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   Table of Contents - Current issue
October-December 2022
Volume 23 | Issue 4
Page Nos. 195-247

Online since Thursday, November 17, 2022

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Robotic coronary revascularization is feasible and safe: 10-year single-center experience p. 195
Abdul Wahid Al-Mulla, Hatem Hemdan Taha Sarhan, Tamer Abdalghafoor, Sara Al-Balushi, Mohamed Ibrahim El Kahlout, Laith Tbishat, Dina Fa Alwaheidi, Maurice Maksoud, Amr S Omar, Shady Ashraf, Ali Kindawi
Objective: The purpose of this study is to investigate the outcomes of patients undergoing robotic surgical coronary revascularization whether total endoscopic coronary artery bypass (TECAB) or robotic-assisted minimally invasive direct coronary artery bypass (RA-MIDCAB) in our center. Methods: This is a retrospective single-center study. It was conducted in the heart hospital at Hamad Medical Corporation, Qatar. We retrospectively studied all cases that had single grafts, left internal mammary artery (LIMA) to left anterior descending (LAD) coronary artery through a minimally invasive approach, either TECAB grafting or RA-MIDCAB grafting operations between February 2009 and December 2020. Both procedures were performed with the assistance of the da Vinci robotic system. In TECAB, the robotic system was used to harvest LIMA and perform the anastomosis with LAD. Whereas in RA-MIDCAB, LIMA was harvested by the robotic system but the anastomosis of LIMA to LAD was performed under direct vision through a small anterior thoracotomy incision. Seventy-one patients' files from the medical records department were reviewed. Preoperative data included age, gender, ethnicity, body mass index (BMI), cardiac risk factors, Euro score, presentation, and the results of the cardiac investigations. The intraoperative data were the type of procedure, operative time, and whether the procedure was completed as planned or converted to thoracotomy or sternotomy. The postoperative data included the length of hospital stay, postoperative complications, 3-month clinic follow-up, and the need for repeat coronary angiography or revascularization. Results: We found that our patients' ages ranged from 31 to 70 years. The majority were males, with 64 (90.14%) patients. Thirty-one (44.93%) patients were found to have a BMI of 25–29.9 Kg/m2. Forty-seven (66.2%) patients were hypertensive and 37 (52.11%) were diabetic. Dyslipidemia was reported in 35 (50%) patients. TECAB was the primary procedure in 47 (66.2%) patients and the rest underwent RA-MIDCAB. Only 7 (10.14%) patients underwent a planned hybrid procedure. The procedure was completed as planned in 52 (73.2%) patients. The mean operative time was 355.9 ± 95.79 min. Fourteen (19.72%) TECAB procedures were converted to MIDCAB, whereas 5 (7.04%) required sternotomy. Thirteen (18.3%) patients were extubated on the table, 47 (66%) patients were extubated in <24 h, and 7 (9.8%) patients were extubated after 24 h of the procedure. Forty-two (59%) patients stayed only 24 h in ICU and 24 (33.8%) spent more than 24 h. Blood transfusion was required in 8 (11.2%) patients. Only 2 (2.8%) patients experienced bleeding after the surgery. Postoperative infection was observed in 3 (4.29%) patients. No new cerebrovascular accident was detected among the patients after the procedure. Median postoperative hospital stay was 5 days, interquartile range 2, range (2–39). During the 3-month postoperative follow-up, we found that three unplanned coronary angiographies were required for repeat intervention, one of them for LIMA-LAD anastomosis. No redo surgery was performed. Thirty-day mortality was reported in two patients only. Conclusion: From our experience over more than 10 years in robotic cardiac surgery in Qatar, we believe that robotic coronary revascularization is safe and feasible in selected patients mainly with single vessel coronary artery disease but should be performed in specialized centers and by robotic-trained surgeons.
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Psychological distress in patients with coronary artery disease during the COVID-19 pandemic and its association with coping mechanisms p. 201
Prerna Maheshwari, KP Lakshmi, Bindu Menon, Rajesh Thachathodiyl, Renjitha Bhaskaran, Subhash Chandra
Background and Objectives: Coronary artery disease (CAD) has been associated with increased stress both etiologically and as a consequence. The current pandemic of COVID-19 infection has impacted the personal, social, and occupational spheres of people's lives and has negatively affected mental health. People with existing chronic medical illnesses may be more vulnerable to the stressful effects of the ongoing pandemic. This study was conducted on patients with CAD during the COVID-19 pandemic to estimate the prevalence of psychological distress, the factors associated with distress, and their coping mechanisms. Materials and Methods: A cross-sectional study was conducted at a tertiary care teaching hospital in Kerala in the cardiology department. After informed consent was obtained from the patients with CAD, sociodemographic details were collected, Kessler Psychological Distress Scale (K-10 scale) was administered to assess psychological distress and the Brief COPE scale was administered to assess their coping mechanisms. Results: Among 50 patients who participated, the prevalence of psychological distress was 50%. The factors associated with distress were female gender, semiskilled occupation, incomplete COVID-19 vaccination status, exposure of family to COVID-19, experiencing financial difficulties, and experiencing difficulty acquiring medications prescribed for CAD. Religion and acceptance were the most common coping strategies applied by the patients and acceptance was found to be a better coping strategy than religion. Conclusion: There is a high prevalence of psychological distress among patients with CAD during the pandemic, owing to the emotional, financial, and familial instability faced during the pandemic.
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Does cardiovascular disease risk decrease after smoking cessation in occupational risk groups? p. 208
Nurgul Bozkurt, Süleyman Utku Uzun, Ali Ihsan Bozkurt, Sebahat Turgut
Objectives: Smoking cessation is very important for workers due to the possibility of exposure to additional environmental risks in the workplace environment. This study was performed to determine the changes in the Framingham Risk Score (FRS) and 10-year risk of cardiovascular disease (CVD) of employees before smoking cessation and after 6 months. Materials and Methods: Five hundred and sixty-two employees who want to quit smoking were included in the study. In this prospective study, the baseline and 6-month FRS, and 10-year risk of CVD of workers were calculated. Furthermore, the Hospital Anxiety and Depression Scale was used for assessments of employees' anxiety and depression symptoms. Results: After 6 months, 37% of the participants quit smoking. It was determined that 11.9% of employees have a high CVD risk and 10.6% moderate CVD risk. After 6 months, there was a statistically significant reduction in FRS who quit smoking (P < 0.001). In addition, within the 6 months after smoking cessation, 10-year coronary heart disease risk reduction was higher in quitters than those who cannot quit smoking (47.6% decrease in quitters and 14.9% in nonquitters, P < 0.001). Significant decreases in fasting blood glucose levels were determined after smoking cessation (P = 0.003). Conclusions: The FRS and CVD risk of smoker employees were decreased 6 months after smoking cessation. In 6 months, CVD risk is reduced in almost half of those who quit smoking. Even in the short term, it is possible to reduce the CVD risk of a worker who quits smoking.
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Physical exercise and arrhythmogenic right ventricular cardiomyopathy/dysplasia: An overview p. 215
Rasha Kaddoura, Hassan Al-Tamimi
Arrhythmogenic right ventricular cardiomyopathy/dysplasia is inherited cardiomyopathy that has a propensity for ventricular arrhythmia, ventricular dysfunction, and sudden cardiac death. High-intensity exercise is associated with early disease manifestation and increased risk of malignant arrhythmia and sudden death. Exercise restriction should be advised as an integral part of disease management. This overview summarizes the medical literature on the impact of exercise in triggering ventricular arrhythmias and disease progression.
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Acute ST-Elevation myocardial infarction in patient with severe uncontrolled hyperthyroidism complicated by thyroid storm p. 221
Khaled Al Khodari, Raad Alhaj Tahtouh, Tahir Hamid
Acute ST-elevation myocardial infarction is a life-threatening medical emergency that needs to be recognized early and treated properly to prevent deleterious complications, including death. A thyroid storm (TS) is a rare but severe manifestation of uncontrolled hyperthyroidism that might present with serious cardiovascular or neurological problems. We described a case of a 40-year-old male patient, known to have uncontrolled hyperthyroidism, who presented with acute onset of central chest pain, agitation, tachycardia, and pulmonary congestion. Fast atrial fibrillation with ST-segment elevation in anterior leads was detected on electrocardiogram. Thyroxin level (T4) was very high with undetectable thyroid stimulating hormone. Initially, the patient refused any type of coronary revascularization; therefore, he was admitted to the cardiology intensive care unit, and medical treatment was commenced for both TS and acute coronary syndrome. High-risk coronary angiography was done 2 h later because he had worsening persistent chest pain and started to develop signs of heart failure. It showed embolic occlusion of the distal left anterior descending artery that was treated medically with anti-coagulation. There were no complications. Chest pain and thyroid function tests settled down during his hospital stay with close cardiology and endocrinology follow-up.
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Early hemodynamic recovery after a successful transcatheter aortic valve implantation in cardiogenic shock secondary to severe bicuspid aortic stenosis p. 226
Abdalazeem Ibrahem, Mohamed Farag, Mohammad Alkhalil
Pulmonary edema secondary to severe aortic stenosis is an emergency condition that carries a high risk of mortality and is resistant to treatment using standard heart failure therapies. We present here a patient with severe aortic stenosis, complicated by poor left ventricular function and cardiogenic shock, who has immediate hemodynamic recovery after successful balloon aortic valvuloplasty and transcatheter aortic valve implantation (TAVI) procedures.This case presentation highlights the efficacy of using the TAVI procedure in the management of severe aortic stenosis complicated by acute heart failure and cardiogenic shock with immediate improvement of hemodynamic parameters more effectively sooner after the procedure.
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Tiger stripes in carditis of rheumatic origin p. 230
Najeeb Ullah Sofi, Santosh Kumar Sinha, Mohit Sachan, Ramesh Thakur
“Tiger stripes” or “Zebra stripes” are multiple band-like signals noted on Doppler spectral recordings and have been associated with intracardiac oscillating structures. They have been attributed to flail prosthetic valve leaflet, native valve regurgitation without flail leaflet, papillary muscle rupture in acute coronary syndrome, and possibly Lambl's excrescences. To our knowledge, there is only one case report in the English literature that had identified this sign in rheumatic carditis. We present the case of a 14-year-old boy, who was known to have rheumatic heart disease and presented with worsening dyspnea of recent onset. His antistreptolysin O, C-reactive protein, and erythrocyte sedimentation rate titer were raised. Echocardiography revealed severe eccentric mitral regurgitation with multiple high-intensity signals (tiger stripes) on continuous wave (CW) Doppler. The patient was managed as rheumatic carditis with steroids. Repeat echocardiography after 1 month showed the resolution of tiger stripes. Upon tapering, steroids patient's symptoms worsened and echocardiography revealed the reappearance of tiger stripes. We propose that these high-intensity signals in spectral Doppler reflect valvulitis and are the echocardiographic counterpart of musical overtones. We suggest that these signals on CW Doppler in a patient with established rheumatic heart disease be taken as a marker of carditis and the patient should be managed accordingly. We refer to this sign as a “Fingerprint sign” due to its resemblance to it and to differentiate it from Tiger strips because of its dynamic nature. This sign can be used to identify and follow carditis in a rheumatic scenario.
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Cardiac computed tomography pictorial equivalent of angiographic gooseneck sign in a case of atrioventricular septal defect with cor triatriatum sinister p. 235
Nikhil Balpande, Narendra Kuber Bodhey, Satyajit Singh
In the literature, multiple radiological signs of clinically important congenital cardiovascular abnormalities have been described which are named as per the object they resemble. These signs are very useful in learning. The Gooseneck sign is a sign seen in left ventricle catheter angiography in case of an atrioventricular septal defect. This sign has not been demonstrated on a cardiac computed tomography (CT) so far, to the best of our knowledge. We present a case showing cardiac CT pictorial equivalent of angiographic Gooseneck sign.
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Echocardiography-Guided pericardiocentesis using a central venous catheter in rural area p. 240
Thomas Rikl, Dwita Rian Desandri
Large pericardial effusion may possess potential risks of hemodynamic consequences and may progress into cardiac tamponade unexpectedly. Pericardiocentesis is advisable in asymptomatic large pericardial effusion when there are signs of hemodynamic collapse on echocardiography. However, in a limited setting, the ideal equipment is rarely available. Thus, we present a case of echocardiography-guided pericardiocentesis using a central venous catheter (CVC) in a large pericardial effusion with massive pleural effusion in a rural area.
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Ruptured head of papillary muscle complicating non-ST elevation myocardial infarction p. 244
Abdel Haleem Shawky Hamada, Mohammed A .A. Al-Hashemi, Smitha Anilkumar
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Can an artwork a day keep the doctor away? p. 246
Rachel Hajar
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