Hasanat Sharif

Surgical management of valvular heart diseases in pregnancy

Heart disease in pregnancy remains one of the important causes for maternal and fetal mortality and morbidity. Cardiac surgery undertaken in pregnancy presents specific additional issues for both the mother and fetus; especially cardiopulmonary bypass and the factors associated with it. Successful outcome of cardiopulmonary bypass surgery during pregnancy depends upon the multidisciplinary management of the patient, which is frequently under reported from the developing world. We present our experience of two cases where cardiopulmonary bypass surgery for cardiac valve replacement was successfully performed during pregnancy without any maternal or fetal mortality. A review of published literature is also undertaken in order to present evidence based recommendations for undertaking such procedures in pregnancy.

Body mass index—predictor of outcome after coronary artery bypass grafting

Objective: Increased body mass index has been associated with increased postoperative morbidity. We studied the effect of body mass index in our population, using a modified scale suggested by the World Health Organization. Methods: From January 2006 to December 2008, 1019 patients undergoing first-time isolated elective coronary artery bypass grafting were selected from our cardiac surgery database. Data were analyzed by univariate and multivariate analyses. Results: Of the 1019 elective coronary artery bypass patients, 168 (15.8%) had a normal body mass index (18.5–22.9 kg·m−2) and 894 (84.2%) had a high body mass index (≥23.0 kg·m−2). There were 921 (86.7%) patients with 3-vessel disease, and 1012 (95.3%) had internal mammary artery grafts. The 30-day mortality was 0.8%. Multivariate analysis revealed age, hospital stay, perfusion time, and renal failure were significantly associated with hospital complications. High body mass index was not significantly associated with morbidity or mortality. The model had an adequate fit at p = 0.708 by the Hosmer and Lemeshow test. Conclusion: Increased body mass index alone is not a predictor of increased mortality and morbidity. In fact, these outcomes were associated with advanced age, hospital stay, perfusion time, and renal failure.

Aneurysm of a patent ductus arteriosus.

(J Card Surg 2011;26:225‐226)

Outcome of coronary artery bypass grafting in a tertiary-care center in Pakistan.

Background Coronary artery bypass grafting and percutaneous coronary intervention are revascularization options for significant coronary artery disease. While international data support the use of coronary artery bypass in high-risk groups, regional data on outcomes in these groups are rare. We conducted a retrospective study to determine the outcomes of patients undergoing coronary artery bypass for left main and multivessel disease. Methods Two thousand eight hundred and fifty-one patients undergoing coronary artery bypass at the Aga Khan University Hospital from 2006 to 2013 were included; patients undergoing redo surgery were excluded. Demographic data, comorbidities, angiography findings, in-hospital complications, one-month and one-year follow-up were analyzed. Results Of the 2851 patients, 568 had left main disease (group 1) and 2283 (group 2) had multivessel disease (≥2 vessels excluding the left main). Group 1 had significantly more chronic lung disease, cardiogenic shock, and congestive heart failure than group 2 (p < 0.001); 50.6% of patients were diabetic and 71.8% were hypertensive. Mortality was 5.1% and 2.2% during hospital stay, 6.5% and 2.6% at 30 days, and 6.7% and 2.7% at 1 year in groups 1 and 2, respectively. Conclusion Our comparable results and international data advocate revision of the current practice of using percutaneous coronary intervention over coronary artery bypass in the developing world. Institutional results are essential to determine the outcome of coronary artery bypass in high-risk populations with a high burden of diabetes and hypertension. We noted increased complications and mortality in patients with left main rather than multivessel disease.

A case of cellulitis of the hands caused by a predatory bird attack.

Many species have been drastically affected by rapid urbanization. Harriss hawks from their natural habitat of open spaces and a supply of rodents, lizards and other small prey have been forced to change their natural environment adapting to living in open spaces in sub- and peri-urban areas. Specific areas include playgrounds, parks and school courtyards. The migration of this predatory species into these areas poses a risk to individuals, and especially the children are often attacked by claws, talons and beaks intentionally or as collateral damage while attacking rodent prey. In addition, the diverse micro-organisms harbored in the beaks and talons can result in wound infections, presenting a challenge to clinical management. Here we would like to present a case of an 80-year-old man with cellulitis of both hands after sustaining minor injuries from the talons of a Harriss hawk and review the management options. We would also like to draw attention to the matter that, even though previously a rarity, more cases of injuries caused by birds of prey may be seen in hospital settings.

Surveillance of Cardio Vascular Risk Factors Among Patients Undergoing Coronary Artery Bypass Surgery

According to world health organization report 2011, coronary artery diseases are the number one cause of death globally: more people die annually from coronary artery diseases than from any other cause. For this big burden of disease we need to know the ,prevalence of cardiovascular risk factors among patients undergoing elective Coronary Artery Bypass Graft surgery (CABG) in Karachi, Pakistan.