Mustard Surgery Three Months after A Covid-19 Infection. A Case Report

Introduction: This past year, on a global scale, since 2019, public health warnings have gone off because of the recent epidemiological crisis set of the Covid-19 pandemic. This pandemic holds responsibility for millions of infections, manifesting broadly in its clinical presentation, which ranges from asymptomatic carriers to respiratory failure, myocardial pathology and death; increasing the rates of hospitalization. Pediatric patients are at high risk of contracting the disease including those with congenital cardiomyopathy that are in need of surgical intervention in order to survive. Objective: Show that there exists an opportunity for elective surgical treatment and short term and medium term recovery in these patients in spite of respiratory and cardiovascular sequelae. Case presentation of an eleven-month infant diagnosed with Transposition of the Great Vessels, who after three months of idleness for having tested positive for Covid-19, received definitive surgical care for the initial diagnosis. Results: The perioperative strategy was based in the probable sequelae due to the infection. There are not respiratory complications like consequence for the previous lung injury. The auriculoventricular dysfunctional immediate post-operative was related with the surgical technique. Conclusion: A period no less than three months could be offer security for surgery using extracorporeal circulation in pediatric patients who suffered covid-19. Patient with favorable post-op prognosis resulting from the work of a multi-disciplinary team that met all challenges of the complications inherent in the post-operative period following a complex cardiovascular surgery along with those of a potentially fatal virus.

Conduction System Pacing: Basis and Scope

Long-term right ventricular pacing (RVP) is associated with more cardiovascular death, atrial fibrillation (AF), thromboembolic complications and heart failure(HF). RVP often results in prolonged QRS duration(QRSd) and ventricular desynchronization. The ventricular desynchronization as a result of RVP leads to an increased risk of heart failure hospitalization (HFH) and AF, and this effect is dependent on cumulative percent ventricular paced ( % VP). In the sub-study from the MOST trial, it was evident that % VP >40% was associated with a 2.6-fold increased risk of HFH compared with pacing < 40% of the time despite preserved atrioventricular synchrony. Moreover this adverse effect of RVP induced ventricular desynchrony was more pronounced in patients with left ventricular ejection fraction( LVEF) of 40% or less resulting in increased death or HFH.

Esquirol-Séguin-Down Syndrome Associated with Atrial Septal Defect plus Tricuspid Regurgitation

Background: Esquirol-Séguin-Down syndrome (Trisomy 21) was first described by Jean-Etienne Dominique Esquirol in 1838 and later by Edouard Séguin in 1846. Thereafter, in 1862, John Langdon Down, a British physician emphasized that the syndrome is a distinct form of mental retardation. Congenital cardiac defects are observed in more than one third of the patients with Esquirol-Séguin-Down syndrome, and in approximately 80% these cardiac defects are atrioventricular septal defect or ventricular septal defect with the former being more common. The association of Esquirol-Séguin-Down syndrome with atrial septal defect plus tricuspid regurgitation has been rarely reported. The aim of this paper is to report the rare association of Esquirol-Séguin-Down syndrome with atrial septal defect plus tricuspid regurgitation. Patients and methods: Two and half years old boy with Esquirol-Séguin-Down syndrome, developmental delay and abnormal echocardiography was studied, and the recent relevant literatures were reviewed. Results: Dysmorphic facial features included hypertelorism, oblique palpebral fissures, epicanthic folds, depressed nasal bridge and low set ears. Echocardiography showed atrial septal defect with tricuspid regurgitation. Conclusion: This paper reports the first case of Esquirol-Séguin-Down syndrome in Iraq associated with atrial septal defect plus tricuspid regurgitation.

Prediction of the Population at Risk of Atherothrombotic Disease: A Three Step Approach

The mainstay of the prevention of atherothrombotic disease (ATD, which is atherosclerotic disease, with emphasis on the thrombosis that so often precipitates the acute ATD event, such as acute myocardial infarction, acute cerebral infarction, aortic aneurysm, etc) is the prediction of the population at risk of ATD. There are many predictive tools, all of which use the same general risk factors, but the one favored by the author is the Bowling Green Study (BGS) graph.. This graph is based on the ATD risk factor constellations of 870 people in Bowling Green, Ohio, the county seat of Wood County, in northwest Ohio. (There is one other patient who has full lipid data and blood pressure data, but whose cigarette smoking status is not known.) The ordinate of the graph is the lipid arm and consists of the Cholesterol Retention Fraction (CRF, defined as [LDL-HDL]/LDL). HDL refers to high-density lipoprotein cholesterol and LDL refers to low-density lipoprotein cholesterol. The abscissa of the graph is the blood pressure arm, represented by the systolic blood pressure (SBP). This graph was initially developed in 1981 (using the LDL:HDL ratio) then modified in 1983 (using the CRF), and, by 1988, the author was able to generate a threshold line, which separated the main stream of ATD patients’ CRF-SBP plots from those of a few outliers. (The threshold line is not a regression line, but rather a divider, based on the principle of the fewest false negatives.) The 1988 threshold line was modified in 2000 to its present location at CRF-SBP loci (0.74, 100) and (0.49, 140). Many of the various ATD risk predictors are complex and difficult to use, whereas the graph is simple to use and based on the risk factor constellations of actual ATD patients, wherein lies its value.

Tips and Tricks in Cardiac Surgical Anesthesia

For operations including coronary artery by-pass grafting (CABG), heart valve repair or replacement, ascending aorta surgeries, heart transplantation, and surgical correction of congenital heart defects, anesthesia management shares many similar concepts

Fulminant Myocarditis: Brief Review

Fulminant myocarditis (FM) is a rare disease characterized by acute hemodynamic impairment and ventricular arrhythmias due to severe myocardial inflammation. It is typically preceded by a viral infection but any of multiple other toxic and infective agents may also be the inciting agent. Diagnosis is based on biomarkers and/or cardiac imaging, but endomyocardial biopsy is the standard test for confirming the diagnosis. FM usually requires therapeutic support of cardiac function and treatment of malignant arrhythmias. Contrary to prior concepts, recent evidence has revealed that patients with FM are more likely to die or need heart transplantation than those with the nonfulminant form of the disease. Early recognition and aggressive management are essential for favorable outcomes.

IVIG: The Heart Savior in Covid 19 era

Coronavirus disease 2019 (COVID-19) is defined as illness caused by a novel coronavirus now called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; formerly called 2019-nCoV), which was first identified as an outbreak in Wuhan City, Hubei Province, China [1]. Cases of multisystem inflammatory syndrome after Covid – 19 infection have been extensively documented in children. CDC reported 27 cases of multisystem inflammatory syndrome in adults (MIS-A) in direct reports through October 2020, as well as various case series and published case reports [2]. Cytokine storm, as a trigger of the progression of HF in patients with COVID-19, has become a novel focus to explore therapies for target populations [3]. In this article, we briefly present a case of a Covid-19 infection associated myocarditis complicated by acute heart failure successfully treated with IVIG.

Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary spasm; dramatic Oxygen reversal

Rationale: Tetany is a common, serious, well-established endocrinal and metabolic hypocalcemic disorder. Chest tetany is a novel metabolic term in hypocalcemia characterized by acute severe twisting chest pain. Movable phenomenon (Yasser’s phenomenon) is a new phenomenon that is usually associated with hypocalcemia. oxygenation may have a role in the management of coronary artery spasm. Patient concerns: A middle-aged farmer smoker male patient presented to physician outpatient clinic with tetany, mimic high lateral myocardial infarction, mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Diagnosis: Mimic high lateral myocardial infarction in chest tetany with mirror electrocardiographic change, Movable phenomenon (Yasser’s phenomenon), and coronary artery spasm. Interventions: Electrocardiography, oxygenation, IV calcium injection, and echocardiography. Outcomes: Acute dramatic clinical and electrocardiographic improvement had happened. Lessons: The reversal of mirror electrocardiographic change, reversal of ST-segment depression coronary artery spasm, and normalization of Movable phenomenon (Yasser’s phenomenon) after oxygenation. It signifies the role of oxygen in both coronary artery spasm and tetany. Mirror local electrocardiographic change is a novel described expression that may reflect the myocardial polarity in this chest tetany.

Description of the Mechanism of Positive Inotropic Action of the Isoquinoline Alkaloid F-18

This study evaluated the mechanism of inotropic effect of an isoquinoline alkaloid derivative, 1-(2´-bromine-4´,5´-dimethoxyphenyl)-6,7-dimethoxy-1,2,3,4- tetrahydroisoquinoline (F-18) using electrically stimulated rat left ventricular papillary muscle of rat. The F-18 alkaloid have been shown to have positive inotropic effect on papillary muscle contraction activity, IC50 value -14,6 µM. Са2+L-channel blocker - nifedipine was used in experiments. Inotropic effects of F-18 isoquinoline alkaloid on cardiomyocytes were suggested, based on results obtained in experiments carried in cardiomyocytes SR Ca2+- transport systems modulation.

Glycated Hemoglobin in the Pre and Diabetes Ranges as Related to Lipid Cardiovascular Risk

The concomitance of diabetes metabolic markers, as Glycated Hemoglobin and blood glucose, together with lipid changes; Cholesterol and fractions and Triglycerides, occurs very frequently but not always in the same pairs of markers, being its peculiarities important factors for the estimation of the cardiovascular risk. Not only has the association of high glucose levels and high triglycerides pointed to an augmented risk. The study of the correlations of the parameter Glycated Hemoglobin with all the values of the lipid profile may help gain a broader insight as to the associated risks. A database of 548 individuals with concomitant results of HbA1C, triglycerides, CT and HDL-c were applied statistical tests of ANOVA and Tukey. Most of the 546 individuals tested for glycated hemoglobin (HbA1C) and lipid profile had HbA1C levels within normal range (49.8%), 15.4% were classified as prediabetic, and 34.8% had HbA1C levels above 6.4% (diabetics). The overall mean HbA1C observed was 6.3%, and triglycerides was 236.8 mg/dL. Data from HbA1C-lipid profile comparations are not superimposed, as expected, to the combinations of fasting glucose and triglycerides. In not accompanying lipids concomitantly with HbA1C, the correct assessment of the overall risk calculation for atherosclerosis can be omitted. In conclusion, HbA1C levels should be added to the lipid profile for a more accurate estimation of the cardiovascular risk.