Percutaneous retrieval of a dislodged guide wire by dormia basket in a 98-year-old patient, still a safe and feasible approach

Since the first report of percutaneous retrieval of intravascular foreign body in 1964, it has been accepted as a favorite approach for intravascular foreign body removal. Various instruments such as snares, biopsy forceps, dormia basket or tip deflecting wires are available for this approach. Herein, we report percutaneous retrieval of a dislodged guide-wire by dormia basket. The Patient was a 98-year-old female who was admitted in the Intensive care unit due to confusional state. The physian incharge left the guide-wire in her subclavian vein during central venous catheter insertion. He realized his fault immediately, so he started anti-coagulation therapy and requested surgical consult. Because of the patient's high risk of surgery, the surgeon referred the patient to cardiologist for non-invasive guide wire removal. The guide wire was apprpached through femoral vein by a dormia basket [4/6 F] and it was removed without any difficulties or complications. Utilization of baskets for intravascular foreign body removal is frequently reported and has been successful with low complication rates; In addition, the low cost of the device makes it less of a burden to the patient and the hospital

short term results of complete revascularization in diabetic patients by off- pump coronary artery bypass graft [OPCAG]

Complete revascularization in diabetic patients due to small size and diffuse involvement of vessels is a problem in cardiac surgery. Due to known complications of on-pump CABG, the off-pump CABG has been suggested in these patients. This study was carried out to assess the short term results of complete revascularization in diabetic patients. This retrospective study was done during 2002 to 2006 at Imam Reza Cardiac Surgery Ward on 500 patients who were operated by off-pump CABG. The patients were divided into two groups, a: diabetic [235 pts] and b: non diabetic [265 pts]. The preoperative comorbidity, intraoperative measurement of the size of the artery at the site of anastomosis with different gauged probes, and the number of grafts per patient were recorded. Intraoperative and postoperative variables between two groups compared. The observed number of grafts [O] after surgery compared with the number of grafts predicted [P] before surgery. The O/P ratio or [completion index] of >/= 1 signifies complete revascularization. Logistic regression analysis used to test possibility that diabetes was a predictor of poor outcomes. Diabetic patients were older, with more comorbidity [congestive heart failure, peripheral vascular diseases, dialysis-dependent]. The number of grafts per patient was 4.2 +/- 1.3 [DM] and 4.2 +/- 1.3 [non-DM]. The size of 875 DM and 1068 non-DM arteries were gauged. There was no statistical difference in size between DM and non-DM [in millimeters] at each artery. All ratios ranged from 0.9 to 1.2, indicating similarity between DM and non-DM. The only significant risk factor for operative death was low left ventricular ejection fraction [P=0.001]. patients with DM were sicker, but tolerated off-pump coronary artery bypass grafting as well as non-DM patients. The number of grafts per patient and O/P ratio signified the ability to perform complete revascularization. We were able to bypass the small target vessels, as anticipated. Diabetes is not a predictor of the outcomes

relationship between sleep patterns and the quality of life in coronary artery bypass graft patients

Rest and sleep have restorative and protective roles in the restoration of our mental and physical abilities which are two important dimensions in the quality of life. Non-rapid eye movement sleep is important in protecting the cardiac function in CABG patients, who return to normal life after 8-12 weeks while sleep disorders prevail for one year after surgery. Therefore, this study was conducted to investigate the relationship between sleep patterns and the quality of life in CABG patients. This longitudinal, descriptive and correlational study was conducted on 91 patients admitted to Imam Reza Hospital in Mashad, Iran in 2005 [1384]. Subjects were selected in three phases: 24 hours before surgery, as well as 6 and 10 weeks after surgery. Interview checklists were used for data collection. Three scales were used to measure sleep patterns: Pittsburgh sleep quality index, Epworth sleepiness scale and sleep log. Quality of life was measured with 36 short form. The first two interviews were done at the hospital clinic and the last via telephone. Relevant data were analyzed in SPSS using student t-test and pearson correlation coefficient. Mean score of nocturnal sleep quality and efficiency in all three stages were undesirable. Also, mean score of sleepiness in all three stages were normal and mean score of quality of life was in the mid one-third of 0-100 scale. No significant differences were found between on-pump and off-pump groups in their sleep patterns and quality of life. In all three stages, sleep quality positively and significantly correlated with quality of life [p<0.001, p<0.002 and p=0.004 respectively]. Moreover, significant positive correlation existed between sleep efficiency and quality of life [p<0.001, p=0.002 and p=0.005 respectively]. However, no significant correlation was found to exist between sleepiness and quality of life. The findings of the present study indicated a significant and positive correlation between sleep pattern and quality of life in CABG patients. Therefore, it is necessary to restore their physical and mental health as soon as possible

Maternal and Fetal outcomes following open heart surgery during pregnancy

This study is aimed at evaluation fetal and maternal outcome in pregnant women with heart disease candidate for open heart surgery. In this study we evaluated adverse complications in 14 pregnant women underwent open heart surgery during three years period. Variable parameters were: age, parity; gestational age, history of cardiac surgery and medications, cardiac complications during pregnancy surgical indications of cardiac disease, fetal and maternal mortality and related complications. Mean age and gestational age were 38.4 years and 17.28 weeks respectively. Most of the patients were multiparous [71.42%] and in functional NYHA class III or IV [85.70%]. During pregnancy 71.43 percent of patients showed signs and symptoms of CHF and 64.28 percent of them had atrial fibrillation. All patients underwent emergent open heart surgery. Maternal and fetal mortality following surgery were 35.71 and 78/57 percent respectively. Cardiac Surgery during pregnancy were accompanied with high fetal and maternal mortality. Such pregnancies need to be managed by a team including obstetrician, cardiologist, anesthetist and cardiac surgeon. For best result, it is better to postpone surgery whenever possible and surgery is performed only when it was indicated. The present study demonstrates that emergency surgery, poor NYHA class, Atrial Fibrilation, unstable heart disease, poor economical cultural conditions will result in adverse outcome in mother and fetus following cardiac surgery