<p class="Abstract">This study aimed to evaluate the hemostatic derangement in patients undergoing elective cardiac surgery using cardiopulmonary bypass. Total 55 patients of either sex, were divided into three groups: Group A (n=20): Patients selected for elective cardiac surgery without cardiopulmonary bypass; Group B (n=20): Patients who undergone cardiac surgery with cardiopulmonary bypass time &lt;90 min; and Group C (n=15): Patients who undergone cardiac surgery with cardiopulmonary bypass time either 90 min or more. The difference of mean hemoglobin, total count of WBC, and platelet count on immediate post-operative period and at 7 days after surgery were statistically significant among the groups. The mean hematocrit value, fibrinogen level and coagulation profile were statistically significant between the two groups in comparison to pre-operative value. The mean cross-clamp time and bypass time were statistically significant between the two sub-groups of cardiopulmonary bypass population. The mean blood loss was more (1513.3 ± 307.9 mL) where the cardiopulmonary bypass was used for &gt;90 min in comparison to other population. Prolong cardiopulmonary bypass time associated with more hemostatic abnormalities and complications can be minimized by shortening the bypass time.</p>

Background: Vascular injuries occur in approximately 25% of all penetrating neck traumas, with carotid artery injuries being particularly lethal. Penetrating neck injuries are potentially fatal. Vascular injuries occur in approximately 25% of cases, which can lead to the formation of arteriovenous fistulas. Case Description: The authors present a case of delayed open surgery to repair a carotid-jugular fistula that resulted in an unprecedented complication, as well as a brief review of the condition’s diagnosis and treatment options. Conclusion: This case report suggests us that, penetrating neck injuries should be thoroughly evaluated for arteriovenous fistulae. To avoid complications, common carotid-jugular fistulas must be treated as soon as possible. Postoperative complications can be effectively managed with prompt action.

Objectives: Algorithms of risk stratification for coronary artery bypass grafting (CABG) do not include a weighting for preoperative mild to moderate renal impairment defined as a serum creatinine 130 to 199mmol/L, which may impact mortality and morbidity after CABG. Hence our first objective was to ascertain the effect of a mild-to-moderate elevation in the preoperative serum creatinine level on post-operative outcomes. Our second objective was to ascertain which patient variables contributed to an increase in the serum creatinine level in association with coronary artery bypass grafting. Materials and methods: We reviewed the prospectively collected data from the cardiac surgical database, which holds clinical information on all the patients undergoing cardiac surgery at our department since July 2014 to June 2017. A total of 101 patients who had known pre-existing mild to moderate renal disease and who were undergoing first-time coronary artery bypass grafting with cardiopulmonary bypass were recruited for the study. Patients were divided, based on preoperative serum creatinine level, into 3 groups as follows: Group A: creatinine level of less than 130μmol/L; Group B: creatinine level of 130 to 159μmol/L; and Group C: creatinine level of 160μmol/L or greater. Result: Multivariate logistic regression showed that elevation of the preoperative serum creatinine level to 130μmol/L or greater increased the likelihood of hemodialysis postoperatively (P<0.001), as well as the need for postoperative ICU stay (P<0.001). Other factors contributing to a prolonged ICU stay were being 60 years of age or older (P=0.007), having a preoperative left ventricular ejection fraction of less than 40% (P=0.001), and having a prolonged cardiopulmonary bypass time (P< 0.001). In-hospital mortality was also significantly elevated in Group B and Group C; P=0.045 and <0.001 respectively with a few factors contributing to an increase in mortality on multivariable analysis were being female (P<0.001), being 60 years of age or older (P=0.004), having a preoperative left ventricular ejection fraction of less than 40% (P=0.006), and having a prolonged cardiopulmonary bypass time (P<0.001). Of particular note, the method of myocardial protection (cardioplegia with or without topical cooling) did not significantly influence in-hospital mortality, need for mechanical renal support, or ICU stay. Conclusions: Mild to moderate renal dysfunction is an important predictor of outcome in terms of inhospital mortality, morbidity, and midterm survival in patients undergoing CABG. As the preoperative serum creatinine level increases further (³160 μmol/L), this effect is more pronounced. Journal of Surgical Sciences (2018) Vol. 22 (2) : 104-109

Background & objective: Cardiac remodeling manifested clinically as changes in size, shape and function of the heart. The extent of remodeling depends on initial morphological changes. So the time at which the surgical correction of atrial septal defect (ASD) done is important. Apparently surgical outcome and remodeling is better at earlier age in comparison to adult age. The aim of this study was to find whether surgical correction of ASD is beneficial at younger age (up to 18 years) in comparison to adult age (above 18 years). Methods: This prospective cohort study was carried out on a total of 70 patients who underwent surgical closure of atrial septal defect over a period of twenty three months (23) months (from February 2013 to December 2014) in the Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka. The recruited patients were divided into two groups – Group-A (comprised of ≤ 18 years old patients) and Group-B (comprised of >18 years old patients) 35 patients in each. Condition of the heart was evaluated preoperatively by echocardiography and the result was compared with postoperative echocardiographic findings at follow-ups after 1 and 3 months after surgery. Results: The comparison of echocardiographic parameters between baseline (preoperative) and those at 1 and 3 months after surgery in Group-A demonstrated that statistically significant remodeling occurred after 1st month (p < 0.001) and it further improved at 3 months. In Group-B the comparison of echo parameters between baseline and at 1 month revealed that all the parameters responded significantly indicating that remodeling occurred well after 1 month. But the same parameters when compared between baseline and at months after repair revealed insignificant differences in all the parameters, except PWT indicating that remodeling that occurred at month 1 regressed at 3 months interval. Cardiac remodeling occurred in both groups, but the degree of remodeling between patients of early age (Group-A) and late age (Group-B) revealed that ASD repair at early age responded well with respect to all the echocardiographic variables of remodeling. Conclusion: Cardiac remodeling occurs after surgical closure of atrial septal defect. But the degree of remodeling is better if the closure is done at earlier age (at or below 18 years). Ibrahim Card Med J 2018; 8 (1&2): 48-52

True subclavian artery aneurysms are relatively rare events. Thoracic outlet compression is responsible for 75% of those aneurysms. They are formed as a result of compression of subclavian artery, for example a cervical rib. A case of subclavian artery aneurysm secondary to cervical rib in a 35 year old young adult, who presented with a critical ischemia in his dominant right upper limb. Plain x-ray of cervical spine revealed bilateral cervical ribs and duplex study of the both upper limb arteries concluded aneurysmal dilatation of mid-distal subclavian artery of both sides with mural thrombus on the right side, marked distal ischemia in the right upper limb due to occlusive thrombus in the distal arterial tree, normal distal arterial flow in the left upper limb. Although it is a rare lesion, cervical rib leading to thoracic outlet compression should always be included in the differential diagnosis of a critically ischemic limb in young age group. Surgical management should be considered in a patient with subclavian artery aneurysm due to cervical rib to prevent additional embolic events.University Heart Journal Vol. 11, No. 1, January 2015; 48-51