Journal of the Saudi Heart Association - Articles in Press

Outcome of Tracheostomy after Pediatric Cardiac Surgery - Accepted Manuscript

2012-02-03

Abstract: Objectives: To investigate the incidence, timing, indications and outcome of tracheotomy in children who underwent cardiac surgeries.Methods: All pediatric cardiac patients (under 14 years of age) who underwent cardiac surgeries and required tracheotomy from Nov 2000 to Nov 2010 were reviewed. The data were collected and reviewed retrospectively.Results: Sixteen children underwent tracheotomy after cardiac surgery. Fifteen of these cases had surgery for congenital heart disease, and one had surgery for an acquired rheumatic mitral valve disease. The mean +/- SEMs of the durations of ventilation before and after tracheotomy were 60.4 +/- 9.8 days and 14.5 +/- 4.79 days respectively (P value 0.0002). The means +/- SEM of the lengths of ICU, stay before and after tracheotomy were 63.31 +/-10.15 days and 22+/- 5.4 days respectively (P value 0.0012). After the tracheotomy 12/16 patients (75%) were weaned from their ventilators and 10/16 were discharged from the PCICU. Six patients were discharged from the hospital and 3 were successfully decannulated. The overall survival rate was 9/16 (56%).Conclusion: Tracheostomy shortens the duration of mechanical ventilation and facilitate discharge from the ICU. The mortality of tracheotomy patients is still significant but is mainly related to theprimary cardiac disease.

Diastolic dysfunction and Heart Failure with a Preserved Ejection Fraction: Relevance in critical illness and anaesthesia - Accepted Manuscript

R. Maharaj — 2012-02-03

Abstract: Epidemiological and clinical studies suggest that heart failure with a preserved ejection fraction will become the more common form of heart failure clinicians’ encounter. The spectrum of diastolic disease extends from the asymptomatic phase to fulminant cardiac failure. These patients are commonly encountered in operating rooms and critical care units. A clearer understanding of the underlying pathophysiology and clinical implications of heart failure with a preserved ejection fraction is fundamental to directing further research and to evaluate interventions. This review highlights the impact of diastolic dysfunction and heart failure with a preserved ejection fraction during the perioperative period and during critical illness.

The Fate of Thrombi Post Myocardial Infarction - Accepted Manuscript

Abdulhalim Jamal Kinsara, Adel M. Hasanin — 2012-02-03

Abstract: We are reporting a patient who sustained a large Myocardial infarction with large kissing thrombi in echocardiogram that disappeared in one month without being given thrombolytic, anticoagulation or antiplatelets therapy. The patient did not manifest any embolic events.This unusual course calls for specific studies on the natural history of thrombi post myocardial infarction and the best modality to treat such thrombi.

The prognostic role of serum uric acid level in patients with acute ST elevation myocardial infarction - Accepted Manuscript

Bita Omidvar, Fazlolah Ayatollahi, Mohammad Alasti — 2012-02-02

Abstract: Objectives: The role of uric acid as a prognostic factor in patients with acute ST elevation myocardial infarction is controversial. The purpose of this study was to demonstrate the relationship between serum uric acid level and mortality during admission period and 30-day period after admission.Methods: We assessed the relation between serum uric acid level and in-hospital and short-term mortality rates in 184 patients admitted with acute ST elevation myocardial infarction. We divided the patients according to their gender and uric acid level measured on admission into four groups: group A1: men with uric acid⩽7 mg/dl versus group B1: men with uric acid > 7 mg/dl and group A2: women with uric acid⩽5.4 mg/dl versus group B2: women with uric acid > 5.4 mg/dl. The patients were followed for 30 days after admission.Results: In-hospital mortality rate in group B1 was higher than group A1 [P value: 0.011, Relative risk: 13.33 (95% confidence interval: 1.55-114.7)]. Short-term all-cause mortality was significantly higher in group B1 patients [P value: 0.037, Relative risk: 3.3 (95% confidence interval: 1.02-10.64)]. Multivariate logistic regression analysis of data showed an odds ratio of 15.23 for in-hospital mortality and odds ratio of 3.76 for short-term mortality in male hyperuricemic patientsConclusions: Our data suggest that in the acute phase of ST elevation myocardial infarction, uric acid has a prognostic role for in-hospital and short-term (30-day) mortality in men.

Ischemic heart disease in pregnancy - Accepted Manuscript

Nabeel S. Bondagji — 2012-01-24

Abstract: Ischemic heart disease (IHD) in pregnancy, particularly myocardial infarction (MI), is a rare yet potentially fatal condition for the mother and the foetus. With delays in the age of conception, the changes in some social habits among females including cigarette and shisha smoking in addition to an increased prevalence of diabetes mellitus, IHD may represent a real hazard among pregnant women in the near future. The difficulty in the diagnosis emerges from the similarity of the signs and symptoms of ischemia and infarct to some of the physiological adaptations that occur in a normal pregnancy. The physiological changes that are normal in pregnancy may aggravate pre-existing disease and may unmask some underlying unrecognized coronary vascular changes; therefore, the diagnosis requires a high index of suspicion and careful assessment of the underlying risk factors. The management of IHD always requires a multidisciplinary team approach. The management of each patient should be individualized according to the clinical condition, the risk factors, and the availability of the necessary support. Pregnancy after MI may be an acceptable and reasonably safe option provided the cited criteria are met. A systematic PubMed search was performed to identify all published data including cases reports, small series and systematic reviews in the existing literature. These publications were comprised of both retrospective and cross sectional population studies to maximize the number of cases considered in order to reach conclusions and make recommendations based on the best available evidence considering the rare occurrence of this event. The epidemiology, diagnosis, medical and surgical treatment, and prognosis of IHD in pregnancy are the subjects of the present review.

Response to Letter by: Chase, doi: 10.1016/j.jsha.2012.01.001 - Corrected Proof

Mark M. Gallagher — 2012-01-19

In reply to the letter by Dr. Chase, we agree that differences between individuals in the anatomy of the right atrium can make cannulation of the coronary sinus difficult in some cases. We routinely use a medium curve deflectable catheter. In difficult cases we perform imaging of the coronary sinus by contrast injection using an Amplaz Left II coronary catheter from a femoral approach. Long sheaths such as the SL0 are very rarely required (<1% of cases) in our institution. The experience of the operator is more important than these technical details. In our institution, an experienced operator (>1000 cases as first operator) is available for all procedures to avoid having to revert to subclavian access for coronary sinus cannulation.

Letter in response to the original article: “Evaluation of femoral approach to coronary sinus catheterisation in electrophysiological and ablation procedures: Single centre experience” authored by Osama Abdel Atty, Mohamed Morsy and Mark M. Gallagher (Journal of the Saudi Heart Association, Volume 23, Issue 4, October 2011, pp. 213–216) - Corrected Proof

David Chase — 2012-01-11

The authors present data from their centre regarding cannulating the coronary sinus by the femoral venous approach. As the author correctly points out, this approach has become increasingly feasible with the use of long sheaths such as the Swartz SL3 sheath (Daig Corp., Minnetonka, MN, USA) as has been previously demonstrated .

Use of microvena snare catheter in non-ST elevation myocardial infarction due to saphenous vein graft occlusive thrombi - Corrected Proof

Mohammed Balghith — 2011-12-15

Abstract: A 75-year-old man presented with acute coronary syndrome; he had a saphenous vein graft thrombosis. Percutaneous coronary intervention of bypass graft vessels is more challenging due to a higher incidence of periprocedural distal micro-emobilization and myocardial infarction. Current guidelines for percutaneous coronary intervention advocate the use of distal embolic protection devices, especially in patients with large thrombus burden, undergoing percutaneous intervention for vein graft disease. This patient was treated by manual aspiration of graft thrombus using a microvena catheter and successful clot removal was achieved. There are yet no best available therapeutic options for patients undergoing percutaneous coronary intervention of saphenous vein graft lesions.

The ECG role in identifying the etiology of tachycardia-induced cardiomyopathy (TIC) - Corrected Proof

M. Al Mehairi, S.A. Al Ghamdi, K. Dagriri, A. Al Fagih — 2011-12-12

Abstract: Tachycardia-induced cardiomyopathy (TIC) is a well recognized entity of heart failure (HF) and various mechanisms due to tachyarrhythmias have been postulated to be responsible for impaired cardiac contractility. Previously reported cases showed reversibility of such disorders whenever stable cardiac rhythm is maintained adequately and we report on a 16-year-old boy who has been diagnosed to have TIC, which was misinterpreted initially as sinus tachycardia secondary to dilated cardiomyopathy and heart failure. A complete recovery of his left ventricular function was achieved by radiofrequency catheter ablation and highlights the importance of a 12-lead electrocardiogram (ECG) assessment in such patients.

Hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection: Imaging of a very rare association - Corrected Proof

2011-10-24

Abstract: A newborn is presented with an association of hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection. The diagnosis was established with echocardiography and further confirmed with computed tomography. To our knowledge the images of such an association have never been reported before.

Waiting time for transfer of patients with prostaglandin dependant congenital heart defects to tertiary cardiac centers - Corrected Proof

Abdul Rahman Al Mesned, Ali A. Al Akhfash, Maha Sayed — 2011-10-24

Abstract: Worldwide congenital heart defects (CHD) are the leading cause of infant deaths owing to congenital anomalies. Delay in diagnosing and operating in neonates with prostaglandin dependant CHD may lead to significant morbidity and mortality.Objectives: To assess the time interval needed for acceptance and transfer of patients with critical CHD to a tertiary cardiac center and the impact on the patient’s survival.Study design: Retrospective database reviews of all cases diagnosed to have prostaglandin dependant (PG) CHD at Prince Sultan Cardiac Center-Qassim during a 43months period (from May 2007 to December 2010).Results: During the study period 104 patients were diagnosed to have PG dependant CHD. Patients with PG dependant systemic circulation constitute 60% of patients. Patients with ventricular septal defect (VSD) associated with coarctation of the aorta constituted 16% of patients. The mean waiting time for transfer to a tertiary cardiac center was 10±10days. Twenty-two (21%) patients died while waiting for acceptance and transfer. Eleven patients were diagnosed with hypoplastic left heart syndrome (HLHS). There was no significant difference in the waiting time for those with or without HLHS, with a mean of 9days for both. Six of our patients had infections with positive blood cultures. The mean waiting period for those with proved infection was 25days compared with 8days for those with no proved infection (p value<0.005).Conclusion: There are a significant number of patients with severe CHD who die while waiting for acceptance and transfer to a tertiary cardiac center. The causes for delay could be the presence of infection, prematurity and low birth weight. The limited numbers of tertiary cardiac centers in Saudi Arabia as well as cardiac ICU beds are among the factors delaying the acceptance of patients requiring cardiac surgery.

Gender differences in cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia - Corrected Proof

2011-10-19

Abstract: Objective: The objective of this study was to explore gender differences in the prevalence of silent and clinical apparent cardiovascular risk factors among adolescents in Aseer Region, southwestern Saudi Arabia.Materials and methods: A cross-sectional study on a stratified sample of 1869 adolescents was carried out. They were interviewed and examined for weight and height, systolic and diastolic blood pressure using standardized techniques.Results: The study revealed high prevalence of some potential behavioral and biological cardiovascular diseases (CVD) risk factors among adolescent males and females in the study area. Behavioral risk factors included inadequate low consumption of fruits and vegetables, physical inactivity, and smoking. Physical inactivity was significantly more prevalent among females than males (42.9% and 25.7%, respectively). Smoking was significantly more among females than males (11.8% and 1.3%, respectively). Biological risk factors found were family history of CVD, obesity and high blood pressure. Obesity was significantly prevalent among females (29.4%) compared to males (20.6%). Males had significantly more high blood pressure than females. In logistic regression analysis, being male (aOR=2.992, 95% CI=1.933–4.742) and obesity (aOR=2.995, 95% CI=2.342–3.991) were found to be significant risk factors in developing high blood pressure among adolescents in the region.Conclusions: Presence of cardiovascular risk factors among adolescents is a public health problem in the region. There is a need for a national program in the country to prevent and control cardiovascular risk factors among adolescents.

Relationship between HLA molecules and late restenosis after coronary stent placement - Corrected Proof

2011-10-17

Abstract: Objective: The objective of this study is to confirm whether there is relation between the human leucocyte antigen (HLA) locus and restenosis after percutaneous coronary intervention (PCI) holds in our patient population and whether it can be useful as a prognostic factor.Methods: We examined the HLA phenotypes in 46 consecutive patients (39 men, 7 women, mean age of 57±9years) who had successful stent implantation in the coronary artery. Selective coronary arteriography was performed 6months after coronary stenting to assess the presence of restenosis. The HLA phenotyping was performed for HLA-A,-B,-C antigens by Terasaki microlymphocytotoxicity technique and for HLA-DR alleles with PCR-SSP technique.Results: Restenosis(R+) was present in 12 (26.1%) patients (11 men, 1 woman, mean age of 57±10years). For HLA Class I antigens frequency of HLA-B62 and HLA-CW2 antigen was slightly higher in restenotic patients but did not reach statistical significance. For HLA-DR alleles restenotic patients had higher frequencies for HLA-DRB1∗01(R+ %25, R− %14.7), and HLA-DR11(R+ %41.7, R− %20.6), without reaching statistical significance and lower frequencies for DR7(R+ %0, R− %17.6) and D13(R+%8.3, R− %32.4) and HLA-DR53 (R+ %25, R− %35.3) without reaching statistical significance.Conclusion: In conclusion, results show that there was no relationship between the development of restenosis and HLA-subtypes.

WITHDRAWN: Prevalence of coronary artery disease risk factors in Saudi children - Corrected Proof

2010-05-31

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

WITHDRAWN: Consanguinity as a risk factor in congenital heart disease in Saudi Arabia - Corrected Proof

Susan M. Becker — 2010-05-11

Effect of oral ibuprofen on patent ductus arteriosus in premature newborns - Corrected Proof

Sabry Ghanem, Mansour mostafa, Mohamed Shafee — 2010-03-02

Abstract: Background aim of the study: Patent ductus arteriosus (PDA), a common finding among premature infants, is conventionally treated by intravenous indomethacin. Intravenous ibuprofen was recently shown to be as effective and to have fewer adverse reactions in preterm infants. If equally effective, then oral ibuprofen for PDA closure would have several important advantages over the intravenous route. This study was designed to determine whether oral ibuprofen treatment is efficacious and safe in closure of a PDA in premature infants.Patients and methods: Thirty-three premature group I (study group) were treated with ibuprofen 10mg/kg administered through a feeding tube. Thirty-three premature group II (control group) receive placebo the two imaging procedures were again performed 24h after each ibuprofen dose. When the PDA was still hemodynamically significant, as demonstrated by echocardiography, and there was no evidence of deterioration in brain ultrasonography, a second dose of ibuprofen 5mg/kg (placebo for control) was administered. A third equivalent dose was given after another 24h if necessary. Cranial ultrasound was repeated 1week after the last ibuprofen dose and again before discharge from the ward. Hematochemical analysis was preformed daily in the unit during the first days of life.Results: In the study group the rate of PDA closure was 93.9% (31 of 33 cases) while in the control group the rate of PDA closure was 30.3% (10 of 33 cases) with significant difference in between. There was no reopening of the ductus after closure had been achieved. No infant required surgical ligation of the ductus in study group while in the control group 24.2% (8 of 33 cases) were required surgical ligation (). Twenty-one newborns were treated with 1 dose of ibuprofen, nine were treated with 2 doses, and the remaining three were treated with 3 doses.Conclusion: Oral ibuprofen is an effective and safe alternative to intravenous ibuprofen for PDA closure in premature infants.