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The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are... more
The world has been devastated facing the outbreak of a novel infectious disease known as Corona virus disease (COVID-19). This has been declared as a pandemic by the World Health Organization. The frontline health care workers, who are directly involved in the diagnosis, treatment and care of patients with COVID-19, are taking significant personal risks on their own health and those of their family members. Objectives of the study include establishing the physical, psychological and social impact experience by the healthcare workers serving in public hospitals of Bangladesh. This prospective cross-sectional observational study was carried out at Kuwait Bangladesh Friendship Government Hospital, the first Covid-19 designated hospital of Bangladesh between the 1st June and the 31st August, 2020. A total of 294 doctors, nurses, ward boys and ailed healthcare workers were included in this study via purposive sampling. The study found statistically significant (p value 0.024) difference of medical co-morbidities between Covid-19 positive and Covid-19 negative groups of health care professionals. Significant association was found between duration of work and presence during aerosol generating procedure with COVID infectivity of the study subjects. 72.8% respondents experienced public fear of contracting the virus from them and 69.0% noticed negative attitude of the society towards them. Eighty five percent (85.0%) did not get any community support during this pandemic crisis. The health care professionals engaged in COVID-19 treatment have been taking significant personal risk on their life in terms of physical, psychological and social perspective. Providing safeguard to the health care workers are integral components of public health measures for addressing the COVID-19 pandemic. Special interventions to promote their physical wellbeing and arrangement of adequate psychological training need to be immediately implemented to cope up this critical situation.
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Background: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder during pregnancy and is associated with increased maternal and neonatal morbidity. There are many serum markers known to be associated with Gestational... more
Background: Gestational Diabetes Mellitus (GDM) is the most common metabolic disorder during pregnancy and is associated with increased maternal and neonatal morbidity. There are many serum markers known to be associated with Gestational Diabetes Mellitus (GDM). High serum ferritin level has been associated with the risk of developing gestational diabetes mellitus. The aim of the study was to investigate the association of serum ferritin levels with GDM. Materials and methods: This case control study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical University (BSMMU) Dhaka, Bangladesh between February 2018 and January 2019. A total of 120 pregnant women between 18 and 35 years of age attending outdoor antenatal clinic in their second or third trimester of pregnancy were included in this study. Among them 60 diagnosed cases of GDM were consider as group A and rest 60 (Without GDM) were considered as group B. Serum ferritin concentration ...
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Background: Gestational Diabetes Mellitus (GDM) is a common medical disorder detected during pregnancy with adverse consequences on the health of the mother and the fetus. Glycosylated hemoglobin (HbA1c) is an important parameter of... more
Background: Gestational Diabetes Mellitus (GDM) is a common medical disorder detected during pregnancy with adverse consequences on the health of the mother and the fetus. Glycosylated hemoglobin (HbA1c) is an important parameter of glycemic control in patients with diabetes mellitus. However, it only reflects the long-term glycemic status, but can’t reflect short term glycemic control. It has also been demonstrated that HbA1c does not reflect glycemic control accurately during pregnancy because of iron deficiency. But Glycosylated Albumin (GA) reflects average blood glucose within 2-3 weeks and is not influenced by iron deficiency. Therefore, glycosylated albumin may be used to measure recent changes in blood glucose level in GDM patients. The aim of the study is to evaluate the association of glycosylated albumin and glycemic status in GDM. Materials and methods: This case control study was carried out in the Department of Obstetrics & Gynecology, Bangabandhu Sheikh Mujib Medical ...
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A 35 years old male living in Jamalpur district of Bangladesh working as a shopkeeper presented with dyspnea, fatigue, occasional fever and cough for two years. He did not give any history of hemoptysis or weight loss. He was smoker and... more
A 35 years old male living in Jamalpur district of Bangladesh working as a shopkeeper presented with dyspnea, fatigue, occasional fever and cough for two years. He did not give any history of hemoptysis or weight loss. He was smoker and non-alcoholic. He had a soft systolic murmur over pulmonary area and wide fixed splitting of the second heart sound. An Atrial septal defect (ASD) was detected by echocardiography. The patient had high circulating eosinophil count and Complement Fixation Test for filarial antibody revealed positive result. Moreover the patient's response to drug Diethylcarbamazime indicated suspected tropical pulmonary eosinophilia with Atrial Septal Defect.
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Coronavirus disease (COVID-19) has emerged as a global threat. The disease largely attacks adults with higher mortality among the aged and compromised people. Although previous coronavirus havocs caused significant number of maternal and... more
Coronavirus disease (COVID-19) has emerged as a global threat. The disease largely attacks adults with higher mortality among the aged and compromised people. Although previous coronavirus havocs caused significant number of maternal and neonatal demise, most pregnant cases with COVID-19 infection are either asymptomatic or with mild symptoms only. This pandemic brought significant disruption of essential antenatal and intranatal care worldwide. The health resources became diverted to focus on general population needs rather than the specified needs of pregnant women. Limited information is known about the effect of COVID-19 disease on pregnancy. Recent evidence indicates that pregnant women are not vulnerable group for severe COVID-19 illness. However, immunological and physiological alterations during pregnancy expose women more vulnerable to SARS-CoV- 2 infection in comparison to general population.Covid-19 pandemic has created a global crisis causing great challenges for pregnan...
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Heart surgery is one of the areas of greatest achievement in 20th century medical science. As the number one killer, Ischemic heart disease (IHD) was a big hurdle in achieving health for all. In this century, cardiovascular scientists put... more
Heart surgery is one of the areas of greatest achievement in 20th century medical science. As the number one killer, Ischemic heart disease (IHD) was a big hurdle in achieving health for all. In this century, cardiovascular scientists put effort to combat the disease. Vasilii Ivanovich Kolesov is the early and successful contributor among them in the field of coronary surgery. On 25 February 1964, V.I. Kolesov successfully performed the first anastomosis between the left internal thoracic artery and the left circumflex artery. This was the beginning of a new era of coronary bypass surgeries, carried out on a regular basis to re-establish coronary flow in patients with IHD. This operation, in combination with Rene G. Favaloro’s method of using the saphenous vein in coronary surgery become the most commonly performed surgical procedure in the world. Cardiovasc j 2023; 15(2): 189-194
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Coronary bypass operation is one of the greatest achievements of medical science in the 20th century. Alexis Carrel in 1910 and Arthur Vineberg in 1945 tried to perform surgical revascularization of the diseased coronary arteries. In the... more
Coronary bypass operation is one of the greatest achievements of medical science in the 20th century. Alexis Carrel in 1910 and Arthur Vineberg in 1945 tried to perform surgical revascularization of the diseased coronary arteries. In the beginning of the 1950s many surgeons attempted experimentally to anastomose internal thoracic artery to the coronary arteries. Success was achieved simultaneously and independently by Vladimir Demikhov in Russia and Gordon Murray in Canada. Then the real success come of mammary-coronary bypass with tantalum ring by Robert H Goetz and with suture technique by Vasilii I Kolesov. Then autogenous great saphenous vein used by Rene G Favaloro and others and made the procedure popular worldwide. Which contribution is greater, when medicine depends on evolution and big accomplishment reached by means of the contribution of many. There comes the interesting question who should be given the credit of introducing this major surgical procedure, and along comes...
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Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is... more
Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is an effective drug for various postoperative arrhythmias. Objective of this study is to evaluate the efficacy of Amiodarone in controlling postoperative arrhythmia in our settings at the department of cardiac surgery. Methods: This retrospective observational study involved random selection of 20 patients, who developed potentially life-threatening arrhythmia following cardiac surgical procedures under cardiopulmonary bypass (CPB) at Chittagong Medical College Hospital (CMCH) between January 2018 and December 2020. Amiodarone was used in controlling postoperative cardiac arrhythmia by loading 1000 mg in first 24 hours, followed by 800 mg orally in daily divided doses. Results: Among 20 patients under study, five had valvular replacement, three had A...
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Background: There has been a radical improvement lately both for coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in Bangladesh. Besides the clinical goals, the economic impact of these procedures is very... more
Background: There has been a radical improvement lately both for coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in Bangladesh. Besides the clinical goals, the economic impact of these procedures is very important as well. Out of pocket spending is the major payment strategy for healthcare in Bangladesh. It is estimated that the poverty headcount increased by 3.5% due to out of pocket healthcare payments. Methods: Data on patients’ expenditure for CABG and PCI in seven Bangladeshi hospitals were collected between 16th and 30th August, 2020. Several models were created, where the cost of CABG was compared with that of PCI in each of these hospital settings. Results: In the two public hospitals CABG is much cheaper than PCI. However, in mid-level expensive hospitals the cost of PCI with 2 stents is comparable with that of CABG, but with 3 or more stents, PCI becomes more expensive. In the big corporate hospitals, CABG tends to be relatively more expens...
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Infertility is a rising problem worldwide, hampering the psychological and social wellbeing of thousands of couples. There is a huge financial involvement for its diagnosis and treatment as well. The main goal of reproductive pelvic... more
Infertility is a rising problem worldwide, hampering the psychological and social wellbeing of thousands of couples. There is a huge financial involvement for its diagnosis and treatment as well. The main goal of reproductive pelvic surgery is to restore pelvic anatomy ensuring a patent and functional pathway for the sperm to reach the ovulated oocyte and a safe implantation into the endometrial cavity. The striking progress in assisted reproductive technology (ART) have upgraded the fertility outcome in despondent cases recently. This review article aims to highlight some surgical procedures commonly performed for better fertility outcome. It involves studying the available material in the textbooks, printed and online journals. The surgically treatable causes of infertility include Endometriosis, Polycystic Ovarian Syndrome, Tubo-peritoneal disease, Mullerian Anomalies and Uterine Myoma. In addition, Endometrial Polyps and Asherman’s Syndrome may also be treated surgically. A thor...
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Inorganic arsenic (iAs) exposure has been reported to have an impact on cardiovascular diseases (CVD). However, there is not much known about the cardiac tissue injury of CVD patients in relation to iAs exposure and potential role of... more
Inorganic arsenic (iAs) exposure has been reported to have an impact on cardiovascular diseases (CVD). However, there is not much known about the cardiac tissue injury of CVD patients in relation to iAs exposure and potential role of single nucleotide polymorphisms (SNPs) of genes related to iAs metabolism, oxidative stress, endothelial dysfunction and inflammation which may play important roles in such CVD cases. In this dual center cross-sectional study, based on the exclusion and inclusion criteria, we have recruited 50 patients out of 270, who came from known arsenic-affected and- unaffected areas of mainly Chittagong, Dhaka and Rajshahi divisions of Bangladesh and underwent open-heart surgery at the selected centers during July 2017 to June 2018. We found that the patients from arsenic affected areas contained significantly higher average iAs concentrations in their urine (6.72 ± 0.54 ppb, P = 0.028), nail (529.29 ± 38.76 ppb, P
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Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is... more
Background: Postoperative cardiac arrhythmias may present as life threatening complications like- cerebrovascular strokes, thrombo-embolic manifestations, inadequate ventricular filling and compromised hemodynamic stability. Amiodarone is an effective drug for various postoperative arrhythmias. Objective of this study is to evaluate the efficacy of Amiodarone in controlling postoperative arrhythmia in our settings at the department of cardiac surgery. Methods: This retrospective observational study involved random selection of 20 patients, who developed potentially life-threatening arrhythmia following cardiac surgical procedures under cardiopulmonary bypass (CPB) at Chittagong Medical College Hospital (CMCH) between January 2018 and December 2020. Amiodarone was used in controlling postoperative cardiac arrhythmia by loading 1000 mg in first 24 hours, followed by 800 mg orally in daily divided doses. Results: Among 20 patients under study, five had valvular replacement, three had A...
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John Webster Kirklin was an American cardiothoracic surgeon, prolific author and medical educator who is best remembered for refining John Gibbon’s heart-lung bypass machine via a pump-oxygenator to make feasible under direct vision... more
John Webster Kirklin was an American cardiothoracic surgeon, prolific author and medical educator who is best remembered for refining John Gibbon’s heart-lung bypass machine via a pump-oxygenator to make feasible under direct vision routine open-heart surgery. His other advances, on which success of heart surgeries depends, including teamwork, developments in establishing the correct diagnosis before surgery and progress in computerized intensive care unit monitoring after open heart surgery. Wayne Miller refers to Dr Kirklin in the 1970s as “arguably the best practicing open heart surgeon anywhere. He was one of cardiac surgery’s most accomplished researchers, a scientist whose mind was sometimes compared, flatteringly, to a computer.” John W Kirklin and Brian G Barratt-Boyes drafted the book ‘Cardiac Surgery’, which is considered as the Bible of the subject. Cardiovasc j 2021; 14(1): 93-96
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Background: One of the main causes of post-operative morbidity in cardiac surgical patient is excessive bleeding requiring transfusion of blood component after CPB. Re-exploration due to bleeding occurs in 2% to 7% of post bypass patient... more
Background: One of the main causes of post-operative morbidity in cardiac surgical patient is excessive bleeding requiring transfusion of blood component after CPB. Re-exploration due to bleeding occurs in 2% to 7% of post bypass patient and 50% to 80% of these patients not having any identifiable surgical bleeding source. Tranexamic acid is competitive inhibitor of plasminogen activator and at higher concentration a non-competitive inhibitor of plasmin. It is 10 times more potent than Epsilone Aminocaproic Acid in preventing post-operative haemorrhage following CPB. Methods: This study was conducted in the Department of Cardiac Surgery, National Institute of Cardiovascular Diseases (NICVD), Dhaka, Bangladesh between January 2009 and December 2010. The Study population was divided into two groups. Group A comprised of 35 patients, who had received Tranexamic Acid 10 mg /kg after induction and then 1 mg/kg/hour till time of protamin infusion and Group B comprised of 35 patients who h...
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Background: Exposure to inorganic arsenic (iAs) through drinking water is currently a serious threat to public health of millions of people worldwide including Bangladesh. Some recent studies have shown that telomere dysfunction is... more
Background: Exposure to inorganic arsenic (iAs) through drinking water is currently a serious threat to public health of millions of people worldwide including Bangladesh. Some recent studies have shown that telomere dysfunction is emerging as an important factor in the pathogenesis of different cardiovascular diseases. Arsenic plays significant role on telomere dysfunction by altering the expression of telomere-related genes. The study was aimed to investigate the effects of arsenic on hTERT mRNA levels and their combined role in increasing CVD susceptibility. Methods: In this cross sectional study, total of 50 CVD patients who underwent open heart surgery were recruited for this study. Urine, nail and cardiac tissue samples were collected and analyzed for As. Blood samples were quantified for hTERT expression analysis using real-time polymerase chain reaction. Results: The hTERT mRNA expression was found approx. 10 fold higher in the As-exposed patients than the As-unexposed pati...
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Background: Varicose vein is one of the most common vascular conditions in the adult population. These are conventionally treated with surgical high ligation of Sapheno-femoral junction and stripping of Great Saphenous Vein (GSV) with... more
Background: Varicose vein is one of the most common vascular conditions in the adult population. These are conventionally treated with surgical high ligation of Sapheno-femoral junction and stripping of Great Saphenous Vein (GSV) with multiple phlebectomy. The aim of this study was to highlight the technical considerations in performing endovenous laser ablation of varicose vein, understanding the importance and role of Duplex Machine and Tumescent anesthesia with evaluation of outcome.Methods: In this retrospective study we examined the records of 297 limbs of 220 patients operated at Vascular Care Centre at Dhaka, Bangladesh between October 2013 and October 2015. Among them 1 year follow up was performed in 118 patients. Patients were contacted through telephone calls and mobile SMSs with requests for follow up.Results: Vast majority of the patients had a smooth recovery. Significant pain was present in only 10% of patients for 1week after laser therapy and 3% of patients noted br...
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The South Asian neighboring countries of India include Bangladesh, Bhutan, Nepal, The Maldives, Pakistan and Sri Lanka. Interestingly all these countries possess either a land or a sea border with India and no border among themselves.... more
The South Asian neighboring countries of India include Bangladesh, Bhutan, Nepal, The Maldives, Pakistan and Sri Lanka. Interestingly all these countries possess either a land or a sea border with India and no border among themselves. These countries have historic, cultural, ethnic and genetic links with India. The paper describes the developmental history and current status of cardiac surgery in these countries. Thorough search of the printed and electronic materials has been made. The authors visited all these countries and contacted the eminent surgeons personally or through mails. All the information is cross-checked and compiled. Record keeping is not well organized in most of these countries. Best information often came from unusual sources like Anesthetists' society or the corporate houses. Four of these countries Bangladesh, Nepal, Pakistan and Sri Lanka have their cardiac surgical programs. Collectively they perform around 38000 cardiac operations a year which is a quar...
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Objective: Off-pump CABG (OPCAB) is a well established surgical procedure in Bangladesh now. Majority of Bangladeshi patients having CABG are undergoing OPCAB procedures these days. Patients with left ventricular dysfunction are known to... more
Objective: Off-pump CABG (OPCAB) is a well established surgical procedure in Bangladesh now. Majority of Bangladeshi patients having CABG are undergoing OPCAB procedures these days. Patients with left ventricular dysfunction are known to be particularly at risk of complications after surgical coronary revascularization. Off-pump procedure can be considered in these patients, avoiding the potentially damaging effect of cardiopulmonary bypass (CPB). Patients with left ventricular dysfunction are thus thought to be ideal OPCAB candidates. This study is undertaken to check the advantage of OPCAB over conventional CABG of Bangladeshi patients with left ventricular dysfunction. Methods: This is a prospective clinical trial done in National Institute of Cardiovascular Diseases (NICVD), Dhaka during the period of January 2006 to Dec 2007. Among the 52 patients 26 patients underwent OPCAB with preoperative ejection fraction (EF) 35.2±3.2% and rest 26 patients had conventional bypass (CCABG) ...
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Background: Bronchodilators, by dilatation of bronchial tree through relaxation of bronchial smooth muscle increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. This study was conducted to assess the... more
Background: Bronchodilators, by dilatation of bronchial tree through relaxation of bronchial smooth muscle increases the vital capacity, tidal volume and total lung capacity and reduces gas trapping. This study was conducted to assess the pulmonary function after off-pump coronary artery bypass graft (CABG) surgery between patients with impaired pulmonary function treated with or without preoperative bronchodilator. We also compared duration of mechanical ventilation and days spent in the surgical intensive care unit (ICU) after CABG in both group of patients. Methods: This prospective cohort study was carried out in the department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from July 2009 to April 2011. This study included 50 patients (25 patients in each group) with multi-vessels coronary artery disease with impaired pulmonary function who underwent off-pump CABG. Results: Spirometry was done in both groups of patients after admissio...
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Dr Parafulla Kumar Sen, popularly known as P K Sen was a great Bengali surgeon of Twentieth century. Regarded as the founder of cardiothoracic surgery in India, Dr Sen performed the first intracardiac operation of any kind, the first open... more
Dr Parafulla Kumar Sen, popularly known as P K Sen was a great Bengali surgeon of Twentieth century. Regarded as the founder of cardiothoracic surgery in India, Dr Sen performed the first intracardiac operation of any kind, the first open heart surgery and also the first heart transplantation in this subcontinent. He also made very significant contribution in the development of transmyocardial revascularization, a new technique for aortic arch replacement and described a group of nonspecific vasculitis. Dr P K Sen was born in Kolkata, the then capital of undivided Bengal in 1915. But he is little known in Bangladesh. This article is an attempt to notify the deeds of this Bengali surgeon.DOI: http://dx.doi.org/10.3329/cardio.v3i2.9200 Cardiovasc. J. 2011; 3(2): 254-257
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A 68 yr old man with ischemic heart disease (IHD) affecting triple vessels was admitted in National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka for Coronary artery bypass grafting (CABG). He had been suffering from... more
A 68 yr old man with ischemic heart disease (IHD) affecting triple vessels was admitted in National Institute of Cardiovascular Diseases & Hospital (NICVD), Dhaka for Coronary artery bypass grafting (CABG). He had been suffering from angina with minimal exercise with mild left ventricular systolic dysfunction. He was also suffering from hypertension and mild obstructive airway disease for the last ten years. He underwent off-pump CABG on beating heart using high thoracic epidural anaesthesia (TEA) without intubation. The patient was awake and breathing spontaneously, tolerated each phase of the operation without having any harmful effect. The effect of movement of the chest wall and the heart during spontaneous respiration did not influence the conduction of the operation. Epidurall catheter was placed at TI-2 interspace, in lateral decubitous position. After a test dose of 2% lignocaine 5ml, 0.5% Bupivacaine 14 ml + Fentanyl 2 ?gm/ml was injected epidurally. Central venous catheter...
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Coronary artery disease is the most common form of heart disease and the single most important cause of premature death world-wide. Thymomas are anterior mediastinal neoplasms, characterized by epithelial cells and lymphocytes. Although... more
Coronary artery disease is the most common form of heart disease and the single most important cause of premature death world-wide. Thymomas are anterior mediastinal neoplasms, characterized by epithelial cells and lymphocytes. Although they are often encapsulated and well differentiated tumors, they can show local invasion, pleural invasion or extrathoracic metastasis. In this article, we report the case of a rare patient who underwent thymectomy along with off-pump coronary artery bypass graft surgery. DOI: http://dx.doi.org/10.3329/cardio.v7i1.20801 Cardiovasc. j. 2014; 7(1): 55-57
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Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the... more
Background: Vascular access care is a classic example of multidisciplinary team work among nephrologists, vascular surgeons, duplex specialists, dialysis nurses and dialysis staff. The objectives of this study were to determine the complication of arteriovenous fistula (AVF) for hemodialysis (HD) and to find out the role of duplex study for the management of fistula complications. Methods: This was a prospective type of study done on 121 arteriovenous fistulas. All operations were done in different hospitals in Dhaka city. After duplex study of upper limb vessels, the site of fistula creation was determined. All Radio-cephalic, ulnar-basilic and brachiocephalic fistulas were done under local anesthesia. Other fistula of the series was done under brachial block. Immediate postoperative bruit, thrill and distal pulses were monitored. Fistulas were considered mature after at least 6 weeks of fistula creation with good visualization of arterialized vein and good thrill. Patients were ad...
Coronary artery disease in pregnancy is a catastrophic situation that may endanger the lives of both the mother and the fetus. Cardiac diseases may account for up to 15% of maternal mortality. Pregnancy may increase the risk of acute... more
Coronary artery disease in pregnancy is a catastrophic situation that may endanger the lives of both the mother and the fetus. Cardiac diseases may account for up to 15% of maternal mortality. Pregnancy may increase the risk of acute myocardial infarction up to 4-fold. Various hemodynamic derangements may occur during pregnancy including expansion of plasma and blood volume, compression of inferior vena cava and fall in both systemic and pulmonary vascular resistances. If pregnant women present with acute coronary artery disease, medical management should be attempted first and if any intervention or surgery is needed, efforts must be made to lower the risk. A multidisciplinary approach is essential involving obstetrician, cardiologist, cardiac surgeons, anesthesiologist and neonatologists or pediatrician. Pregnancy is considered to be a relative contraindication to thrombolytic therapy due to some complications. Revascularization may be considered in acute coronary syndrome in preg...
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Background: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope... more
Background: Endotracheal intubation is an essential primary skill for all anesthesiologists. For cardiac anesthesiologists rapid and proper intubation is more important as failure may cause serious consequences. Video laryngoscope provides a better real time view of the larynx, epiglottis and vocal cords. It also keeps the intubating anesthetist away from the patient as compared to conventional laryngoscopy. This may be very important in this COVID-19 era. To the best of our knowledge the Department of Cardiac Surgery and Cardiac Anesthesia of Chattogram Medical College & Hospital is the first center in Bangladesh to introduce video laryngoscope in cardiac OT. The objective of this study was aimed to compare the intubation time, hemodynamic response to laryngoscopy, success rates and operator’s comfort using the conventional Macintosh laryngoscope and video laryngoscope in adult patients undergoing cardiac surgery. Materials and Methods: A total of 60 adult patients were included in...
Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery... more
Background: Mitral stenosis is often present with pulmonary hypertension. Closed Mitral Commissurotomy (CMC) is a treatment of choice for severe mitral stenosis. In this study, we examined the per-operative changes of pulmonary artery pressure following opening of stenosed mitral valve. Methods: All these CMCs were performed routinely through the left antero-lateral thoracotomy (4th intercostal space) and dilatation was done by metallic Tubb’s Dilator. Peroperative left atrial and Pulminary Arterial pressures were measured before and after dilatation. Results: 15 patients had undergone CMC. Following CMC, per-operative mean Pulmonary artery pressure was reduced from 45.5±7.1 mm of Hg to 39.0±8.8 mm of Hg (p=0.043). Mean left atrial pressure reduced from 35.9±5.6 mm of Hg to 30.0±9.1 mm of Hg (p = 0.049). At three months follow up after closed mitral commissurotomy mitral valve area at echocardiography was found 2.29±0.18 cm2. There was no case of death after closed mitral commissuro...
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Despite all the devastating effects, wars have made some very significant positive impact in the development of cardiac surgery. Heart is an organ that cannot be stopped even for a minute, there by making it very difficult for the... more
Despite all the devastating effects, wars have made some very significant positive impact in the development of cardiac surgery. Heart is an organ that cannot be stopped even for a minute, there by making it very difficult for the surgeons to operate. The wars of the Twentieth Century, particularly the two Great wars produced a significant number of patients with heart injury to reach surgeons operating tables. This gave the surgeons a unique opportunity to study, operate, practice and research cardiac surgical patients. Notable names including Wilfred Bigelow, Walton Lillehei, John Gibbon, Christian Cabrol, Vasilii Kolessov and Alexander Vishnevsky all were world war veterans and utilized their wartime experience later on in the development of cardiac surgery. Had there not been the two great wars, the development of cardiac surgery would have been delayed probably by years. DOI: http://dx.doi.org/10.3329/cardio.v4i2.10463 Cardiovasc. j. 2012; 4(2): 174-178
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Innovation in surgery plays a very important role of easing the task of the surgeons. Some instruments used in cardiac surgery today were designed by legendary surgeons from the past. These useful articles bear the names of their... more
Innovation in surgery plays a very important role of easing the task of the surgeons. Some instruments used in cardiac surgery today were designed by legendary surgeons from the past. These useful articles bear the names of their inventors. There hasnt been much documentation on the development of cardiothoracic surgical instruments. The historian claims that first known surgical instruments were developed as early as 10,000 BC! Hippocrates had reportedly developed different surgical instruments made of copper, iron, bronze, and brass. Renowned Muslim surgeon of middle age Al-Zahrawi devised many surgical instruments. Some surgeons developed instruments based on their own anatomical size and others for new operations that required more delicate instrumentation to perform them. Cardiothoracic surgeons also have adopted instruments innovated, designed and used by colleagues belonging to other surgical specialty. This article would explore a few of these legendary innovators, illumi...
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We reviewed the management of 6 cases of chylothorax (5 male, 1 female; 1-12 years old) following 500 cardiothoracic procedures during January 2004- December 2006 at National Institute of Cardiovascular Diseases, Dhaka. Results: The... more
We reviewed the management of 6 cases of chylothorax (5 male, 1 female; 1-12 years old) following 500 cardiothoracic procedures during January 2004- December 2006 at National Institute of Cardiovascular Diseases, Dhaka. Results: The surgical procedures preceding the occurrence of lymph leak included ligation of PDA in 3 patients (50%), modified Blalock-Taussig Shunt in 2 cases (33.33%), bidirectional Glenn shunt in 1 case (16.67%). A protocol for management of postoperative chylothorax was applied for all patients. In this protocol, non-surgical management was always the first line of treatment for patients with postoperative chylothorax in the form of intercostal tube drainage and diet modification using either medium-chain triglycerides (MCT). All of our patients responded to conservative therapy. Conclusions: Conservative management of postoperative chylothorax should be the first line of treatment in postoperative chylothorax either by MCT diet alone or (in case of failure) to b...
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Inorganic arsenic (iAs) exposure has been reported to have an impact on cardiovascular diseases (CVD). However, there is not much known about the cardiac tissue injury of CVD patients in relation to iAs exposure and potential role of... more
Inorganic arsenic (iAs) exposure has been reported to have an impact on cardiovascular diseases (CVD). However, there is not much known about the cardiac tissue injury of CVD patients in relation to iAs exposure and potential role of single nucleotide polymorphisms (SNPs) of genes related to iAs metabolism, oxidative stress, endothelial dysfunction and inflammation which may play important roles in such CVD cases. In this dual center cross-sectional study, based on the exclusion and inclusion criteria, we have recruited 50 patients out of 270, who came from known arsenic-affected and- unaffected areas of mainly Chittagong, Dhaka and Rajshahi divisions of Bangladesh and underwent open-heart surgery at the selected centers during July 2017 to June 2018. We found that the patients from arsenic affected areas contained significantly higher average iAs concentrations in their urine (6.72 ± 0.54 ppb, P = 0.028), nail (529.29 ± 38.76 ppb, P < 0.05) and cardiac tissue (4.83 ± 0.50 ppb, P < 0.05) samples. Patients’ age, sex, BMI, hypertension and diabetes status adjusted analysis showed that patients from arsenic-affected areas had significantly higher iAs concentration in cardiac tissue (2.854, 95%CI 1.017–8.012, P = 0.046) reflecting higher cardiac tissue injury among them (1.831, 95%CI 1.032–3.249, P = 0.039), which in turn allowed the analysis to assume that the iAs exposure have played a vital role in patients’ disease condition. Adjusted analysis showed significant association between urinary iAs concentration with AA (P = 0.012) and AG (P = 0.034) genotypes and cardiac iAs concentration with AA (P = 0.017) genotype of AS3MT rs10748835. The AG genotype of AS3MT rs10748835 (13.333 95%CI 1.280–138.845, P = 0.013), AA genotype of NOS3 rs3918181 (25.333 95%CI 2.065–310.757, P = 0.002), GG genotype of ICAM1 rs281432 (12.000 95%CI 1.325–108.674, P = 0.010) and AA genotype of SOD2 rs2758331 (13.333 95%CI 1.280–138.845, P = 0.013) were found significantly associated with CVD patients from arsenic-affected areas. Again, adjusted analysis showed significant association of AA genotype of AS3MT rs10748835 with CVD patients from arsenic affected areas. In comparison to the reference genotypes of the selected SNPs, AA of AS3MT 10748835, AG of NOS3 rs3918181 and AC of rs3918188, GG of ICAM1 rs281432, TT of VCAM1 rs3176867, AA of SOD2 rs2758331 and GT of APOE rs405509 significantly increased odds of cardiac tissue injury of CVD patients from arsenic affected areas. The results showed that the selected SNPs played a susceptibility role towards cardiac tissue iAs concentration and injury among CVD patients from iAs affected areas.