Coronary heart disease is a common diseases of atherosclerosis. Despite the development of noninvasive therapies and the advancement of pharmacological methods and extensive drug regimens, coronary artery bypass grafting surgery is still the ultimate treatment option in many patients. Among the various complications following open heart surgery, one of the common difficulties is pulmonary complications associated with subsequent morbidity and mortality, which should be studied according to preoperative, perioperative, and postoperative factors. Preoperative factors include genetics, age, family history of pulmonary disease, smoking, coexisting disease, etc. Perioperative factors include surgical procedures like sternotomy incision, cardioplegia, and internal mammary artery harvesting; anaesthesia procedure effects like pulmonary collapse, maintenance drugs and morphine administration; and cardiopulmonary bypass pump by systemic inflammatory response syndromes. And finally, postoperative factors, especially mediastinitis and the role of nursing in the intensive care unit. Pulmonary complications after cardiac surgery include atelectasis, pleural effusions, pneumonia, pulmonary oedema, cardiogenic pulmonary oedema, acute respiratory distress syndrome, pulmonary embolism, phrenic nerve injury, pneumothorax, sternal wound infection, and mediastinitis, with different outbreaks in patients reported. Although the preoperative, perioperative, and postoperative factors play an important role in the occurrence of these complications, the preoperative factors, as factors that can be adjusted, should be considered more than the others and explained to the patient, and the preoperative patient's assessment should be noted. Also, postoperative care with the goal of reducing infections and pulmonary complications should be addressed by the nursing team.

BACKGROUND: Combined open-heart surgery and thyroidectomy is a rare procedure. However, some difficulties will occur for cardiac surgery when thyromegaly extends into the retrosternal space. CASE DETAILS: A 54-year-old woman suffering from dyspnea, chest pain and decreased left ventricular function (EF=40%) was diagnosed with coronary artery disease (3 vessel disease) and became candidate for coronary artery bypass grafting (CABG). Also, she had multinodular goiter with normal thyroid function test. After midsternotomy, a huge goiter was seen in the upper mediastinum. Because the mass had covered the ascending aorta and involved the posterior aspect of the innominate vein making access to aorta impossible, thyroidectomy was performed at first followed by CABG. Postoperation course was satisfactory. Fourteen months later, the patient was euthyroid and in NYHA class 1. CONCLUSION: The evidence of the case showed that combined CABG and thyroidectomy can be performed safely.

Background: Due to the controversy over the effect of serum testosterone levels on coronary artery diseases, this survey explores the serum levels of free testosterone, luteinizing hormone, and follicle-stimulating hormone in candidates for coronary artery bypass graft compared with an age-matched control group and evaluates the associated factors in these participants. Objective: To determine the testosterone level in elective coronary artery bypass grafting participants. Materials and Methods: In this cross-sectional study, all male patients aged > 40 yr as candidates for elective coronary artery bypass grafting, who were referred to the Afshar Hospital, Yazd, Iran, from March 2018 to March 2019, were included. In total, 100 men were enrolled (50 cases and 50 controls). Their serum levels of free and total testosterone, luteinizing hormone, and follicle-stimulating hormone were measured and the results were compared. Results: The findings indicated a significant difference between the two groups in total and free testosterone (both p < 0.001); they were lower in the case group. There was also a significant difference in the total testosterone of the participants with diabetes mellitus compared with no-diabetic individuals (p = 0.007). Free testosterone of diabetic subjects taking insulin was lower compared with those taking no insulin (p = 0.04). There was also an association between the body mass index and free testosterone, left ventricular ejection fraction and total testosterone, and a significant and negative relation between the duration of hospital admissions and free testosterone (p < 0.05). Conclusion: This study illustrates that participants with coronary artery disease bear a significantly low testosterone level in comparison with the healthy control group. Key words: Coronary artery disease, Testosterone, Coronary artery bypass graft surgery.

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Background: Recently, some studies have investigated type D personality as a critical factor in developing depression and reducing the quality of life. Objectives: This study aimed to compare depression and quality of life after coronary artery bypass graft surgery in patients with and without type D personalities. Methods: Sixty-nine participants who underwent coronary artery bypass grafting at Imam Khomeini hospital, Ahvaz, Iran, referred to the cardiac surgery clinic for their first visit (1 to 1.5 months after surgery) were included in the study. All participants completed the World Health Organization Quality of Life questionnaire, type D personality scale, and Beck’s Depression Inventory. Finally, depression and quality of life were compared in two groups with and without type D personalities using ANOVA and correlation tests. Results: The two groups were significantly different in depression and quality of life scores after coronary artery bypass graft surgery. Depression and quality of life impairment were higher in participants with type D personality. There was no significant relationship between depression and quality of life with age, gender, and occupation in participants with type D personality. Conclusion: Depression and quality of life were higher in patients with type D personality after coronary artery bypass graft surgery than patients without type D personality. Episodic screening of these patients can prevent future somatic and psychological problems.