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   2013| July-September  | Volume 16 | Issue 3  
    Online since June 29, 2013

 
 
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JANAK MEHTA AWARDS
The application of European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for risk stratification in Indian patients undergoing cardiac surgery
Deepak Borde, Uday Gandhe, Neha Hargave, Kaushal Pandey, Vishal Khullar
July-September 2013, 16(3):163-166
DOI:10.4103/0971-9784.114234  PMID:23816669
Aims and Objectives: To validate European system for cardiac operative risk evaluation II (EuroSCORE II) and Society of Thoracic Surgeons (STS) risk-score for predicting mortality and STS risk-score for predicting morbidity in Indian patients after cardiac surgery. Materials and Methods: EuroSCORE II and STS risk-scores were obtained pre-operatively for 498 consecutive patients. The patients were followed for mortality and various morbidities. The calibration of the scoring systems was assessed using Hosmer-Lemeshow test. The discriminative capacity was estimated by area under receiver operating characteristic (ROC) curves. Results: The mortality was 1.6%. For EuroSCORE II and STS risk-score C-statics of 5.43 and 6.11 were obtained indicating satisfactory model fit for both the scores. Area under ROC was 0.69 and 0.65 for EuroSCORE II and STS risk-score with P values of 0.068 and 0.15, respectively, indicating poor discriminatory power. Good fit and discrimination was obtained for renal failure, long-stay in hospital, prolonged ventilator support and deep sternal wound infection but the scores failed in predicting risk of reoperation and stroke. Mortality risk was correctly estimated in low (< 2%) and moderate (2-5%) risk patients, but over-estimated in high-risk (> 5%) patients by both scoring systems. Conclusions: EuroSCORE II and STS risk-scores have satisfactory calibration power in Indian patients but their discriminatory power is poor. Mortality risk was over-estimated by both the scoring systems in high-risk patients. The present study highlights the need for forming a national database and formulating risk stratification tools to provide better quality care to cardiac surgical patients in India.
  11,007 883 5
CASE REPORTS
Cardiac surgery in a patient with severe thrombocytopenia: How low is too low?
Ahmed Ashoub, Suresh Lakshmanan, Heyman Luckraz
July-September 2013, 16(3):215-217
DOI:10.4103/0971-9784.114258  PMID:23816678
Platelets play a very important role in hemostasis, especially after cardiac surgery. Excessive bleeding after such surgery may lead to increased need for transfusion and its incumbent increase in post-operative morbidity and mortality. Although most cardiac surgeons will offer a surgical option to a patient with moderate thrombocytopenia (platelet count around 70 × 10 9 /L), successful cardiac surgery has not been reported in patients with significantly lower platelets counts (less than 40 × 10 9 /L). We report a case of severe thrombocytopenia (19 × 10 9 /L) where coronary artery bypass grafting was performed with minimal blood loss post-operatively, discuss the patient's management and provide insights while dealing with such patients.
  10,716 368 2
REVIEW ARTICLE
New orally active anticoagulants in critical care and anesthesia practice: The good, the bad and the ugly
Vishal Sehgal, Sukhminder Jit Singh Bajwa, Anurag Bajaj
July-September 2013, 16(3):193-200
DOI:10.4103/0971-9784.114244  PMID:23816673
With the adoption of dabigatran, rivaroxaban, and apixaban into clinical practice, a new era has arrived in the practice of oral anticoagulants. Venous thromboembolism (VTE) has traditionally been underdiagnosed and under treated in Asia. With increasing longevity, the diagnosis and the need for management of atrial fibrillation (AF) and VTE is likely to increase significantly. The new orally active anticoagulants (NOACs) have reasonably filled the lacunae that clinicians traditionally faced when treating patients with vitamin K antagonist (VKA). Unlike VKA, NOACs do not need frequent monitoring. Therefore, more patients are likely to get therapeutic effects of anticoagulation and thus reduce morbidity and mortality associated with VTE and AF. However, the clinicians need to be circumspect and exercise caution in use of these medications. In particular (in geriatric population), the clinicians should look out for drug-drug interactions and underlying renal insufficiency. This would ensure therapeutic efficacy and minimize bleeding complications. Here, it is important to note that the antidote for NOACs is not available and is a major concern if emergency surgical procedure is required in their presence.
  7,665 957 2
BRIEF COMMUNICATION
How standard transesophageal echocardiography views change with dextrocardia
Monish S Raut, Arun Maheshwari, Sujay Shad, G Rachna
July-September 2013, 16(3):218-220
DOI:10.4103/0971-9784.114261  PMID:23816679
Dextrocardia with situs inversus is a rare condition. Situs inversus with dextrocardia is also called as "situs inversus totalis". Transesophageal echocardiography (TEE) views in dextrocardia patient are not discussed in the literature. The cardiac position and the cardiac chambers are mirror image of the normal anatomy. Because of this positional change, certain TEE probe and multiplane angle manipulations are required to obtain the recommended views.
  6,871 264 1
ORIGINAL ARTICLE
Efficacy of perioperative pregabalin in acute and chronic post-operative pain after off-pump coronary artery bypass surgery: A randomized, double-blind placebo controlled trial
Shreedhar S Joshi, AM Jagadeesh
July-September 2013, 16(3):180-185
DOI:10.4103/0971-9784.114239  PMID:23816671
Aims and Objectives: We evaluated the efficacy of perioperative pregabalin on acute and chronic post-operative pain after off-pump coronary artery bypass (OPCAB) surgery. Materials and Methods: Forty patients undergoing elective OPCAB surgery were randomized to pregabalin and control groups. Pregabalin group received 150 mg pregabalin 2 h prior to induction of anesthesia and 75 mg twice daily for 2 post-operative days whereas the control group received placebo at similar timings; pregabalin and placebo were administered by an anesthesiologist blinded to the drugs. Pain scores (visual analogue scale [VAS]) and sedation scores were observed at 0, 4, 6, 12, 24, 36 and 48 h after extubation. Time to extubation, tramadol consumption and side-effects were noted. VAS score was analyzed by Mann-Whitney U test. The analysis of variance test for repeated measures was used for comparison of the means of continuous variables. Group comparisons were made using the Chi-square-test. Results: Pain-scores at 6, 12, 24 and 36 h from extubation at rest and at deep breath were less in pregabalin treated patients ( P < 0.05). Tramadol consumption was reduced by 60% in pregabalin group ( P < 0.001). Extent of sedation, extubation times and incidence of nausea were comparable. The effect on chronic post-operative pain was not significant. Conclusions: Perioperative pregabalin reduced pain scores at rest and deep breath and reduced consumption of tramadol in the post-operative period without delaying extubation and causing excessive sedation.
  5,529 561 14
Epidural catheterization in cardiac surgery: The 2012 risk assessment
Thomas M Hemmerling, Shantale Cyr, Nora Terrasini
July-September 2013, 16(3):169-177
DOI:10.4103/0971-9784.114237  PMID:23816670
Aims and Objectives: The risk assessment of epidural hematoma due to catheter placement in patients undergoing cardiac surgery is essential since its benefits have to be weighed against risks, such as the risk of paraplegia. We determined the risk of the catheter-related epidural hematoma in cardiac surgery based on the cases reported in the literature up to September 2012. Materials and Methods: We included all reported cases of epidural catheter placement for cardiac surgery in web and in literature from 1966 to September 2012. Risks of other medical and non-medical activities were retrieved from recent reviews or national statistical reports. Results: Based on our analysis the risk of catheter-related epidural hematoma is 1 in 5493 with a 95% confidence interval (CI) of 1/970-1/31114. The risk of catheter-related epidural hematoma in cardiac surgery is similar to the risk in the general surgery population at 1 in 6,628 (95% CI 1/1,170-1/37,552). Conclusions: The present risk calculation does not justify not offering epidural analgesia as part of a multimodal analgesia protocol in cardiac surgery.
  4,563 506 7
CASE REPORTS
Idiopathic left ventricular outflow tract pseudoaneurysm
Ajay Kumar Jha, Rakesh Pandey, Parag Gharde, V Devagourou, Usha Kiran
July-September 2013, 16(3):209-211
DOI:10.4103/0971-9784.114252  PMID:23816676
Left ventricular outflow tract (LVOT) pseudoaneurysm is a rare occurrence and may produce clinically unpredictable symptoms. A very few cases of LVOT pseudoaneurysm are reported and there has always been a predisposing factor in these reported cases such as history of infective endocarditis, myocardial infarction, prosthetic aortic valve replacement or chest trauma. Our patient did not have the above predisposing conditions. Intra operative transesophageal echocardiography helped patient management and guided the surgical team in securing and isolation of the aneurysmal sac from the LVOT.
  2,664 157 3
Levosimendan in a neonate with severe coarctation of aorta and low cardiac output syndrome
Yann Olivier Boegli, Simone Gioanni, Mathieu van Steenberghe, Philippe Pouard
July-September 2013, 16(3):212-214
DOI:10.4103/0971-9784.114254  PMID:23816677
We report successful use of levosimendan after failed balloon angioplasty in a critically ill neonate with coarctation of aorta (CoA) and severe low cardiac output syndrome (LCOS). Treatment with levosimendan improved left heart function, and decreased lactate and brain natriuretic peptide levels. To our knowledge, this is the first report on the safe and successful use of levosimendan in the management of LCOS due to severe CoA in a neonate awaiting surgical repair.
  2,456 325 1
Emergent cardiopulmonary bypass during pectus excavatum repair
Ryan Craner, Ricardo Weis, Harish Ramakrishna
July-September 2013, 16(3):205-208
DOI:10.4103/0971-9784.114249  PMID:23816675
Pectus excavatum is a chest wall deformity that produces significant cardiopulmonary disability and is typically seen in younger patients. Minimally invasive repair of pectus excavatum or Nuss procedure has become a widely accepted technique for adult and pediatric patients. Although it is carried out through a thoracoscopic approach, the procedure is associated with a number of potential intraoperative and post-operative complications. We present a case of cardiac perforation requiring emergent cardiopulmonary bypass in a 29-year-old male with Marfan syndrome and previous mitral valve repair undergoing a Nuss procedure for pectus excavatum. This case illustrates the importance of vigilance and preparation by the surgeons, anesthesia providers as well as the institution to be prepared with resources to handle the possible complications. This includes available cardiac surgical backup, perfusionist support and adequate blood product availability.
  2,294 142 1
ORIGINAL ARTICLE
Coronary angiography findings in lung injured patients with sulfur mustard compared to a control group
Reza Karbasi-Afshar, Ayat Shahmari, Mahdi Madadi, Zohreh Poursaleh, Amin Saburi
July-September 2013, 16(3):188-192
DOI:10.4103/0971-9784.114242  PMID:23816672
Aims and Objectives: We evaluated the incidence of coronary artery disease (CAD) in Sulfur mustard (SM) exposed veterans. We also evaluated the relationship between exposure to SM and angiography findings and compared angiography findings of SM exposed individuals with unexposed ones after two decades from the time of exposure to SM. Materials and Methods: A case-control study was conducted on 200 consecutive patients (100 SM exposed vs. 100 unexposed) undergoing angiographic assessments due to CAD. Results: The coronary angiography findings between two groups were significantly different ( P < 0.001). Ninety two (92%) patients in SM exposed group and 82 (82%) in unexposed group had abnormal findings in their coronary arteries ( P = 0.031). Conclusions: The incidence of CAD and angiographic changes were significantly increased with exposure to SM. Further studies on cardiovascular effects of SM are needed.
  2,215 175 1
LETTERS TO EDITOR
Anatomical landmark technique for internal jugular vein cannulation in patients with cyanotic congenital heart disease: A word of caution
Samarjit Bisoyi
July-September 2013, 16(3):224-225
DOI:10.4103/0971-9784.114241  PMID:23816682
  2,177 164 -
Anaphylaxis during intravenous administration of amiodarone
Hizir Okuyan, Cihan Altin, Okan Arihan
July-September 2013, 16(3):229-230
DOI:10.4103/0971-9784.114251  PMID:23816686
  1,972 176 2
CASE REPORTS
Use of dopamine infusion improved oxygenation in a patient of Ebstein's anomaly with atrial septal defect
Mukul C Kapoor, Pramil Kumar, Priyadarshani Chakravarti
July-September 2013, 16(3):201-204
DOI:10.4103/0971-9784.114247  PMID:23816674
We present the successful perioperative management of an adult patient with Ebstein's anomaly for abdominal rectopexy surgery. The patient developed mild hypotension and a fall in peripheral oxygen saturation (SpO 2 ) after administration of a graded epidural block. Correction of the fall in the blood pressure; however, did not improve the SpO 2 . The patient was administered an intravenous infusion of dopamine to improve the cardiac output and this led to improvement in the SpO 2 .
  2,001 142 -
INTERESTING IMAGES
Mobile left atrial mass
Deepak K Tempe, Devesh Dutta, Deepti Saigal, Amit Banerjee
July-September 2013, 16(3):221-222
DOI:10.4103/0971-9784.114260  PMID:23816680
  1,638 131 -
INVITED COMMENTARY
Oral pregabalin holds promise to reduce pain after cardiac surgery
PN Jain
July-September 2013, 16(3):186-187
  1,594 162 -
EDITORIAL
The value of database and data interpretation
Praveen Kumar Neema
July-September 2013, 16(3):161-162
DOI:10.4103/0971-9784.114235  PMID:23816668
  1,523 153 1
LETTERS TO EDITOR
Perioperative management of emergency aortic valve replacement for infective endocarditis after liver transplantation
Deepak Prakash Borde, Uday Gandhe, Neha Hargave, Kaushal Pandey
July-September 2013, 16(3):227-229
DOI:10.4103/0971-9784.114248  PMID:23816685
  1,426 113 -
Asystole during pulmonary artery catheter sheath removal: A rare occurance
Sukhen Samanta, Rudrashish Haldar, Sujay Samanta
July-September 2013, 16(3):231-232
DOI:10.4103/0971-9784.114255  PMID:23816687
  1,324 93 -
INTERESTING IMAGES
Necklace shadow in the neck after surgery
Rajinder Singh Rawat, Yatin Mehta, Naresh Trehan
July-September 2013, 16(3):223-223
DOI:10.4103/0971-9784.114259  PMID:23816681
  989 105 -
LETTERS TO EDITOR
In response to, aortic dissection: To be or not to be?
Bhupesh Kumar, Aveek Jayant
July-September 2013, 16(3):226-227
DOI:10.4103/0971-9784.114246  PMID:23816684
  938 73 -
INVITED COMMENTARY
A small step in the right direction
Praveen Kerala Varma
July-September 2013, 16(3):167-168
  895 107 2
LETTERS TO EDITOR
False diagnosis of acute Type A dissection
Praveen Kerala Varma, Madathipatt Unnikrishnan Menon
July-September 2013, 16(3):225-226
DOI:10.4103/0971-9784.114245  PMID:23816683
  899 75 -
INVITED COMMENTARY
Challenges in measuring and comparing the risk of an iatrogenic epidural hematoma
Howard Barkan
July-September 2013, 16(3):177-179
  826 91 -
LETTERS TO EDITOR
Authors' reply
Deepak K Tempe, Sanjula Virmani, Jyotsana Agarwal, Manisha Hemrajani, Subodh Satyarthi, Harpreet Singh Minhas
July-September 2013, 16(3):225-225
  829 73 -
ERRATUM
Erratum

July-September 2013, 16(3):232-232
PMID:23816688
  381 57 -