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Background: Ventricular septal defect (VSD), accounts for up to 40% of all cardiac malformations. Defects that are present alone or in conjunction with other congenital cardiac abnormalities can be diagnosed. The conduction system, particularly the bundle of his and its branches, is susceptible to harm when the individual sutures are inserted. A permanent pacemaker is typically needed if a heart block occurs during or after therapy. Objective: we aimed to evaluate the incidence of conductive disorders after surgical VSD closure. Patients and Methods: A prospective observational study was conducted on 100 patients < 18 years with VSD from 2019 to 2021 at the Cardiothoracic Surgery Department of Cairo University Hospitals and Atfal Masr children's hospital. They had a clinical diagnosis of VSD and are referred for elective surgical VSD closure either including isolated VSD or combined with other intracardiac lesions. Results: The peri-membranous defect was the most common type and most VSD lesions were of moderate diameter. The mean ICU stay was 2.91 days. Abnormal rhythm occurred in 12 patients (12%). The most common conductive disturbance that occurred was incomplete right bundle branch block (RBBB) (6%), but complete heart block (CHB) occur in 1% which need a permanent pacemaker, bleeding happened in 2 (2%) patients and one patient died. Regarding the comparison between populations with post-operative normal rhythm and conductive disturbance, there was a significant difference in VSD types and diameter. Conductive disorder in surgical VSD closure was mostly associated with a larger diameter, Peri-membranous, and doubly committed VSD. Conclusion: VSD repair is considered to be a safe procedure with a very low mortality rate. In this study, we found out that large VSD was the most associated risk factor for conductive disturbance occurrence in VSD patients. [ABSTRACT FROM AUTHOR]

Background: Although mitral annuloplasty is an essential component of mitral repair, there remains little agreement on the ideal device to be used or the ideal sizing method. Objectives: The purpose of this study was to report the early clinical and echocardiographic outcomes of patients undergoing repair for degenerative mitral regurgitation using a homemade single-sized (65 mm) Polytetrafluoroethylene band, and comparing it to the use of commercially available complete rigid rings. Patients and methods: This is a retrospective study including 106 patients, who underwent mitral repair for degenerative mitral regurgitation at Cairo University Hospitals between February 2013 and July 2019. These patients were divided into 2 groups. Group (A) included 69 patients who underwent repair with a single-sized band, and group (B) included 37 patients whose repair included the use of a commercial rigid ring. The primary endpoint was freedom from significant mitral regurgitation at one-year follow-up. Secondary endpoints included mean mitral valve gradient measured postoperatively, and freedom from reoperation at one year. Results: There was no statistically significant difference between both groups in any of the above-mentioned endpoints being examined. Conclusion: The use of a single-sized Polytetrafluoroethylene band for annuloplasty in degenerative mitral disease showed satisfactory results comparable to the commercial rigid rings. Further studies with longer follow-up are needed to confirm the durability of mitral repair using this technique. [ABSTRACT FROM AUTHOR]

Background: The use of Custodiol cardioplegia solution may be tempting in cases undergoing long open-heart surgical procedures, given its single dose administration, which offers myocardial protection for a long period. Objective: The aim of the current study is to report our initial experience with the use of Custodial cardioplegia in patients undergoing triple valve surgery, and comparing it with our routinely used cold blood cardioplegia. Patients and Methods: A retrospective observational study including 79 consecutive patients who underwent first-time triple valve surgery in the period between April 2018 and May 2020. Patients were divided into two groups. Group (A) included 31 patients where Custodiol cardioplegia was used, and Group (B) included 48 patients where cold blood cardioplegia was used. The primary endpoint was in-hospital mortality. Secondary endpoints included postoperative levels of CK-Mb, the need for inotropes and the incidence of ventricular fibrillation on aortic declamping. Results: Apart from a higher incidence of ventricular fibrillation on aortic declamping, there was no statistically significant difference between groups in any of the endpoints examined. Conclusion: Custodiol cardioplegia is a safe option for myocardial protection in patients undergoing triple valve surgery. The added cost and the concerns about its efficacy in patients with impaired ventricular function reported by other authors should be borne in mind while considering its use. [ABSTRACT FROM AUTHOR]

Background: Establishing a definite diagnosis in cases of pleural effusion is sometimes challenging. Adding ultrasound-guided tru-cut biopsy at the time of obtaining pleural fluid for analysis may increase the diagnostic yield in such cases. Objective: The aim of the current work was to assess the diagnostic yield and the safety of percutaneous ultrasound guided tru-cut needle biopsy in patients with recurrent undiagnosed pleural effusion. Patients and Methods: A retrospective observational study including 45 patients with recurrent undiagnosed pleural effusion who underwent ultrasound-guided tru-cut needle biopsy in the period between January 2019 and October 2020. Results: By using ultrasound-guided needle biopsy, we were able to reach a final histopathological diagnosis in 40 patients with a diagnostic yield of 88.8%. Only 5 cases remained undiagnosed (11.1%). Mesothelioma was found in 13 cases (28.9%) and bronchogenic carcinoma in 7 cases (15.5%). Post-procedural complications included 1 case of pneumothorax (2.2%) and 1 case of hemothorax (2.2%) all resolving with the small caliber chest drain that was inserted at the conclusion of the procedure. Conclusion: It could be concluded that ultrasound-guided needle biopsy is a safe procedure that can be useful in establishing a diagnosis in patients with recurrent pleural effusion. Its high diagnostic yield, while being simpler and cheaper than CT guided biopsy or thoracoscopy, makes it a suitable option in our clinical settings. More studies are needed to validate our findings. [ABSTRACT FROM AUTHOR]

Background: Liver cirrhosis is known to be associated with increased morbidity and mortality in patients undergoing cardiac surgery. Objective: The purpose of this study was to evaluate the early outcomes of cardiac surgery in patients with liver cirrhosis in our settings, and to assess the performance of the Child-Pugh classification as a predictor of early mortality. Patients and Methods: A retrospective observational study included 58 patients operated between March 2012 and October 2019. Among these 52 patients required open-heart procedures and 6 were operated without the use of cardiopulmonary bypass. The primary endpoint being examined was early mortality. Results: The overall mortality was 20.7%. Higher Child-Pugh (CP) class was associated with marked rise in mortality. The mortality rate increased from 10.8% patients in class A of the Child-Pugh, to 25% in class B patients to 80% in class C patients. The need for urgent or emergent procedures was also found to be associated with an increased risk of mortality. Conclusion: Early results of cardiac surgery in Child-Pugh class A patients although apparently higher than the general population, remain acceptable. The mortality in patients with CP class C is extremely high and almost prohibitive. Non-elective procedures also seemed to be associated with a significant increase in early mortality. This should be borne in mind while assessing surgical risk in cirrhotic patients. [ABSTRACT FROM AUTHOR]

Background: Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. Objectives: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on the treatment of patients with abnormal uterine bleeding. Patients and Methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital. Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old. Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixtyone women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant-E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who had endometrial sampling demonstrated progestational effect on histo-pathological examination. Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathological levels. [ABSTRACT FROM AUTHOR]

Background: Dysfunctional uterine bleeding (DUB) is one of the commonest condition for which patient seeks out medical consultation. The prevalence increases with the increase of age peaking before menopause. Objective: The aim of this work is to evaluate the effect of this new form of levonorgestrel-releasing IUD on the treatment of patients with abnormal uterine bleeding. Subjects and methods: A prospective age-specific comparative analysis of 61 peri-menopausal women presented with dysfunctional uterine bleeding who constituted the study group. They underwent hysteroscopy and endometrial sampling during an 18 months period from June 2014 to January 2016 at Ain Shams University Materity Hospital. Prior to metraplant-E application, all the patients in this study were in the age of 25-58 years old. Results: The role of Metraplant-E in the treatment of abnormal uterine bleeding (AUB) was evaluated. Sixty-one women with failed attempt(s) of medical treatment unwilling or unfit for hysterectomy were treated with Metaplant- E. Menstrual blood loss was assessed by pictoral bleeding assessment chart (PBAC), bleeding index (B.I) and total bleeding score (T.B.S/month). The bleeding patterns in the form of the mean menstrual blood loss estimated by bleeding index and the mean menstrual loss estimated by the total bleeding score/month and PBAC decreased significantly (p = 0.001). The quality of life scale (Likert scale) improved significantly (p = 0.001). All 15 cases who had endometrial sampling demonstrated progestational effect on histo-pathological examination. Conclusion: Metraplant-E was found to be effective in managing dysfunctional menorrhagia on both clinical and histopathological levels. [ABSTRACT FROM AUTHOR]

Background: Induction of labour is common in clinical practice and is usually troublesome in primigravidas. Obestatricians are always in search of the best method of induction to ensure the best maternal and fetal outcome. Objectives: to evaluate the effect of dexamethasone on labor outcome and to establish whether dexamethasone plays a role in shorting of the duration interval between initiation of labor induction and beginning of the active phase of labor in primigravida late-term pregnancy. Patients and methods: Case control study included 120 primigravidae with late-term pregnancy classified into two groups: group I (cases) included 60 women assigned to receive a single 8-mg dose of dexamethasone intra-muscular and group II (control) included 60 women will not receive dexamethasone or any other cervical ripening agent. Results: The interval between initiation of labor induction and beginning of active phase of labor was shorter in the dexamethasone group than in the control group (2.54 ± 0.94 hours vs. 3.59 ± 0.86 hours; p=0.001). Dexamethasone group showed shorter duration of active phase of labor than control group (4.82 ± 0.56 hrs. vs. 5.12 ± 0.58 hrs.). Dexamethasone group showed shorter duration of first stage of labor than control group (7.35 ± 1.15 hrs. vs. 8.69 ± 1.09 hrs.). Dexamethasone group showed faster rate of cervical dilatation than control group (1.37 ± 0.18 cm/hr. vs. 1.28 ± 0.17 cm/hr.). Dexamethasone group showed shorter duration of second stage of labor than control group (25.09 ± 12.99 minutes vs. 30.73 ± 12.96 minutes). Conclusions: The administration of dexamethasone shortened labor duration with no significant difference between the two groups involving the duration of the third stage of labour, the neonatal outcome (meconium stained liquor, Apgar score at 1 minute and 5 minute birth weight, neonatal admission to neonatal intensive care unit and number of cases with fetal heart rate disturbance) and maternal complication. [ABSTRACT FROM AUTHOR]