The Incidence and Clinical Outcome of Cardiac Tamponade Following an Open Heart Surgery in a Developing Country

Introduction: Pericardial effusion is not uncommon following an open heart surgery, thus, it may progress to cardiac tamponade. This is a retrospective cross-sectional analysis evaluates the incidence, the potential perioperative and surgical risk factors causing cardiac tamponade following an open-heart surgery of patients during the period 2001-2006 at Ahmed Gasim Cardiac Center in Khartoum, North Sudan. Methods: Diagnosis of cardiac tamponade was based on clinical and echocardiographic findings. Univariate analysis was performed to assess possible risk factors related to both, early and late cardiac tamponade. Results: Among the 890 patients who underwent open heart surgery in this study, 47(5%) patients developed tamponade (early 49% or 51%). Early cardiac tamponade was found to be present with significant cardiac compromise and can easily be detected using echocardiography. In contrast the presentation of late cardiac tamponade, atypical and echocardiography was inconclusive. The mean age of patients was 31 ± 12 with slight female predominance. The main indication for the operation was rheumatic heart disease (89%), mainly mechanical valve replacement of the mitral valve. Eight (17%) patients were receiving warfarin preoperatively. Oozing wounds and blocked drains were encountered in 27% and 37%, respectively. About 6% of the patients recollect tamponade after decompression and one in-hospital death directly related to the cardiac tamponade. Conclusion: Significant cardiac tamponade was associated with preexisting rheumatic heart disease, (preoperative warfarin use), mechanical valve replacement in the mitral position, oozing wounds and blocked drain. Echocardiography was reliable in early diagnosis, but not late, hemodynamically significant cardiac tamponade.

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Giant Left Atrium in Triple Rheumatic Heart Disease

International Cardiovascular Forum Journal ◽

10.17987/icfj.v13i0.498 ◽

2018 ◽

Vol 13 ◽

Author(s):

Gëzim Berisha ◽

Edmond Haliti ◽

Gani Bajraktari

Keyword(s):

Pulmonary Hypertension ◽

Heart Disease ◽

Mitral Valve ◽

Left Atrium ◽

Rheumatic Heart Disease ◽

Heart Surgery ◽

Open Heart Surgery ◽

Heart Team ◽

Giant Left Atrium ◽

Rheumatic Heart

The giant left atrium (GLA) is a rare condition, commonly associated with rheumatic mitral valve disease, and very rarely with non rheumatic heart disease (nRHD). The triple valvular heart disease with involved mitral, aortic and tricuspid valves is quite uncommon. A 47 year female patient with a past medical history of rheumatic heart disease (RHD) and known severe mitral stenosis was with severe breathlessness (NYHA class IV). She had undergone mitral valve commissurotomy and tricuspid valve annuloplasty 12 years previously. Transthoracic echocardiography revealed a giant left atrium, moderate to severe mitral valve restenosis, severe mitral regurgitation, moderate aortic regurgitation and severe tricuspid regurgitation, associated with severe secondary pulmonary hypertension and a markedly dilated right heart chambers. The patient was considered inoperable by the heart team, because of advanced pulmonary hypertension predicting a very high risk for open heart surgery. The final treatment decision was a difficult and complex issue.

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III-1-10 Open heart surgery of acquired heart disease in patients with risk factors, referring to preoperative renal dysfunction

Japanese Journal of Cardiovascular Surgery ◽

10.4326/jjcvs.9.197 ◽

1979 ◽

Vol 9 (3) ◽

pp. 197-199

Author(s):

K. Nakada

Keyword(s):

Risk Factors ◽

Heart Disease ◽

Renal Dysfunction ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Acquired Heart Disease

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Short-term outcome after open-heart surgery for severe chronic rheumatic heart disease in a low-income country, with comparison with an historical control group: an observational study

Open Heart ◽

10.1136/openhrt-2021-001706 ◽

2021 ◽

Vol 8 (2) ◽

pp. e001706

Author(s):

Ståle Wågen Hauge ◽

Havard Dalen ◽

Mette E Estensen ◽

Robert Matongo Persson ◽

Sintayehu Abebe ◽

...

Keyword(s):

Cardiac Surgery ◽

Heart Disease ◽

Low Income ◽

Heart Surgery ◽

Open Heart Surgery ◽

Control Group ◽

First Year ◽

Open Heart ◽

Surgical Group ◽

Rheumatic Heart

ObjectivesRheumatic heart disease (RHD) is a major burden in low-income and middle-income countries (LMICs). Cardiac surgery is the only curative treatment. Little is known about patients with severe chronic RHD operated in LMICs, and challenges regarding postoperative follow-up are an important issue. At Tikur Anbessa Specialised Hospital, Addis Ababa, Ethiopia, we aimed to evaluate the course and 12-month outcome of patients with severe chronic RHD who received open-heart surgery, as compared with the natural course of controls waiting for surgery and undergoing only medical treatment.MethodsClinical data and outcome measures were registered in 46 patients operated during five missions from March 2016 to November 2019, and compared with the first-year course in a cohort of 49 controls from the same hospital’s waiting list for surgery. Adverse events were death or complications such as stroke, other thromboembolic events, bleeding, hospitalisation for heart failure and infectious endocarditis.ResultsSurvival at 12 months was 89% and survival free from complications was 80% in the surgical group. Despite undergoing open-heart surgery, with its inherent risks, outcome measures of the surgical group were non-inferior to the natural course of the control group in the first year after inclusion on the waiting list (p≥0.45). All except six surgical patients were in New York Heart Association class I after 12 months and 84% had resumed working.ConclusionsCardiac surgery for severe chronic RHD is feasible in LMICs if the service is structured and planned. Rates of survival and survival free from complications were similar to those of controls at 12 months. Functional level and resumption of work were high in the surgical group. Whether the patients who underwent cardiac surgery will have better long-term prognosis, in line with what is known in high-income countries, needs to be evaluated in future studies.

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P1798Assessing attitudes and knowledge of infective endocarditis in adult survivors of congenital heart disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0550 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Krishanthasan ◽

S Haider ◽

A Khokhar ◽

K Dimopoulos ◽

I Rafiq

Keyword(s):

Risk Factors ◽

Congenital Heart Disease ◽

Heart Disease ◽

Infective Endocarditis ◽

Antibiotic Treatment ◽

Congenital Heart ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Significant Morbidity

Abstract Background Adults with congenital heart disease (ACHD) have an increased risk of infective endocarditis (IE), which is associated with significant morbidity and mortality. This risk is further compounded by patient-related factors such as education and awareness of IE. The onus of patient education falls on both patient and physician, and is paramount to successful outcomes. Our study sought to evaluate patients' understanding of the risks, preventative measures and symptoms of IE, and to identify high-risk ACHD patients who would benefit from targeted education. Methods A cross-sectional study was conducted using a pre-tested questionnaire to assess knowledge of and attitudes towards IE. Patients attending the outpatient department of a tertiary referral centre completed the questionnaires independently. Baseline demographics and clinical data were collected from electronic patient records. Results 132 questionnaires were completed (median age 38 years, 50% male). 106 patients (80%) had previous surgical or percutaneous interventions and 7 patients (5%) had suffered with infective endocarditis in the past. 37% were able to accurately define IE. Out of a range of symptoms, most patients chose temperature (47%) and tiredness (39%) as classical symptoms of IE, however none correctly identified all listed symptoms as potential signs of IE. The majority of patients knew tooth abscess (58%) and body piercings (50%) were risk factors for IE. A fifth of patients (20%) were failing to have annual dental check-ups. 22% thought that IE would only require a few days stay as an inpatient and only 20% of patients were aware of the requirement for prolonged antibiotic treatment and the majority (63%) were unaware of the potential need for open heart surgery. 1 in 4 patients could recall having received information regarding IE. A third of patients reported that they would have made lifestyle changes had they known that IE required prolonged intravenous antibiotic treatment and could result in open heart surgery and death. Discussion Our study highlights key issues in the management of ACHD. Moving forward with the continuously growing population of patients we need to focus on the multi-disciplinary approach including specialist clinical nurses and increasing awareness online and through meetings and patient days as well as the importance of transition services as paediatric patients move across to adult specialists. General physcians will also encounter ACHD, therefore it is important to ensure awareness is widespread in the form online platforms and leaflets. We must also acknowledge the impact of guidelines and ensure there is still a significant focus on IE within them. To conclude, despite the significant morbidity and mortality associated with IE in ACHD, patient awareness of symptoms, risk factors and consequences is limited. Promotion of IE awareness is a cost-effective intervention, which can reduce the incidence and complications of IE.

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