Journal of Cardiovascular Medicine and Surgery

 A chronic contained rupture of an abdominal aortic aneurysm (CCRAAA) is a well- documented subtype of abdominal aortic aneurysm (AAA) rupture in which the hematoma is sealed by the retro-peritoneum first described by Szilagyi et al. in 1961. Patients with a sealed AAA rupture often present a diagnostic and therapeutic dilemma as they lack the typical features of hemorrhagic shock usually seen with frank rupture. While AAA is a common disorder, CCR-AAA constitute only 4% of all ruptured aortic aneurysms.Treatmentvaries from stenting to open surgery or combination of both.But it is costly. We report a case of a 27 year-old Indian female who presented with a 6-month history of low back pain and a mass per abdomen. A contrast enhanced CT scan with an aortogram demonstrated a 8.8cm partially thrombosedpseudoanerysm just after the origin of superior mesenteric artery extending to both the common iliac artery.Patient was not affordable for stenting procedure so open surgery planned under GA. After left thoracoabdominal incision, as first step left common iliac artery to left renal artery grafting was done using 6 mm PTFE graft for maintaining the its blood supply after clamping aorta. After 200iu/kg heparinisation the descending thoracic aorto and femoral artery cannulated . ¾ th size tubing connected to both these canulla. Aorta clamped distal to canulla along with clamping both common iliac arteries.Aneurysm opened and large 8cm by 8cm aortic thrombus evacuated. End to end aortobiiliac grafting done using 24mm by 9 mm Y graft. Right renal artery anastomosed directly on the graft.Incision closed with two drains,one in abdomen and other in left chest.Patientextubated after 6 hours and discharged after ten days.Patients with low financial income - open surgery was the only valid and better option. Though it was difficult but with proper planning and protocols ,surgery seems to be easy with better results.

Keywords: Chronic Contained Rupture (CCR); Abdominal Aorticaneurysm (AAA).

 Isolated RSCA from the right pulmonary artery is a very rare vascular arch anomaly. Complete loss of continuity of subclavian artery from the aortic arch was named ISOLATION by Stewart and colleagues [4] in 1964. They are commonly associated with DiGeorge syndrome [2] or intracardiac anomalies [3]. We report a case of 6 years old female child diagnosed with Tetralogy of Fallot with single pulmonary (right) artery with no left pulmonary artery with an anomalous Right Subclavian artery arising from the single pulmonary artery with left arch and left superior vena cava. Patient underwent single lung repair with total transatrial approach with reimplantation of the right subclavian artery into the right carotid/ innominate artery (first branch of the ascending aorta). Early intervention with complete surgical repair normalised the patient’s circulation with resolution of both the pulmonary and subclavian steal phenomenon.

 Diabetes and its complications continue to have a major impact on the morbidity and mortality in both the developed and developing world. While the condition does have a gamut of options at the physician’s disposal such as insulin, metformin, GLP analogues, DPP-4 inhibitors and SGLT-2 inhibitors, each of these drugs are not without its own set of unique nuances. A significant proportion of patients do not achieve adequate glucose control.Lixisenatide is a novel GLP-1 agonist that is approved for the treatment of diabetes. The drug is given at a dose of 10 mcg once daily for 14 days via subcutaneous route using a pre-filled pen. Gastrointestinal intolerance is a common issue as seen with other GLP agonists. Efficacy with the drug has been modest and been shown to be non-inferior to other GLP agonists such as exenatide. The once daily dosing, low risk of hypoglycemia and the relative cost benefit may make it an attractive option for physicians to prescribe this molecule in patients with uncontrolled diabetes.

 Junctional ectopic tachycardia is a form of supraventricular tachyarrhythmia which is very common after cardiac surgery. It is more often detected in pediatric age group. The development of JET is because of multiple risk factors and triggers. The etiopathology is complex and diagnosis may be difficult. The association of JET creates hemodynamic alteration, delay extubation, ICU stay and hospital discharge. The treatment of JET is not fully established; many researches continue to explore better understanding and its management. Hence in this review authors described the different aspects epidemiology of JET after cardiac surgery in the recent literatures from different data base. The results from available studies suggest that younger age children, long bypass and cross clamp time, particular set of surgery, hyperthermia, use of inotrope and hypomagnesemia are the risk factor for inducing JET. Management of JET is complex; some occasions resistant to treatments and self-limiting. Hypothermia, judicious use of inotropes, amiodarone, dexmedetomidine, magnesium and radiofrequency ablation are most effective remedies for controlling JET.

 Keywords: Junctional Ectopic Tachycardia; Cardiac Surgery; Epidemiology; Tetralogy of Fallot; Arterial Switch Operation; Dexmedetomidine; Amiodarone; Hypothermia; Magnesium.

 Dextro cardia is a rare heart condition of 0.37 to 0.53% 10,000 live births. 45 year old patient had successful double valve replacement (AVR and MVR) with moderate pulmonary hypertention in this anomaly and is extremely rare. The altered surgical anomaly and the necessary changes in surgical approach are described. This procedure is rarely done and is reported very few in the literature to our knowledge.

 Background of Study: In modern medical practice, approximately 90% of patients in acute care setting receive some form of intravenous infusion therapy (JeniseWillin, 1999). Phlebitis is one of the most common complications of IV therapy. Among hospitalized patients, 25% to70% of patients receiving IV therapy develops phlebitis. According to statistics, the most common grade of phlebitis were 1 and 2 (37% and 53.6%, respectively) [1]. Objectives: 1. To assess the degree of phlebitis, 2. To determine the effect of cold glycerin magsulf application in relieving phlebitis, 3. To determine the effect of hot glycerin magsulf application in relieving phlebitis, 4. To compare the effectiveness between cold and hot glycerin magsulf application in relieving phlebitis. Methods and Material: This study was conducted with the objectives to determine the effect of hot and cold glycerin magsulf application in relieving phlebitis among patients in a selected hospital.Hence evaluative research approach was considered as appropriate. With this approach it would be possible to evaluate the effectiveness of hot and cold glycerin magsuf application in relieving phlebitis. It consists of two group’s pre- test post- test, designed to assess the effectiveness of hot and cold glycerin magsulf in relieving phlebitis.The research design selected for the present study was quasi experimental two group pre-test and post-test design. Study conducted in medical surgical wards target population was patient with infusion phlebitis. Samples collected by purposive sampling technique. Research tool was standard infusion phlebitis scale and descriptive and inferential statistically, paired test “t” test was used for analysis. Reliability was established by interrater method and it was found as r = 0.88. Results: Majority of sample i.e. 96.6% were found with grade 3. None of sample had Grade 1 and Grade 5. For the grade 4 phebitis need to do further study, this 4 degree of phlebitis not relived in 5 days of intervention with hot and cold glycerin magsulf application. As per day of relief proved that hot glycerin magsulf application was more effective than the cold glycerin magsulf application. All over 56% of sample in hot glycerin magsulf application and 26.63% of sample in cold glycerin magsulf application got relief on the 3rd day and 43% of sample in cold glycerin magsulf application and 6.67% of hot glycerin magsulf application relief on the 4th day. Majority of sample got relief on the 3rd day with hot glycerin magsulf application. So hot glycerin magsulf application was more effective than cold glycerin magsulf application in reliving phlebitis. The effectiveness of hot and cold glycerin magsulf application in relieving phlebitis at pre and posttest. Mean, standard deviation and mean difference values were compared and student’s paired ‘t’ test was applied at 0.05 level of significance. The tabulated ‘t’ value was 2.05. The calculated ‘t’ value was much higher than the tabulated value at 0.05 level of significance which is statistically acceptable level of significance. Hence it is statistically interpreted that hot and cold glycerin magsulf applications in relieving phlebitis were effective. Conclusion: In this study, during a period of data collection the visual infusion phlebitis scale was used, onset of phlebitis, degree of phlebitis, site and size of cannulation were observed. Data showed that, majority of sample were found with grade three phlebitis and both the interventions i.e. hot glycerin magsulf and cold glycerin magsulf application both are effective which is already proved but as compare to cold glycerin magsulf application hot glycerin magsulf application is more effective in relieving phlebitis. Sample with grade 4 Phlebitis is not relieved in four days of intervention. Further study may need to prove this. In conclusion investigator state that the aim of investigator was achieved. This study can improve the outcome of nursing practice, which has been proven to be relevant also from a legal point of view. In fact, evidence based nursing is safer both for patients and nurses themselves.

 Background: The use of cardiopulmonary bypass (CPB) in open heart surgery is frequentl associated with organ dysfunction. We evaluated the patterns of serum bilirubin, enzymes level and early clinical outcomes of postoperative liver dysfunction in open heart surgery patients. ethods: In our study, we assessed the parameters of postoperative liver dysfunction (serum bilirubin, enzymes levels) and their impact on early clinical outcome after open heart surgery of 97 patients from May 2016 to January 2017. Postoperative hyperbilirubinemia was defined as serum total bilirubin >2.0 mg /dl. Results: The patients were divided into two groups: Group A; CPB time  120 minutes (37.11%), Group B; CPB time >120 minutes (62.88%). Mean total CPB and cross clamp time in group A (96.30 & 65.30 minutes respectively) and in group B (176.06 & 139.49 minutes respectively). High inotropic support, ventilation time, ICU stay, blood transfusions and complications were more in group B. The serum total bilirubin reached its maximum level on the first, second and third postoperative day in 17%, 43%, and 34% in group A and 7%, 64%, 44% in group B patients and hyperbilirubinemia came mainly from indirect bilirubin. The pattern of raised liver enzymes mainly AST on the first, second and third postoperative day in 86%, 86%, and 40% in group A and 87%, 98 %, 64 % in group B patients. Hospital mortality was higher in group B (16.33%) than in group A (5.55%). Conclusions: Postoperative hyperbilirubinemia and significantly raised enzyme mainly aspartate aminotransferase is common in patients undergoing cardiopulmonary bypass on second postoperative day and is predictor of mortality.

 Adipose tissues or adipocytes releases signaling proteins called adipokines. Certain adipokines appear to have cardio protective function against myocardial ischaemia/ reperfusion (I/R) injury while others participate in cardiac remodeling. Visfatin also known as nicotinamide phosphoribosyl- transferase, is a cytokine that is highly expressed in visceral fat. The involvement of the levels of this adipokine in cardiovascular disease is still controversial. Similarly low concentration of vaspin levels is associated with the severity of coronary artery disease.The aim of our study was to identify the concentration of the adipokines visfatin and vaspin in patients with coronary artery disease across the spectrum of the disease. A significant difference was observed in visfatin concentration between STEMI and NSTEMI patients. Similarly when vaspin concentration was compared, a remarkable difference was observed between STEMI and NSTEMI groups. There was a significant correlation between vaspin and Left ventricular ejection fraction. In conclusion, visfatin and vaspin concentration are elevated in acute myocardial infarction and could be involved in the pathogenesis of coronary artery disease. More fundamental research on the role of these adipokines in the pathophysiology of the disease is warranted.

 Background: Cardiac myxomas are the benign tumors occurring in any of the cardiac chambers but most commonly in the left atrium. Recent advances facilitate appropriate diagnosis and successful surgical management. This study is a retrospective analysis of myxoma cases focused on the clinical features and successful surgical procedures. Methods: this study was conducted in madras medical college with a duration of 5 years, which includes 30 patients. Age, sex, site of myxoma, diagnosis and surgical approaches done were recorded. Results: A female predominance (73%) with left atrium (70%) being the most common site of myxoma was observed. Trans Thoracic Echocardiography was the choice of diagnosis (83%) and right atrial approach was done in most of the cases (83%). Conclusion: According to our experience in the management of 30 cardiac myxomas during a study period of 5 years, we strongly recommend
right atrial approach instead of the classical bi-atrial approach.
 

 In the modern era, main emphasis has been placed on reducing the length of ICU stay without compromising quality of care in cardiac surgery; only early extubation protocol can meet expectations of today’s heart surgery patients. In our prospective study we used multidisciplinary protocols for early extubation after heart surgery of 89 patients from May 2016 to December 2016. The patients were divided into two groups: Group A, those extubated within six hours of surgery (76.4% cases); Group B, those not extubated after six hours and electively ventilated overnight (23.5% cases). There was no significant difference in age, BSA, preoperative risk factors and left ventricular function in both groups, while female (71.4%) in group B had delayed extubation. Mean total CPB and cross clamp time in group B (187.14 & 139 minutes respectively) was higher than in group A (139.45 & 102.62 minutes respectively). In comparison of postoperative data we found that use of blood products, re-exploration for bleeding (19%) stay in ICU and step down was slightly higher in group B. High inotropic support (42.85%), deep coma (25%) were the two main factors for delayed extubation in our study. Hospital mortality was higher in group B (33.3%) than in group A (2.94%) patients. Due to successful early extubation, it is now common practice to aggressively wean and extubate in most of the patients after cardiac surgery.

 Tocotrienols are member of the vitamin E family, recommended as supplements for maintaining optimum health. Tocotrienols have multieffects as antiangiogenic, antiinflammatory, antidyslipidemic, proapoptotic, antiproliferative, free radical scavenger,radiation countermeasures. The main objective of this study was to determine the effects of TRF supplementation on lipid profile in healthy individuals at low dose of 160 mg/day for 6 months. Method: One hundred subjects were recruited from two age groups, 35-50 years (n=50) and above 50 years age (n=50) and randomly assigned to receive either TRF supplement or placebo capsules for six months. Blood samples investigated at 0, 3 and 6 months. Result: There were no significant alterations observed in total cholesterol, LDL, triglycerides while significant changes had been observed in HDL cholesterol, particularly 6 month TRF supplemented individuals (Pï‚£0.01). Conclusion: Our result indicate that daily supplementation of TRF up to 6 months, raised plasma HDL cholesterol levels, reflects the antiatherogenic properties, predicts for the prevention of cardiovascular diseases risks.
Further need of research study on lipid profile & other cardiac markers with different dose and duration of TRF is indispensable in cardiovascular and other diseases.