Postoperative hyperbilirubinemia is one of the complications of cardiopulmonary bypass. This prospective study was conducted on 77 patients who underwent open-heart surgery, to evaluate the incidence, risk factors, and prognostic significance of postoperative hyperbilirubinemia. Liver function tests were conducted preoperatively, immediately after surgery and on the 1st, 3rd, and 7th postoperative days. The overall incidence of postoperative hyperbilirubinemia was 26%. The incidence was significantly higher in patients who underwent prosthetic valve replacements (31%) than in those without prostheses (22%) and very high in patients undergoing double valve replacement (50%) compared to single valve replacement (27%). Most (90%) of the increase in serum bilirubin was due to a rise in unconjugated bilirubin on the 1st postoperative day. There was no mortality related to postoperative hyperbilirubinemia but it prolonged intensive care stay when it occurred early after surgery and prolonged hospital stay when it occurred later. Preoperative total bilirubin concentration, number of valves to be replaced, and preoperative high right atrial pressure were the factors associated with increased risk of postoperative hyperbilirubinemia by logistic regression analysis.

Evaluation of pulmonary function by spirometry in adult patients undergoing cardiacsurgery is a simple test to assess pulmonary reserve that has important implications in the operative morbidity. Pulmonary function was studied preoperatively, before discharge, and at the 3-month follow-up in 22 randomly selected patients who underwent open-heart surgery for rheumatic mitral valve disease (2 reconstructions, 20 replacements). The mean preoperative cardiothoracic ratio was 0.58. Lung function was found to be impaired preoperatively in all 22 patients and the majority suffered from restrictive lung disease. Better preoperative lung function was seen in nonsmokers, patients with a cardiothoracic ratio of less than 0.50, and those with a normal pulmonary artery pressure. After mitral valve surgery, the mean pulmonary artery pressure was 20.6 ± 2.9 mmHg, the mean mitral valve pressure gradient was 3.6 ± 2.4 mm Hg, and the mean cardiothoracic ratio was 0.52 ± 0.09. A significant deterioration was seen in the predischarge spirometric values of forced vital capacity, forced expiratory volume in one second, peak expiratory flow rate, flow rate at 25% to 75% of expired vital capacity, and maximum volume ventilation. The deterioration was greater in smokers and those who had prolonged cardiopulmonary bypass (more than 80 minutes). No correlation was found with ventilation because all patients were electively ventilated overnight. There was an overall improvement in spirometric parameters at the 3-month follow-up although the values remained lower than predicted. Spirometry was found to be useful for assessing lung function in patients undergoing mitral valve surgery and we recommended it as a routine test.

We retrospectively reviewed the case records of 82 patients with severe left ventricular dysfunction (ejection fraction < 30%) who underwent coronary artery bypass grafting between March 1993 and February 2000. They were aged 28 to 76 years (mean, 60 years), and 66 of them were male. Significant comorbid factors included hypertension (93%), diabetes mellitus (85%), and hypercholesterolemia (49%). The number of grafts used ranged from 1 to 3. The majority of the patients (91%) belonged to the Canadian Cardiovascular Society angina class III. Coronary angiography revealed single-vessel (in 16% of the patients), double-vessel (52%), and triple-vessel disease (32%), and left main stem disease (18%). Seven patients (9%) died within 48 hours after surgery. The mean duration of hospital stay was 7 +/- 2 days. The 75 patients who survived were followed up for 3 months to 7 years. At the 1-year follow-up, 61 of the 68 patients (90%) who were alive moved up from angina class III to class I. Our observations suggest that coronary bypass carries an acceptable mortality risk and may offer a better quality of life in patients with poor ventricular function.

From April 1993 to March 1998 patients with chest injuries were retrospectively assessed for the incidence, presentation, and outcome of thoracic trauma. The majority (55.6%) were less than 40 years of age and 83 (92%) were male. The mode and extent of injury, specific intrathoracic organ injuries, associated injuries, flail chest, ventilatory requirements, management, morbidity, and mortality were analyzed. Blunt injuries were seen in 56 (62.2%) and penetrating injuries in 34 (37.7%). Multiple rib fractures with hemopneumothorax was the most frequent presentation with orthopedic and head injuries being most commonly associated. Patients with tachypnea, cyanosis, lung contusion, partial pressure of aterial oxygen less than 60 mm Hg, and those with more than 6 rib fractures most often required ventilation but the majority (54.4%) were treated with a chest drain only. Emergency or delayed thoracotomy was required in 24.4%. The mortality rate was 6.7%, mainly due to respiratory insufficiency. Subcutaneous emphysema requiring releasing incisions accounted for most of the morbidity. Mean hospital stay was 9.5 days. Chest injuries were of major concern in multisystem trauma patients and early planned management is recommended in a mostly vulnerable section of our population in an age of violence and vehicular accidents.

From January 1995 to December 1996 patients with mitral stenosis underwent surgical valvotomy and another 50 had balloon mitral valvuloplasty. Balloon valvuloplasty was performed by the Inoue technique and surgical closed mitral valvotomy was carried out through a standard anterolateral thoracotomy with transventricular repeated Tubbs or finger dilatation. Functional status, left atrial mean transmitral gradient, mitral valve area, and left atrial size were recorded. No significant difference was found between the values of these parameters in the 2 groups of patients at the end of the study. consecutive patients with mitral stenosis who were suitable for either CMV or BMV were alternately assigned to one or other procedure. Echocardiography and cardiac Doppler studies were performed with a Sonos 1500 system (HewlettPackard, Rockville, MD, USA). The mitral valve orifice area was determined by the pressure half-time method on Doppler echocardiography. Fifty patients underwent CMV by standard transventricular Tubbs dilatation with or without finger dilatation and 50 had BMV by the Inoue balloon (Toray Medical, Tokyo, Japan) technique.Patients undergoing BMV were managed by cardiologists in the cardiac care unit and those undergoing CMV were managed in the postoperative intensive care unit. Postoperative echocardiography was performed on the 3rd post-procedure day, with follow-up echocardiography after 6 months and one year. On follow-up, the patients were also assessed for cardiac rhythm, New York Heart Association functional class, medication, and the presence or progression of the same or other valvular lesions. Results were compared by the Student t test.