A Comparative Study between Radiocephalic and Brachiocephalic Arteriovenous Fistula in End Stage Renal Disease

Background: Chronic Kidney Disease (CKD) is a major health issue all over the world. Patients with deteriorating renal function and end-stage renal disease require vascular access for hemodialysis. Studies suggest that Arterio-Venous fistula (AVF) constructed judiciously using autologous conduit give the best outcome in this regard. Objective of the study was to compare the outcomes of Radiocephalic and Brachiocephalic AVF in end stage renal disease (ESRD). Methods: It was a quasi-experimental study carried out at the Department of Vascular Surgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The study was conducted from June 2019 to May 2020. Patients suffering from ESRD underwent AVF creation surgery for hemodialysis access. A total of 60 (Sixty) patients were included in this study. The patients were divided into two groups; Group I included 30 patients who underwent Radiocephalic AVF operation and Group II included 30 patients who had Brachiocephalic AVF operation. Results: In Group I, (Radiocephalic AVF) 60% were male and 40% were female. On the other hand, in Group II (Brachiocephalic AVF) 73.3% were male and 26.7% were female. Calculated volume flow (Q max) was significantly higher in Group II compared with Group I (769.11±101.54 ml/min vs 626.37±55.81) ml/min) with the difference being statistically significant (P=0.001). Maturation time was significantly less in Group II compared with Group I )37.78±1.93 vs 43.33±2.12 days) with the difference between the two group being statistically significant (P=0.001). Complication was more in Group I than Group II (16.7% vs 3.3%). Conclusion: The present study shows that Brachiocephalic AVF gives significantly better outcome in terms of shorter maturation time and less complications compared with Radio-Cephalic AVF. Color Doppler study is an essential tool for preoperative vessel evaluation which guides the selection of suitable AVF construction site. Cardiovasc j 2021; 14(1): 44-49

Heart Failure: Insights into Device Therapy

not available Cardiovasc j 2021; 14(1): 1-3

Vascular Duplex Study: A Historical Perspective

Ultrasound is a key investigating tool aiding diagnosis and treatment in the day-to-day medical practice nowadays. Like any other invention, ultrasound technology also has a long history strewn with successes and setbacks. From its modest beginning, it has come a long way to be applied not only in medical science but also in many other areas including navigation and warfare. Scientistsengineers, physicists, mathematicians, biomedical engineers and physicians worked relentlessly over centuries to bring about developments in the field of ultrasound technology as a whole. Medical ultrasound has a relatively recent history that has seen great dedication and commitment from researchers to achieve the degree of finesse we see today. The present article looks back on the historical aspects of ultrasound technology with a focus on medical ultrasound. Cardiovasc j 2021; 14(1): 55-60

Experience of Minimal Invasive Cardiac Surgery for repair of Atrial Septal Defects- A Single Center Study

Background: Atrial Septal Defects (ASD) can be closed surgically using conventional midline sternotomy or minimal invasive technique. This study was done to evaluate the outcome and safety of the minimal invasive cardiac surgical (MICS) approach using right vertical infra axillary incision (RVAI) for the repair of ASD. Methods: We performed a prospective observational cross-sectional analysis on 50 patients who were diagnosed as ASD of various types and not amenable to device closure. Their surgery was done RVAI using central cardiopulmonary bypass. Outcome of the study was evaluated using the following variables: length of the incision, satisfaction of patients, mortality, infection of surgical site, blood transfusion, duration of total operation, intensive care unit (ICU) stay, mechanical ventilation, hospital stay and aortic occlusion. Operations were done between December 2013 to December 2020. All the recruited patients were treated through RVAI as per patient’s choice. Results: Mean age was 11.4± 6.4 years. 18(36%) were male and 32(64%) were female. Body weight ranged from 10 to 65 kg. Mean length of incision was 6.2±0.8 cm. Mean aortic occlusion time was 42±14 min. ASD closed directly, using autologous treated pericardial patch or dacron patch. Mean total operation time was 4.08±0.6 hours and mean mechanical ventilation time was 8.3±5 hours. Average ICU stay was 35.6±6 hours and total hospital stay was 7.2±0.9 days. There was no significant blood loss. Only 10 patients required intravenous (IV) analgesics in the post-operative period. One patient required re-exploration, one conversion to median sternotomy and one suffered from superficial skin infection. There were no operative or late mortalities. Patient satisfaction was excellent. Conclusions: MICS technique using RVAI for surgical repair of ASD revealed a safe procedure and could be performed with excellent cosmetic and clinical outcomes. It provided a good alternative to the standard median sternotomy. Cardiovasc j 2021; 14(1): 37-43

Huge Left Atrial Aneurysm: First Case Report in Bangladesh

The left atrial aneurysm (LAA) is an extremely rare congenital malformation of the heart. It can be caused by congenital dysplasia of atrial muscle. It may result secondarily from severe mitral valvular disease. This is the first ever case of left atrial aneurysm in an 8 months old child of Bangladesh who was treated successfully and now leading a normal life after surgical resection. Cardiovasc j 2021; 14(1): 70-72

In Hospital Outcome of Mitral Valve Replacement with Severe Pulmonary Hypertension

Background: In patients undergoing surgery for mitral valve replacement (MVR) for valvular heart disease, pulmonary artery hypertension (PAH) has been considered a major risk factor. In this prospective study, we have studied the early hemodynamic changes and post-operative outcomes of MVR among patients with mild to severe PAH in Bangladesh perspective. Methods: Total 60 patients who underwent mitral valve replacement for predominantly mitral regurgitation (MR) and mixed lesion with mitral stenosis (MS) having pulmonary arterial hypertension ranging from mild to severe pulmonary artery pressure (PAP) were studied prospectively for immediate postoperative haemodynamic and outcome. The mean age of the patients was 36.23±9.18 years. Total 13 (21.66%) patients had mitral regurgitation and 47 (78.33%) had mixed lesion with mitral stenosis. Patients were divided into two groups based on preoperative pulmonary artery pressures. Group A patients with mild to moderate pulmonary hypertension (PASP 40-59 mm of Hg) and Group B patients with severe pulmonary hypertension (PASPe” 60 mm of Hg). Results: After mitral valve replacement, pulmonary arterial systolic pressure (PASP) decreased significantly in Group A to near normal levels (PASP41.25±7.25). In Group B also the PASP decreased insignificantly (PASP 61.85±9.12) but significant residual PAH remained. Operative mortality was nil (0%) in Group A and 6.7% in Group B. Conclusions: Mitral valve replacement is safe and effective at the presence of PAH as long as the PASP is below or equal to 60 mm of Hg. With PASP >60 mm of Hg, MVR carries a high risk of mortality and the patients continues to have severe PAH in the postoperative period. Cardiovasc j 2021; 14(1): 30-36

Echocardiographic Profile of Hypertrophic Cardiomyopathy – A Single-Centre, Observational study

Background: Hypertrophic cardiomyopathy (HCM) is an autosomal dominant disease of left ventricular hypertrophy (LVH). Phenotypic expression varies widely from subclinical hypertrophy to gross asymmetric septal hypertrophy causing left ventricular outflow tract (LVOT) obstruction. On top of genetic and phenotypic heterogeneity, the prevalence of different types of HCM may have geographical, as well as, ethnic variation. Methods: This observational study was carried out during 2010 to 2020 to determine the echocardiographic profile of HCM in Bangladeshi population. All patients undergoing transthoracic echocardiography (TTE) in a private consultation centre of Dhaka, Bangladesh were included. HCM was defined as the presence of a maximal end-diastolic wall thickness of e”15 mm anywhere in the left ventricle (LV), in the absence of another cause of hypertrophy in adults. HCM was further classified according to the pattern of myocardial hypertrophy and presence or absence of LVOT, or mid-left ventricular cavity obstruction. Results: Out of 76 cases, non-obstructive HCM was the commonest type (65.8%), followed by HCM causing LVOT obstruction (13.2%), HCM causing mid-LV cavity obstruction (10.5%), and the apical variety ( 10.5%). Asymmetric septal hypertrophy (ASH) was found in 42.1%, systolic anterior motion (SAM) of anterior mitral leaflet (AML) in 14.5%, mitral regurgitation (MR) in 50%, left ventricular systolic dysfunction in 5.3%, and raised pulmonary artery systolic pressure (PASP) in 15.8% of cases. Maximum LV wall thickness ≥30 mm was found in 66 out of 76 cases. Conclusion: The study highlights the clinically useful profile of HCM in Bangladeshi population based on conventional echocardiography. Further studies involving clinical, newer echocardiographic modalities and genetic analyses are warranted to discover the additional information in this ethnicity. Cardiovasc j 2021; 14(1): 5-11

Fatema’s Basic Paediatric Cardiology, 2nd Edition

not available Cardiovasc j 2021; 14(1): 97-99

Mycobacterium Endocarditis- A Case Report

Mycobacterium Endocarditis is a very rare case. A 5 years old boy presented us with the history of fever and breathlessness. CXR shows huge cardiomegaly, patient is anemic and temperature is raised. On echo revels vegetation on Tricuspid &Mitral valve ç huge pericardial effusion ç features of early tamponade. Pericardial fluid was drawn and the symptoms improved. Pericardial fluid colour was milky and exudative in nature. ADA for mycobacterium tuberculosis was positive. The patient was given anti tuberculosis drug & improved with time. Cardiovasc j 2021; 14(1): 76-78

Socio-demographic and Clinical Profile of Bangladeshi COVID 19 Patients with their Clinical Outcome in National Institute of Cardiovascular Diseases, Dhaka

Background: The novel corona virus (COVID 19) pandemic is a major global health threat of the twenty-first century. Clinical presentation, rapid identification of causes and isolation are vital for containments of rapidly spreading disease. The objective of the study was to report early findings on demographic profile, clinical presentation of the confirmed COVID 19 patients with their clinical outcome. Methods: This observational study was conducted in Microbiology Department of National Institute of Cardiovascular Diseases (NICVD) for the period of October 01, 2020 to November 30, 2020. Total 300 positive COVID 19 patients were included and interviewed. Informed written consent was ensured before participation. After collection, Data were analyzed to show the characteristics of COVID 19 cases and their clinical outcome after treatment. Results: Among the 300 cases 228 (76%) patients were male and 72 (24%) patients were female. Average age of the patients was 39 years. The most commonly observed symptoms were fever (70%), followed by cough (55%), breathlessness (42%), dysgeusia (38%), anosmia (25%). Respiratory symptom was the dominant feature of clinical presentation. The most prevalent affected age groups were 114 (38%) patients in 41-50 years age, 102 (34%) patients in 31- 40 years age. Among the total cases 255 (85%) patients were Urban residents and 234 (78%) had contact history. Among 300 patients 102 (34%) patients had co-morbidities and presence of co-morbidities (p<0.01) were significantly associated with mortality. The death rate was 2%. Conclusion: Typical presentations of COVID-19 were fever, cough, breathlessness, dysgeusia and anosmia. Requirement of ICU was 6% and overall mortality was 2% which was associated with comorbidities. Cardiovasc j 2021; 14(1): 50-54