significant predominant in group I. Mean left ventricular ejection fraction was 25.3±4.3 in group I and 53.3±6.5 in group II. Left main trunk ste-nosis was significantly more (42.1%) in group I than group II (11.7%) (P<0.001). Preoperative intra-aortic balloon pump (IABP) to support the circulation was statistically significant. Aortic cross clamp time was longer in group II (mean = 112.8±14.1 min.) than group I (mean = 96.7±12.6 min.). Postoperative mechanical ventilation time was significantly longer in group I (mean = 29.1±8.2 hours). Intensive care unit and total hospital stay were statistically significant longer in group I (mean 8.3±4.6 and 12.6±6.1 days respectively). Arrhythmias were significantly more frequent in group I that had 8 patients (14.1%) while group II had only 11 patients (4.5%). Overall hospital mortality occurred in 3 patient (5.2%) died in group I, (P<0.001). Conclusion: Patients with ischemic heart disease and poor left ventricular function can be offered CABG with acceptable operative morbidity and mortality. Comprehensive assessment of the efficacy of the preoperative use of IABP requires a prospective randomized trial.

Methods: This retrospective study included 145 consecutive patients who underwent complete atriov... more Methods: This retrospective study included 145 consecutive patients who underwent complete atrioventricular (CAVSD) repair between January 2002 and January 2012. Peri-operative data were analyzed. Ninety-two patients had a two-patch technique (group A); 53 patients had a single-patch technique (group B). Results: Mean age was 13.17 ± 4.94 months (group A) versus 5.15 ± 1.52 months (group B), (p < 0.001). Mean weight was 9.87 ± 5.53 versus 5.23 ± 2.12 kg (p < 0.001). Down syndrome was present in 82 (90.2%) in group A and 48 (90.5%) in group B (p = 0.315). Aortic cross-clamp times in group A was 135.3 ± 19.6 min and group B 107.7 ± 21.4 min (p < 0.0001). Cardiopulmo-nary bypass times were shorter in group B (132.2 ± 24.3 min) than group A (159.42 ± 31.4 min) with p value <0.001. Chylothorax, post operative bleeding, ICU stay and hospital length were not significant. Reoperation for left atrioventricular valve insufficiency occurred in 5 patients (5.4%) in group A, one of them needed valve replacement and 3 patients (5.7%) in group B. Permanent pacemaker was required for postoperative heart block in 3 patients (3.3%) in group A and 2 patients (3.8%) in group B (p = 0.623). Hospital mortality was seen in 6 patients (6.5%) in group A and 3 patients (5.7%) in group B (p = 0.606). Conclusions: Single-patch technique can be performed with the same results like the two patch technique with a significantly shorter aortic cross clamp and bypass time.

Objective: To evaluate our experience in the Fontan procedure comparing those below and above 6 y... more Objective: To evaluate our experience in the Fontan procedure comparing those below and above 6 years of age. Methods: A review of our clinical database was conducted to identify the patients who received extracardiac Fontan between 2002 and 2010. All demographic, echocardiographic, surgical, haemo-dynamic and follow-up data were collected. The overall mortality was defined as death occurring from the time of surgery to the most recent follow-up. Early postoperative death was defined as death occurring during admission or within 30 days from the operation. Seventy-six patients with functionally univentricular hearts were included in the study. Patients were divided into two groups. Group A included patients who had received extracardiac Fontan at the age of 6 years or less, whereas group B included patients who had received extracardiac Fontan at an age of more than 6 years. Results: The overall hospital mortality was 7.9% (10.2% in group A and 5.9% in group B). No statistically significant difference was seen between the two groups regarding the postoperative

Your article is protected by copyright and all rights are held exclusively by Indian Association ... more Your article is protected by copyright and all rights are held exclusively by Indian Association of Cardiovascular-Thoracic Surgeons. This e-offprint is for personal use only and shall not be self-archived in electronic repositories. If you wish to self-archive your article, please use the accepted manuscript version for posting on your own website. You may further deposit the accepted manuscript version in any repository, provided it is only made publicly available 12 months after official publication or later and provided acknowledgement is given to the original source of publication and a link is inserted to the published article on Springer's website. The link must be accompanied by the following text: "The final publication is available at link.springer.com".

Background: chondrosarcoma is the most common primary tumor of the chest wall. We analyzed cases ... more Background: chondrosarcoma is the most common primary tumor of the chest wall. We analyzed cases of chest wall chondrosarcoma to establish the presentation, diagnostic tools, surgical treatment, and outcome. Methods: this was a retrospective observational analysis of 45 patients who underwent surgery for chondrosarcoma. Results: the mean age was 42.3 AE 8.5 years, and 57.8% patients were male. Symptoms were a painful chest wall mass in 91.1% of patients. Chest radiography and computed tomography, and biopsy were the diagnostic tools. The tumor was right-sided in 57.8% of patients. It was located in the lateral (71.1%), anterior (26.7%), or posterior (2.2%) chest wall. The mean tumor diameter was 7.6 AE 3.3 cm. Radical en-bloc excision was performed in all patients. Chest wall reconstruction was carried out using methylmethacrylate and Prolene mesh (42.2%), Prolene mesh alone (37.8%), and direct closure (20%). A muscle flap was used for soft tissue reconstruction in 11.1%. Complications were encountered in 6.7%. There was no operative mortality. Follow-up was complete in 66.7% of patients. The mean follow-up period was 3.7 AE 2.1 years. Local recurrences and late mortality occurred in 4.4%. Conclusion: surgery for chondrosarcoma can be performed with acceptable morbidity and mortality. Proper selection of patients and radical en-block excision of the tumor are the keys for successful treatment and better outcomes.

Background: The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhy... more Background: The reported incidence of AF after CABG surgery varies from 20 to 40%, with the arrhythmia usually occurring between second and fourth postoperative days. Postoperative AF after CABG was associated with greater in-hospital mortality and worse survival at long-term follow-up. Therefore, intensive attention has focused on the prevention of AF in high-risk patients. Many perioperative factors have been suggested to increase the incidence of postoperative AF after conventional CABG. In this study we are trying to examine some of these risk factors as predictors for Post-operative AF in our patients. In this study, our aim was to identify the perioperative predictors of AF in our patients who underwent Coronary Artery Bypass Grafting. Methods: Our Patients were divided into two groups; Group A included patients who did not develop PO AF (168 patients) and Group B patients who developed PO AF (84 patients). Perioperative Data, including gender, age, demographic variables and postoperative morbidity and mortality were extracted from the medical records. Results: This retrospective cohort study was conducted on 252 consecutive adult patients underwent CABG, in King Faisal Specialist Hospital and Research Center in Jeddah, Saudi Arabia. The mean age for patients with PO AF was 65 years (P = .0001). Eight-three patients (49.4%) were diabetics in group A and 56 patients (66.7%) in group B (P = .0001). Patients who developed POAF had a lower ejection fraction (44.8 ± 5.7%) (P = .0001), diastolic dysfunction (P = .0001), Larger Left atrial volume (P = .0001). Bleeding requiring reopening for exploration and Postoperative shock were identified as significant predictors for POAF. Multivariate logistic regression (odds ratio, ±95% CI, P value) was performed to identify the effect of age, preoperative heart rate, ejection fraction, postoperative bleeding, Shock, ventilator time, Sensitivity was 89.5%, specificity was 94.6%, positive predictive value was 89.5%, and negative predictive value was 94.6%.