Background: This is a prospective observational single center study to determine whether bridging anticoagulation with heparin along with warfarin is mandatory in a heterogenous group of patients undergoing valve replacement surgery either single or multiple valve (with mechanical or tissue valve) in the post-operative period. Methods: Perioperative data were collected in 41 patients undergoing multiple valve replacement at this center from July/2019 to September/2019 irrespective of age, sex, number and type of valve replaced. No bridging anticoagulation was given in preoperative and postoperative period in these patients. They were prospectively observed for the incidence of any thromboembolic end bleeding events with daily measurement of International Normalized Ratio (INR) till INR reached at therapeutic level for oral anticoagulant warfarin and complications of warfarin therapy. Results: All the patient suffered from chronic Rheumatic heart disease. Single valve disease was in 70.73% and multiple valve disease was in 29.27% cases. Two patients had left atrial thrombus, seven patient (14.63%) had preoperative atrial fibrillation (AF). Postoperative new onset AF was present in 10 (24.39%) cases. No thromboembolism occurred in these patients and warfarin over anticoagulation was found in 1/41 patient. Conclusion: Patients undergoing valve replacement surgery without concomitant postoperative bridging anticoagulation with heparin do not suffer from any thromboembolic and bleeding complications even at lower level of INR. This study also shows that single and multiple valve (both mechanical and tissue valve) have the same in hospital outcome in relation to thromboembolism and bleeding complications. Cardiovasc. j. 2020; 13(1): 27-34

No abstract

No abstract

Background: Coronary artery disease (CAD) is an important medical and public health issue because it is one of the leading causes of death and disability throughout the world and is rapidly emerging as a major cause of mortality in developing countries including Bangladesh. SPECT-MPI is a cost- effective and non invasive means of identifying ischemic and viable myocardium along with its vascular distribution. This study is aimed to evaluate prospectively the ability of MPI to predict the outcome of Coronary Intervention in CAD patients of Bangladesh who are referred to National Institute of Nuclear Medicine & Allied Sciences (NINMAS) for performing MPI. Patients and Methods: This prospective longitudinal and observational type of study was carried out in National Institute of Nuclear Medicine & Allied Sciences (NINMAS) located at Bangabandhu Sheikh Mujib Medical University (BSMMU) campus, from July 2017 to June 2018with 12 CAD patients who were referred here. Gated SPECT MPI was performed on the selected patients before any coronary intervention to predict myocardial viability & probable outcome of intervention. A follow up MPI of the same patients was performed after minimum 3 to 4 months of  revascularization procedure to determine the outcome of intervention and to detect in stent restenosis or new onset ischemia if present which can be prevented by additional revascularization procedure. Finally pre and post intervention MPI results were analyzed by standard statistical analysis by using the Statistical Package for Social Sciences version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA). P values <0.05 was considered as statistically significant. Results: The sensitivity of MPI for the initial evaluation and risk stratification by diagnosing perfusion defect in the enrolled 12 CAD patients have been found to be 90%,77.8% and 81.8% in case of LAD, LCX and RCA territories respectively. Whereas the specificity and positive predictive value have been found 100% for LAD and RCA territories. About 16.67% patients were found to have restenosis in this study diagnosed by early post-intervention MPI. It was observed that majority of the patients had perfusion defect in LAD territory. 3(25.0%) patients had fixed defect, 5(41.7%) patients had partial reversible defect and 4(33.3%) patients had complete reversible defect in pre intervention MPI. In post intervention MPI, 4(33.3%) patients had partially reversible perfusion defect, 2(16.7%) patients had fixed perfusion defect, 1(3.3%) patient was found with completely reversible perfusion defect and 5(41.7%) patients had normal MPI findings. The result was found statistically significant (P value <0.05) in case of partially reversible perfusion defect and normal MPI findings when before and after intervention MPI results were compared. The difference of mean percentage of involved myocardium by fixed defect between pre and post intervention MPI was found statistically significant (P<0.05) in case of LAD territory and total LV myocardium involvement. 33.3% patients were in high risk before undergoing intervention, whereas it was found to be 25% after intervention which was calculated on the basis of their pre and post intervention SSS(Summed Stress Score) result. Conclusion: The results of this study have indicated that SPECT MPI provides significant independent information concerning the outcome of coronary intervention in CAD patients. Furthermore, early SPECT MPI after intervention successfully identified significant improvement of myocardial viability after revascularization in patients having complete or reversible perfusion defects found in pre intervention MPI along with identifying those having restenosis. It could also depict the reduction of percentage of myocardial fixed defects within 3-4 months after intervention which is also a positive outcome of coronary revascularization. Bangladesh J. Nuclear Med. 22(1): 23-29, Jan 2019

Bidirectional Glenn Shunt is a palliative procedure in single ventricle or hypoplastic right ventricle, tricuspid atresia and pulmonary stenosis complex where definitive repair is not feasible as well as a intermediate step of Fontan procedure. It is done by anastomosing superior venacava with right pulmonary artery or conduit can be used. We were forced to do the anastomosis between superior venacava and left pulmonary artery using a conduit as anatomy wasn’t favorable. Due to unavailability of any recognized conduits we used autologous pericardium and created a conduit with it to carry out anastomosis. Post-operative results were satisfactory. Cardiovasc. j. 2020; 13(1): 92-94