Background Occurrence of acute oliguric renal failure in the immediate postoperative period carries important morbidity and mortality after a successful cardiac surgical procedure. Adult cardiac and aortic surgical procedures are especially prone to this complication with the incidence varying between 2% to 15% and the mortality rate as high as 40% to 60%. Aim of the Work to compare between furosemide versus mannitol as a renal protection after adult cardiac surgery. Patients and Methods This prospective comparative trial was conducted at Academy of Cardiothoracic Surgery Ain Shams University on patients undergoing CABG operation consisting of a total of 50 patients with normal renal function, EF of greater than 40%, normal protein and electrolyte levels. Results the study revealed no statistically significant difference between groups according to cystatin-C Conclusion The difference between patients given mannitol and patients given furosemide regarding urinary microalbumin, urinary creatinine and serum cystatin-c was insignificant. Addition of mannitol to the priming solution of the cardiopulmonary bypass acts as a renal protector against AKI postoperative. Finally, giving furosemide infusion to patients undergoing cardiac surgery at the beginning of the CPB improves renal perfusion.

Background Beta-adrenergic receptor blockers have been studied for minimizing the effects of catecholamines by blocking their activation of beta receptors. They are used to prevent or treat hypertensive crises, tachycardia, ischemic cardiomyopathy, and arrhythmias. Several studies have shown the efficacy of such drugs in decreasing postoperative morbidity and mortality. Aim of the study This study aimed to evaluate the benefit of perioperative beta-blocker therapy in improving the outcome of CABG surgery regarding intra- and postoperative arrhythmias and ventricular function. Method It was a prospective controlled nonrandomized study conducted on 50 patients undergoing elective CABG in Ain Shams University hospitals, in which the study group, who were the patients who were compliant on beta-blocker therapy, received 1 mg of propranolol before removal of aortic cross clamp and continued on beta-blocker therapy in the postoperative period, while the control group who were not on beta-blocker therapy received an equivalent volume of normal saline before removal of aortic cross clamp and received beta-blocker therapy in the postoperative period. Both groups were assessed regarding the heart rate, ventricular systolic function by transesophageal echo intraoperatively and transthoracic echo postoperatively, duration of ICU and hospital stay, and incidence of intra- and postoperative arrhythmias. Results Perioperative beta-blockers decreased the incidence of intra- and postoperative arrhythmias. Conclusion In the absence of contraindications, CABG patients should receive perioperative beta-blockers as they improve the systolic ventricular function, decrease the incidence of intra- and postoperative arrhythmias, and shorten the duration of hospital and ICU stay.

Background: Beta thalassemia major (Cooley's anemia) is a congenital genetic blood disorder resulting from a deficiency of β-globin chains due to severe anemia that depends on continuous blood transfusions for survival. Patients suffer from hemoglobinopathy, infection, diabetes mellitus, growth retardation, enlargement and damage to the liver and spleen, bone marrow aplasia and delayed sexual maturity. This complication arises due to the accumulation of iron, the impairment of antioxidants from vitamins, and an increase in lipid peroxides (MDA).Objectives: The study aimed to evaluate vitamin D and B12 levels and their relationship with MDA, liver enzymes (AST, ALT, ALP), iron and (Total Billirubin, Direct Billirubin, Indirect Billirubin).Materials and methods: The samples of BTM patients under study were (100 samples), (50 samples) for both males and females. Patients' ages ranged from (2-30 years). While the control sample was (40), with (20 samples) for each of the two sexes. Their ages ranged from (2-30 years). Their disease was confirmed by blood tests, hemoglobin electrophoresis, DNA analysis, and elevated ferritin levels. Vitamin D and B12 levels were assessed by immunoassay. While (MDA, Fe, AST, ALT, ALP) and (Total Billirubin, Direct Billirubin, Indirect Billirubin) were evaluated by colorimetric methods.Results: Vitamin D and B12 levels decreased significantly (p≤0.05). While the levels of (MDA, Fe, AST, ALT, ALP) and (Total Billirubin, Direct Billirubin, Indirect Billirubin) increased significantly at (p≤0.05) in BTM patients compared with the control group. Where the effect of the disease according to the results was clear in patients with age. conclusion: Our results indicate that the weakness of the antioxidant systems (vitamin D and B12) with the increase in oxidative factors resulting from the complications of the disease led to the exacerbation of the disease with iron overload, causing an increase in the levels of liver enzymes in the blood, damaging the liver and spleen.

Background Catheter ablation for drug refractory, symptomatic atrial fibrillation (AF), is becoming increasingly common and can be beneficial in alleviating symptoms. However, in the elderly, there are concerns about the risks an invasive procedure poses, with limited published data available in those aged over 80 years. Purpose To determine the complication risk of AF catheter ablation in the elderly Methods Complications were identified from patient records in 3156 consecutive patients who underwent radiofrequency catheter ablation for AF, at a tertiary cardiology centre between 2013–2017. All cases were performed under general anesthesia. Results In this cohort of 3156 patients (mean age= 62.9±11.0 years, female = 29.9%), 90 (2.85%) (mean age= 66±10.0 years, female = 49.5%) complications were identified. In patients aged ≥80 years, complications occurred in 5 out of 99 patients (5.05%) (mean age= 82.6±1.2, female=100%), compared to 85 out of 3057 patients (2.78%) in those aged <80 years (mean age= 65±10.3, female = 49.4%). The difference was not significant p=0.18. Complications in the elderly all occurred acutely, and included groin haematoma (2.02%), pneumonia (2.02%) and pericardial effusion (1.01%). Conclusion Catheter ablation for AF in patients ≥80 years of age, is not associated with a significant increase in complication risk, compared to those who are younger.

Background The assessment of mitral regurgitation (MR) is complex and complicated by the dynamic nature of this valvular abnormality. Intraoperative transesophageal echocardiography (TEE) is a well-established tool that is used to assess the mitral regurgitation (MR) before and after mitral valve reconstruction. Objectives This study conducted in the National Heart Institute in Cairo aimed at assessing the effect of depth of anaesthesia guided by bispectral index on the severity of mitral insufficiency as measured by transesophageal echocardiography. Patients and Methods This study was conducted in the National Heart Institute in Cairo. The study was conducted for a period of about six months after the approval from Ethical committee. Informed oral consent for every patient was obtained. Prospective observational cross-sectional study with a random sample of 20 patients at National Heart Institute. A sample size of at least 15 data pairs achieves 80% power to reject the null hypothesis of zero effect size when the population effect size is 0.80 and the significance level (alpha) is 0.05 using a two-sided paired ttest. Adult patients undergoing elective cardiac surgery in National Heart Institute. Results The MR severity decreased at a deeper anaesthesia at low BIS than at a shallower anaesthesia at high BIS in patients with organic MR. Eight patients out of twenty patients (40% with organic MR) showed a + 1 grade of improvement in MR grade, by semi-quantitively measuring maximal JA and VC width. Improvement in mitral regurge severity thought to be secondary to unloading effect of general anaesthesia on left ventricle causing a decrease in afterload, preload, and left ventricular dimensions. This study demonstrated that, a comparison between deep anaesthesia and shallow anaesthesia using BIS showed there is a significant reduction in multiple parameters of MR severity assessment secondary to unloading effect of general anaesthesia on left ventricle caused by a decrease in both afterload and preload. Conclusion This reduction in MR severity appeared to be significant enough to modify intraoperative decisions regarding valve surgery by underestimation of valve severity. Thus, strong consideration should be given to thorough preoperative assessment of MR severity, rather than relying on intraoperative findings.