فهرست مطالب mohammadali sheikhi

undergoing congenital heart surgery and causes anxiety in the surgeon and the patient's parents. Proper diagnosis and management of fever requires careful preoperative patient evaluation, targeted physical examination, and comprehensive knowledge about the prevalence and common causes of fever. The aim of this study was to determine the prevalence of fever after congenital heart surgery in children.

This was a descriptive-analytical study on children under 10 years of age undergoing congenital heart surgery in the cardiac operating room of Golestan Hospital of Ahvaz in 2021. Data collection tools included a two-section checklist. The first section was related to demographic characteristics and the second addressed patients' clinical status and causes of fever. Data were analyzed using SPSS software.

After surgery, 21 patients (31.8%) developed fever and the prevalence of fever was not significantly associated with age, sex, presence of genetic syndrome, type of disease, type of operation, cardio pulmonary bypass, duration of aortic cross clamp, duration of cardiopulmonary bypass, or duration of operation. However, it was significantly correlated with the mean length of ICU stay (P> 0.05).

The prevalence of fever in patients undergoing congenital heart surgery was relatively high and had a significant relationship with the length of ICU stay.

Mitral Valve (MV) disease is responsible for a considerable number of open cardiac surgeries. Selecting a befitting prosthetic valve is a matter of consideration. Thus, accurate definition of mitral apparatus characteristics, particularly mitral annulus dimensions, preoperatively can shed some light on the situation. The less invasive nature of three-dimensional Transesophageal Echocardiography (3D-TEE) can turn it into a practical modality for preoperative investigation of mitral anatomy.

The present study aimed to investigate the correlation between the size of mitral annulus attained through 3D-TEE and intraoperative size as well as the valve or ring size finally placed in mitral position.

The study was conducted on 28 patients suffering from MV disease who were candidates for MV surgery. All the patients underwent 3D-TEE. Mitral annulus diameters including anteroposterior and intercommissural diameters were measured delicately by using the Mitral Valve Navigation (MVN) tool. In the midst of surgery, a mitral ring sizer was utilized in order to suggest the proper prosthesis size.

The study results demonstrated that the sizer instrument was strongly associated with the inserted prosthesis size and moderately with echocardiographic annulus diameters. The correlation between the deployed prosthesis size and annulus size obtained by intraoperative sizer and 3D echocardiography was assessed, as well. The results indicated that ring sizer showed a strong positive relationship with the intercommissural echocardiography diameter and a moderate positive relationship with the anteroposterior echocardiography diameter.

The results revealed a good correlation between the echocardiography measurements and intraoperative examination along with the deployed prosthesis size. Thus, 3D-TEE could be considered a practical modality for the preoperative investigation of mitral anatomy.

There is little information about the prognostic role of preoperative serum albumin levels in postoperative outcomes following coronary artery bypass grafting (CABG). The aim of this study was to evaluate preoperative hypoalbuminemia as a predictor for complications after CABG.

This prospective observational study was conducted in 200 patients undergoing CABG in Ahvaz Golestan Hospital, 2020. The patients were classified into two groups based on pre-operative hypoalbuminemia (serum Alb <3.5 g/dL). The association between hypoalbuminemia and clinical characteristics and outcomes including postoperative complications, ventilator duration, and length of hospital stay was assessed.

Preoperative hypoalbuminemia was observed in 38 (19%) patients. Patients with hypoalbuminemia had higher postoperative complications including hemorrhage, infection, cardiac arrest, AKI, and in-hospital mortality than patients with normal albumin levels (84.2% vs. 13%, P<0.0001). Ventilator duration, length of hospital stay and ICU were significantly longer in hypoalbuminemia patients than normal albumin group (P<0.0001). Preoperative hypoalbuminemia (P<0.0001), ventilator duration (P=0.025), and length of hospital stay (P=0.002) were independent predictors of CABG postoperative complications.

Preoperative hypoalbuminemia was associated with postoperative mortality and complications, including hemorrhage, infection, stroke, and AKI development in patients undergoing CABG procedure. Thus, serum albumin measurement before CABG as a clinically implementable and easy method could be used for management and prevention of postoperative complications.

The incidence of atrial fibrillation (AF) after coronary artery bypass grafting (CABG) can leave irreparable sequelae; thus, the prevention of this common arrhythmia has particular importance. The aim of this prospective study was to evaluate the efficacy of sodium nitroprusside (SNP) in lessening the incidence and duration of AF after CABG.  

This prospective double-blind randomized clinical trial compared the efficacy of SNP in reducing the incidence and duration of post-CABG AF between 2 groups of 30 patients each hospitalized in the Heart Surgery Department of Golestan Hospital, Ahvaz,  Iran, between February 2017 and June 2017.  

Post-CABG AF occurred in 8 (26.7%) patients in the control group and 2 (6.7%) in the SNP group (p = 0.038). The average surgery time in the control and SNP groups was 189.93 ± 31.40 minutes and 167.47 ± 13.48 minutes, respectively, which was statistically significant (p = 0.001). The findings concerning preoperative treatment drugs showed that 52% (26/50) of the patients without AF had used clopidogrel, with 10% (1/10) of these patients suffering AF (P = 0.015). The consumption of another agent, either angiotensin-converting enzyme (ACE) inhibitors or angiotensin receptor blockers (ARBs), was accompanied by AF in 3 (30%) patients, whereas the use of another agent was not accompanied by AF in 32 (64%) patients (p = 0.046).  

This study demonstrated that the prophylactic administration of SNP during the rewarming period in CABG significantly reduced the incidence of postoperative AF and surgery time. Furthermore, preoperative treatment drugs, including clopidogrel and ACE inhibitors or ARBs played a significant role in reducing AF occurrence. (Iranian Heart Journal 2021; 22(1): 16-25)

Pre-op anxiety has adverse effects on the patientchr('39')s anesthesia and treatment. Currently, electrical interventions are widely used as non-invasive methods to control pre-op anxiety and may have advantages as compared with medical therapies. This study aimed to determine the effect of transcranial alternating current stimulation on anxiety and hemodynamic response of patients undergoing surgery.

This study enrolled 50 patients undergoing surgery with anesthesia class (Ι). Before surgery, the experimental group received a transcranial alternating current stimulation for 20 min. The control group underwent a sham electrical stimulation. The post-test was done 2 hr after the intervention and before surgery. The independent t-test, Chi-square and Kolmogorov-Smirnov tests were used to compare groups. The data were analyzed by SPSS v.16.

There were no significant differences in demographic variables between the groups. Patients’ anxiety level was not significantly different before the intervention between the groups. However, anxiety level of the experimental group was less than that of the control group after the intervention (P= 0.005). The pre-op systolic blood pressure and heart rate were less in the experimental group as compared with the control group
(respectively P<0.001, P=0.001). A positive and significant correlation was observed between two variables of anxiety level and the pre-op need for information (P=0.00).

The results of the present study indicated that transcranial alternating current stimulation is
effective on reducing pre-op anxiety and stability of hemodynamic response of patients. Furthermore, training patients and furnishing them with information before surgery can reduce their anxiety.

Traumatic coronary artery-cameral fistulas (TCAF) are rare and may present secondary to penetrating injuries (80%) or iatrogenic traumas. Early operative intervention remains the recommended treatment modality for accidental traumatic coronary artery fistulas. We report the case of a 17-year-old man who presented with left anterior descending coronary artery-right ventricle fistula following penetrating cardiac trauma, which was successfully repaired surgically.

Cystic hygroma (CH) in the cervical region presents as a challenge to the anesthetist. The anaesthetic difficulties are usually associated with CH because of tumor extension into the mouth, airway management, thoracic extension, hemorrhage, involvement of pretracheal region, Post operative respiratory obstruction and coexisting anomalies (Down syndromes, Turner syndromes and congenital cardiac defects). Disorders of the CH relevant to anaesthesia and intensive care medicine are discussed in this review.