فهرست مطالب nasrollah maghamipour

Cardiovascular diseases contribute to mortality and morbidity in aged individuals.It is crucial to have a clear perception of coronary artery bypass graft (CABG) risks and benefits to make logical decision in aged patients. Unfortunately, cardiovascular disease researches have focused very little on the aged patients. The aim of the present study is to evaluate in-hospital complications in patients older than 70 years old following CABG operation to determine if CABG is preferred or not considering present complications. In a cross sectional study, 500 patients older than 70 years old were randomly selected(70-75 patients for each year) from March 2004 to March 2011. Descriptive statistical methods were used for evaluating the obtained data. Overall, 70.6% of patients (353 individuals) were male and 29.4% were female (147 individuals). Totally, 107 patients (21.4%) had complications during hospitalization; these complications were statistically significant in male individuals. Complications included Stroke 1.6%, deep vein thrombosis 0.8%, MI 2.4%, repeat surgery 2.80%, bleeding 2.40%, and more than 48 hours mechanical ventilation in 13.4%. Need for more than 48 hours mechanical ventilation and bleeding after surgery were the most occurred complications in these patients.

Patients with coronary artery disease and left ventricular dysfunction have high mortality with non surgical (medical) treatment. Coronary artery bypass grafting improves survival and the quality of life. Recently, revascularization without cardiopulmonary bypass has been presented as a viable alternative. The aim of this study was to survey the result of coronary artery bypass grafting with off pump technique using intracoronary shunt in patients with left ventricular ejection fraction≤ 25%. From January 2009 to December 2012, 86 patients with an ejection fraction ≤ 25% (58 males, 28 females) aged 41- 84 years (61.2 ± 3.1 yrs) underwent coronary artery bypass graft surgery with off-pump technique. Grafting was performed as needed with internal mammary artery and saphenous vein. We studied operative and postoperative data. Hospital Mortality was 2.32% (two patients). Postoperative complications were low. Total length of hospital stay was 7.2 days, length of ICU stay 2.1 days pulmonary complications 3.48% (three patients), postoperative bleeding 340, acute renal failure 1.16% (onepatient) and left-ventricle ejection fraction before discharge was increased about 10% in these patients. Coronary artery bypass grafting without cardiopulmonary bypass with intracoronary shunt in patients with severe left ventricular dysfunction is valid and safe and has low mortality and morbidity.

Acute myocardial infarction (AMI) is a life threatening condition that needs emergency diagnosis and early treatment in the emergency room. Rapid laboratory testing for creatine kinase (CK)-MB greatly revolutionized the diagnosis and management of acute myocardial infarction. We report a case with chest pain that referred to the emergency department (ED). Laboratory data showed high serum levels of creatine kinase and lactate dehydrogenase. With diagnosis of acute myocardial infarction, he was hospitalized and angiography was performed which showed three vessels disease; the patient was referred to surgical ward for coronary artery bypass graft. Surgery was performed after one week; during the operation there was no sign of infarction over the heart. Our observation suggests that false positive laboratory result may be due to other condition which must be evaluated.

Patients with valvular heart disease suffer from atrial fibrillation for more than 12 months after valve surgery and have a low probability of remaining in sinus rhythm. We performed an intra-operative procedure similar to surgical maze ІІІ procedure for conversion of this arrhythmia to sinus rhythm. We did this study to evaluate the efficacy of this procedure to restore the sinus rhythm in patients with valvular heart disease. 28 patients with valvular heart disease and chronic persistent atrial fibrillation underwent different combinations of valve surgery and concomitant reduction of left and right atrial size and resection of both atrial auricles in Shahid Madani cardiothoracic center from September 2004 to October 2008. The procedure for atrial fibrillation treatment was performed with cardiopulmonary bypass and after mitral valve replacement. There was one in-hospital death postoperatively because of respiratory failure, but no other complication till 6 months after the operation. Out of 28 patients, 23 were in sinus rhythm one week after the operation, one patient had junctional rhythm after the operation that restored to sinus rhythm and 4 patients had persistent atrial fibrillation. During the 12-month follow up, atrial fibrillation was corrected in 82.14%. Doppler echocardiography in these patients with sinus rhythm demonstrated good atrial contractility. This procedure on both atria is effective and less invasive than the original maze procedure to eliminate the atrial fibrillation, and can be performed in patients with valvular heart disease without increasing the risk of operation.

Neurofibromatosis is a congenital disorder with different kinds of disabling manifestations. There are several types of operations for these manifestations with relative improvement. This study set out to determine age, sex, clinical manifestations and evaluate methods of treatment of these patients. This descriptive, cross-sectional study was conducted through studying the hospital records of patients who had previously undergone surgery. 45 patients with neurofibromatosis who were hospitalized and operated in surgical ward of Firoozgar and orthopedic ward of Shafa hospital from 1995 to 1998 were studied in terms of clinical manifestations and treatment methods. Patients with central nervous system involvement were excluded from the study. 55% of the subjects were male and the rest of them were female. Most of the patients were in the second decade of their life. Skeletal abnormalities were seen in 35 patients (77.77%) and 16 patients (35.55%) were suffering from scoliosis which was the most common complication of this disease. With respect to the progression of the disease, brace was used in 2 patients, which led to their improvement. In 13 patients Horington Rod implantation was used, three cases of which developed scoliosis, who underwent surgical vertebral fusion. Pseudoarthrosis was seen in 8 patients (17/77%). Bone graft and plate were used in their operation. In five cases with pseudoarthrosis in lower limbs no: :union:: occurred. Two patients died with malignant shwanoma. scoliosis is the most common manifestation of neurofibromatosis which can improve in early stages with surgical treatment but pseudoarthrosis in lower limbs has not improved with bone graft and plate. Operation with pediculated fibula resulted in the improvement of this complication. Surgical intervention would be more effective in the early stages of the disease. 2 of thses 5 cases were reoperated with pediculated fibula graft and 3 others were amputated.

Aortic coarctation occurs in 6 to 8% of patients with congenital heart disease. It is the fourth most prevalent heart disease which requires catheterization and surgical involvement in the early years of life. If surgical repair is not conducted on-time, it can lead to heart failure (HF) and death. That is why we decided to study this disease in shahid Madani hospital, Tabriz. 53 patients with aortic coarctation who underwent surgery from early 1999 to late 2003 in Tabriz Shahid Madani Research and Health center were studied retrospectively. 88% of the cases were diagnosed during routine examinations. The most frequent complaints of the patients were palpitation (45%) and exertional dyspnea (41%), and the most important signs were systolic ejection murmur in 96%, weakness of lower limbs pulses in 86% and hypertension in 45%. In ECG, 96% of the patients had LVH and in CXR, 45% had cardiomegaly. In angiography, 100% of the patients had apparent aortic coarctation, which in 14 this was associated with Patent Ductus Arteriosus (PDA) In other 15 cases, PDA was not reported in angiography but was discovered during operation. The most common surgeries were resection, end-to-end anastomosis (43%) and Dacron patch angioplasty (39%). In both methods the pressure graradient decreased to under 10 mmHg in the site of anastomosis and the late complications in the patch method was more than the other one.The diagnosis of this disease had been delayed in these patients because of imprecise examination of all four limb's pulses at the first examination of the patients, the patient's own ignorance, misdiagnosis, mismanagement and symptomatic therapy. In spite of PDA and low blood pressure in coarc region, these patients did not have severe pulmonary hypertension. Resection and end-to-end anastomosis is associated with less common late complications and if conducted in early ages, it can lead to complete recovery.