Background: Pericardiectomy procedure is commonly indicated for constrictive pericarditis (CP). One of the most important clue to diagnosis of CP is the signs and symptoms of right-sided heart failure that are not completely explained by presence of pulmonary disease or left-ventricular failure. The aim of this study was to assess clinical data presentation and early operative outcomes of pericardiectomy performed for symptomatic chronic constrictive pericarditis who had failed maximal medical therapy. Methodology: A retrospective analysis was carried out of consecutive constrictive pericarditis adult age patients who underwent pericardiectomy procedure from 2002 to 2012. The patients who had intraoperative diagnosis of other then constrictive pericarditis were excluded from further analysis. A total 51 patients were selected for this study. The preoperative assessment, intraoperative findings and postoperative course and outcome such as hospital stay, prolonge ICU stay, post-operative CPV etc. were evaluated. Results: 43 males and 8 females were include in the study among them 41% gave history of previous (TB) and 35% were pediatric patients (teens, as shown less than 19 years). 8 patients had effusive type pericarditis. The preoperative findings revealed dyspnea 54%, Chest Pain 45% and persistent cough 31%. Furthermore, 43% patients had ascites and 41% with pleural effusion. The mean preoperative central venous pressure (CVP) was 20.5 respectively. The post-operative outcome was short hospital stay, the post-operative patients CVP was estimated 13.5 and the mean drop of CVP due to pericardiectomy was estimated 7 respectively. Conclusion: The conclusive findings of our study revealed that among the patients of symptomatic chronic tuberculous CP, the timely pericardiectomy attempt can effectively improve the hemodynamics of the patient. The early pericardiectomy can also reduce the morbidity and mortality rate of these patients.

Introduction: Leiomyoma is one of the most common benign smooth muscle tumor of the uterus which on rare occasions may grow into the vessels and extend up till the Inferior Vena cava or the heart and hence be referred to as Intra-Venous Leiomyomatosis and Intra-Cardiac Leiomyomatosis respectively.Case Report: We herein report a rare presentation of leiomyoma in a 46 year old female who presented with complaints of shortness of breath on exertion associated with palpitations for the past 1 year with a history of irregular menstrual bleeding. Ultrasonography of the abdomen and pelvis revealed an enlarged, distorted uterus with multiple intramural fibroids. A trans-thoracic echocardiography was then performed which showed a large right atrial mass. To investigate further, a contrast enhanced computed tomography was performed covering entire chest and upper abdomen. It showed a large lesion in right atrium of heart measuring 6x5cm.

Background: For identification of the coronary artery diseases the neutrophil to lymphocyte ratio is considered as a well-known marker. Objective: To evaluate the relationship of neutrophil to lymphocyte ratio (NLR) with CAD severity and to determine the reference value of NLR for prediction of the CAD. Study design: It was a cross-sectional study with statistical approach, Peshawar institute of cardiology and Punjab Institute of cardiology Lahore from May 2021 to October 2021. Material and Methods: The 132 patients visited the Peshawar institute of Cardiology and Punjab Institute of cardiology Lahore were included in this research. The patients who had undergone the coronary angiography for angina with ischemic ECG changes were selected. SYNTAX score was used to assess the CAD severity. The high, intermediate and low SYNTAX group was created on the basis of results. The BeneSphera analyzer was used to determine the neutrophil and lymphocyte count. The NLR was calculated. The Pearson’s correlation test, ANOVA and logistic regression analysis was performed for the statistical analysis. Results: Out of the 132 patients were selected, the average age range was between 24 years to 85 years. Among them 67 % of the patients were male and 40 % of patients had a low score of SYNTAX. On the other hand, 33 % of the patients had medium syntax scores. The range of the NLR was between 1.1to9.76 (median 2.54 and mean 3.31 ±1.90). The average standard deviations in low SYNTAX group was 57.12 ±12.018. While it was 61.92±12.23 in intermediate SYNTAX group and 63.01±12.54 high SYNTAX group. The dyslipidemia, diabetes mellitus were more commonly observed in the high SYNTAX group. This group also had low lymphocyte count and high neutrophil count. Conclusion: For the prediction of CAD, the ratio of neutrophils to lymphocytes can be considered. By the calculation of this ratio, it is easy to highlight the correlation between CAD and severity level. Keywords: Coronary angiography, SYNTAX, neutrophil to lymphocyte ratio (NLR), Cardiovascular diseases (CAD).

Objective: To investigate the early outcomes of patients undergoing total-correction (TC) for Tetralogy of Fallot (TOF). Methodology: A retrospective study was carried out after acquiring Institutional ethical review committee approval. All patients diagnosed with TOF combined with pulmonary stenosis that had undergone primary repair between November 2016 and November 2018 at the Cardiothoracic Surgery Unit of Rehman Medical Institution, Peshawar were included while patients having anatomical defects alongside TOF were excluded from the study. Data was collected using a proforma. SPSS version 25 format was used for data entry and analysis. Comparisons between age related intraoperative parameters and age related early outcomes of the procedure was done by using the Student’s T-test and Chi-squared test keeping p ≤ 0.05 as significant. Results: A total of 186 patient’s data was retrieved from the hospital record. There were 109 (58.60%) males and 77 (41.40%) females. Mean cardiopulmonary bypass time (CBP) was 94.84±37.92 minutes and aortic cross clamp (ACC) time was 67.17±31.86 minutes. In the postoperative period, 11 (5.91%) patients developed Low cardiac output syndrome (LCOS).  Prolonged ventilator support (>24 hrs.) was required in 21(11.29%) patients and prolonged ICU stay (>48 hrs.) was seen in 38(20.43%) patients. A total of 166 (89.25%) patients were discharged while 20 (10.75%) died post operatively due to complications. Conclusion: Total repair for TOF is a favorable option in most patients as early outcomes were satisfactory with acceptable mortality rate after surgery.

Background: Coronary artery bypass graft (CABG) surgery can result in serious complications for the patients. It is being currently performed with cardiopulmonary bypass with cardiac arrest in 80% of the cases across the world. There have debate in the past regarding the cardiac revascularization via CABG approaches. Aim: The aim of this study is to study the difference in the patient’s ICU stay who have low ejection fraction and are undergoing cardiac revascularization between off pump and on pump coronary artery bypass grafting. Methodology: A sample size of 60 patients has been taken in the study with 30 patients' in the on-pump surgery group and 30 patients' in the off-pump surgery group. The data has been collected from department of Cardiac Srugery AFIC/NIHD, Rawalpindi. Results and Conclusion: The study concludes that the on-pump CABG patients tend to have shorter ICU stay than the off-pump CABG patients who have low ejection fraction and are undergoing cardiac revascularization. Therefore, on-pump treatment is recommended in the study. Keywords: Off pump, on pump, coronary artery bypass grafting, ICU stay, low ejection fraction, cardiac revascularization