Iskander Al-Githmi

Effect of Modified Ultrafiltration on Pulmonary Function After Cardiopulmonary Bypass

BACKGROUNDnPulmonary dysfunction is one of the most common manifestations of inflammatory response after cardiopulmonary bypass (CPB).nnnOBJECTIVEnThis prospective randomized study was conducted to evaluate the effect of a modified ultrafiltration (MUF) technique on pulmonary function after CPB in children.nnnMETHODSnForty patients weighing from 5 to 10 kg with congenital heart disease who required CPB for primary biventricular operative repair were prospectively randomized into two groups. The control group received conventional ultrafiltration (CUF) during CPB, and the study group received CUF and MUF. Pulmonary compliance (static and dynamic) and gas exchange capacity of the lung expressed as oxygen index, respiratory index, ventilation index, and alveolar-arterial oxygen pressure difference were measured after intubation (baseline), at the termination of CPB, at the end of MUF, on admission to the ICU, and 6 h postoperatively.nnnRESULTSnThere was no significant difference in lung compliance and gas exchange between the two groups before CPB. CPB produced a significant decrease in static and dynamic lung compliance in both groups. In the control group, static and dynamic lung compliance decreased from 1.0 +/- 0.3 to 0.90 +/- 0.3 mL/cm/kg and 0.87 +/- 0.2 to 0.71 +/- 0.1 mL/cm/kg (+/- SE) [p = 0.0002 and p = 0.002, respectively]. In the study group, static and dynamic lung compliance decreased from 1.0 +/- 0.2 to 0.89 +/- 0.03 mL/cm/kg and 0.94 +/- 0.2 to 0.77 +/- 0.1 mL/cm/kg (p = 0.002 and p = 0.002, respectively). There was no significant difference in the decrease in static (p = 0.9) or dynamic lung compliance (p = 0.3) between the two groups. MUF produced a significant immediate improvement in both static lung compliance (0.89 +/- 0.2 to 0.98 +/- 0.2 mL/cm/kg, p = 0.03) and dynamic lung compliance (0.77 +/- 0.1 to 0.93 +/- 0.2 mL/cm/kg, p = 0.007). The same was observed regarding the gas exchange capacity. CPB produced a significant decrease in lung gas exchange capacity, and MUF produced a significant immediate improvement in lung gas exchange capacity. The effect of MUF on lung compliance and gas exchange capacity was not sustained after admission to the ICU nor 6 h later postoperatively. There was no significant difference in the time of extubation between the two groups (12 +/- 3 h and 13 +/- 2 h, p = 0.4), the length of ICU stay, or the total hospital stay postoperatively.nnnCONCLUSIONSnThe use of MUF after CPB can produce an immediate improvement in lung compliance and gas exchange capacity, which may effectively minimize pulmonary dysfunction postbiventricular repair of congenital heart disease. However, these improvements are not sustained for the first 6 h postoperatively and do not reduce the duration of postoperative intubation, ICU stay, or total hospital stay.

Primary cardiac paraganglioma with dual coronary blood supply presenting with angina chest pain

Primary cardiac paraganglioma (pheochromocytoma) is very rare, constituting only 1% of cardiac tumours. A case of a 44-year-old woman presenting with angina chest pain and a tumour with dual blood supply from both the right and left coronary arteries is reported.

Esophageal Cancer Associated With Pregnancy

BACKGROUNDnEsophageal cancer concomitant with pregnancy is very rare and the prognosis is poor. The main concern in diagnosis is that the clinical presentations of esophageal cancer in pregnant woman are often not considered serious and are misinterpreted as pregnancy-related symptoms.nnnCASEnA 29-year-old woman presented at 29 weeks gestation with dysphagia, weight loss, and a single episode of hematemesis. Esophageal carcinoma was diagnosed on endoscopy, and local spread confirmed by MRI. A Caesarean section was performed at 32 weeks gestation, and shortly afterwards the patient underwent thoracotomy, but resection of the tumour could not be performed. Palliative treatment was begun and she was discharged from hospital.nnnCONCLUSIONnClinicians must be aware and include the probability of esophageal cancer in the differential diagnosis of gastrointestinal symptoms during pregnancy.

Early Experience with Lung Transplantation in Patients with Idiopathic Pulmonary Fibrosis

Background: Lung transplant is a treatment option for idiopathic pulmonary fibrosis. The purpose of this study was to review the results of lung transplant in patients with idiopathic pulmonary fibrosis. Methods: Between November 2008 and October 2010, there were 11 patients who had lung transplant at our institution; 6 patients (55%) had single lung transplant for idiopathic pulmonary fibrosis. Clinical data were reviewed retrospectively. Follow-up was 4 years. Results: The 6 patients who received single lung transplant for idiopathic pulmonary fibrosis had no perioperative mortality; 1 patient died within 30 days of surgery because of multiple organ failure that resulted from sepsis, and 1 patient died at 14 months after surgery because of respiratory failure and bronchiolitis obliterans. The overall survival was 83% at 1 year, 67% at 2 years, and 67% at 4 years after transplant. Conclusions: Lung transplant is effective in reducing the risk of death and prolonging survival in patients with idiopathic pulmonary fibrosis.

Nitroglycerin Cardioplegia Effect on Coronary Artery Targets in Bypass Grafting

BACKGROUNDnCoronary artery targets are essential for referral acceptance to achieve complete coronary revascularization.nnnPATIENTS AND METHODSnA prospective double-blind study was carried out to determine whether the addition of nitroglycerin to cold blood hyperkalemic cardioplegia would optimize the size and number of coronary artery targets during conventional coronary bypass grafting.nnnRESULTSnA total of 60 adult elective coronary artery bypass grafting cases were enrolled; 30 in group N (nitroglycerin added to cardioplegia) and 30 in group C (controls). The number of bypassed vessels ranged from 2 to 5 with a mean of 3.63. In a comparison between groups N and C, the average number of grafts per patient (3.67u2009±u20090.77 vs. 3.67u2009±u20090.92); the average performed/predicted ratio for coronary artery bypass grafting targets (0.96u2009±u20090.18 vs. 1.02u2009±u20090.31); and the average intraoperatively measured luminal diameter of the bypassed coronary artery targets (1.55u2009±u20090.23 vs. 1.51u2009±u20090.23) showed no significant difference between the two groups, except that the luminal diameter of the obtuse marginal II artery was larger in group C compared to group N ( Pu2009=u20090.037).nnnCONCLUSIONSnThe addition of nitroglycerin to cardioplegia did not show any benefit, either quantitatively or qualitatively, for optimizing coronary artery bypass grafting targets.