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Background: Mitral valve diseases are commonly associated with pulmonary hypertension. The aim of this study was to evaluate the effect of preoperative administration of sildenafil on the outcome after mitral valve replacement in patients with pulmonary hypertension. Methods: This prospective randomized study was carried out on 67 patients who had a mitral valve replacement and associated high systolic pulmonary artery pressure more than 50 mmHg. Patients were randomized into three groups: group A (n= 20) received preoperative sildenafil for one week, group B (n=22) received sildenafil for one month, and group C (n= 25) did not receive sildenafil. All patients had transthoracic echocardiography preoperatively, one week and one month postoperatively. Results: There was no difference in preoperative and operative variables among groups. Dobutamine support was required in 15 patients (60%) in group C vs. 6 patients (30%) in group A and 5 patients (22.5%) in group B (p= 0.012). Duration of mechanical ventilation was significantly longer in group C (389.2 ± 48.79 minutes) compared to group A and B (295.5 ± 17.01 and 281.4 ± 39.44 minutes, respectively, p

Background: Bilateral internal mammary artery (BIMA) use may improve long-term outcomes after coronary artery bypass grafting (CABG); however, the risk of infection is high. Skeletonization of the internal mammary may decrease the risk of infection, especially in patients with diabetes. Our study aimed at evaluation of sternal healing in diabetic patients with different techniques of bilateral internal mammary artery harvesting. Methods: This prospective randomized study included 200 diabetic patients who underwent CABG using BIMA between 2017 and 2019. We divided patients into two groups; Group A had skeletonization of both internal mammary arteries, and Group B had pedicled left mammary and skeletonized right mammary. Patients were observed for three months, post-operatively for any sternal wound problems. Results: There was no significant difference regarding the baseline variables. Type I diabetes mellitus was present in 25% in group A (n= 24) and 13.64% in group B (n= 12) (p= 0.324). There was no difference in harvest time between groups (83 ±4 vs. 81 ±3 minutes in group A vs. B, respectively. P= 0.1). The mean number of grafts was 3± 0.5 in Group A and 3± 0.6 in Group B (p= 0.8). Postoperative drainage was 402.9 ± 174.1 ml in Group A vs. 387.2 ± 153.6 ml in Group B (p= 0.474). The duration of ICU stay did not differ significantly between groups (2± 0.7 in Group A vs. 2± 0.5 in Group B; p= 0.8). Deep sternal wound infection occurred in 4.17% in group A (n= 4) and 4.55% in group B (n= 4) (p= 0.705). Superficial wound infection occurred in eight patients in group A (8.33%) and eight patients in group B (9.1%) (p= 0.59). No patient had sternal dehiscence in group A vs. four patients in group B (4.55%) (p= 0.39). Conclusion: We did not find differences between bilateral mammary artery harvest with skeletonization of both arteries versus skeletonization of the right mammary only on sternal healing nor wound infection in diabetic patients undergoing CABG. A larger study is recommended.

Objective The presence of a chest tube is a factor significantly associated with postoperative pain and functional limitation in patients submitted to pulmonary resection. Our aim was to study if early removal of the chest tube is the better way that can effectively release pain, and improve pulmonary functions without increasing the risk of postoperative complications. Methods A prospective observational study was carried out on 88 patients who underwent lung resection by posterolateral thoracotomy. A single chest tube was inserted. Criteria for chest tubes removal were when air leak resolved and the fluid drainage was 350 ml/day or less provided that the drained fluid was macroscopically non-chylous and non-hemorrhagic. Static and dynamic pain scores and forced expiratory volume in the first second (FEV1) were assessed 2 h before and after the chest tube removal. The pain level was assessed by the numeric rating scale (NRS). Two measurements for FEV1 were performed both before and after the chest tube removal, and the best value measured at each time was recorded and used for the analysis. Postoperative complications were reported. Results The mean static and dynamic pain scores were decreased significantly after chest tube removal. The mean value of FEV1/Liters and FEV1% of predicted also showed statistically significant improvement after chest tube removal. 8 (9%) of patients developed pleural effusion. 5 (5.7%) of patients developed pneumothorax. Empyema was reported in 3 (3.4%) of patients. Conclusion Early removal of chest tube may have beneficial effect on control of post-thoracotomy pain, improvement of pulmonary functions and decreasing the risk of complications after lung resection.

Objectives Pulmonary Tuberculosis (TB) is a disease that is often treated medically. However, medical treatment usually fails in the management of tuberculosis – related hemoptysis. In this study, we aimed to assess the role of surgery in the treatment of hemoptysis due to pulmonary TB. Methods Fifty two patients presented by hemoptysis and underwent pulmonary resection were enrolled in this study. Patients were divided into two groups according to the timing of surgical procedures: Group A (n = 22) included patients who underwent surgery within two days of presentation which was major to massive hemoptysis causing hemodynamic instability. Group B (n = 30) included patients who underwent surgery within 4 days after presentation with hemoptysis which was persistent and minor. Results There was no significant difference in the demographic data between both groups. Major and massive hemoptysis were the common presentation of group A, whereas minor hemoptysis was the main presentation in group B. Tuberculous cavities were the most common lung lesions in both groups (40.9% in group A, versus 40% in group B). Lobectomy was the main surgical procedure performed in both groups (50% in group A, versus 56.7% in group B). Regarding the complications, Bronchopleural fistula occurred in one case in each group after pneumonectomy. Recurrent hemoptysis occurred in only one case in group A. There was one case (4.5%) of mortality in group A. Conclusion Early pulmonary resection in patients with hemoptysis is an effective and safe method to insure good outcome. Limited resections are associated with higher incidence of recurrence.

Objective The aim of this study was to explore the fate of moderate ischemic mitral regurgitation (IMR) following isolated coronary artery bypass grafting (CABG). Background IMR is a frequently encountered problem seen in patients with coronary artery disease. A much-debated question is whether surgical revascularization alone will correct moderate (2+) IMR in such patients. Patients and methods The study group included 20 patients with moderate IMR associated with coronary artery disease undergoing isolated CABG. All patients had an ejection fraction of more than 30%. The patients were clinically and echocardiographically evaluated preoperatively, 1 week postoperatively and at 3- and 6-month intervals. Results CABG alone reduced the degree of IMR in 12 (60%) patients, did not improve it in five (25%) patients, and increased its degree to 3–4 + in three (15%) patients at 6-month follow-up echocardiography. Our study showed improved functional capacity of the patients. A significant reduction in the New York Heart Association functional class was observed. The mean preoperative value for New York Heart Association was 2.45 ± 0.51 versus 2.05 ± 0.88 postoperatively (P = 0.042). Some important variables showed a role in the progression of IMR. These were: left ventricular end-systolic dimension, left ventricular end-diastolic dimension, preoperative ejection fraction%, and failure to graft the diseased right coronary system. Conclusion The presence of moderate IMR in patients undergoing revascularization alone does not add additional burden to the operative risk nor does it affect the short-term outcome of these patients.

Objectives The aim of this study was to demonstrate whether transcatheter aortic valve implantation (TAVI) improves mortality and morbidity compared with surgical aortic valve replacement in high-risk patients who require intervention for aortic valve stenosis (AS). Many patients with severe AS and coexisting conditions are not candidates for surgical replacement of the aortic valve. Recently, TAVI has been suggested as a less invasive treatment for high-risk patients with AS. Patients and methods Fifty patients with severe AS for aortic valve intervention were classified as follows: group A, as TAVI group, included 25 patients who underwent aortic valve replacement by transcatheter femoral approach, and group B, as surgical aortic valve replacement group, included 25 patients who underwent aortic valve replacement by median sternotomy. Results Intraoperatively, procedure duration was 101.8 ± 10.6 and 191.2 ± 7.5 min in group A and B, respectively (P Conclusion In high-risk patients with severe AS, transcatheter and surgical procedures for aortic valve replacement were comparable for survival at 3 months, although there were important differences in periprocedural outcomes.

Objective This study aims to compare the efficacy of mitral valve surgery with left atrial maze versus isolated mitral valve surgery. Background Atrial fibrillation (AF) is the most common arrhythmia in clinical practice, especially with mitral valve disease. It represents a significant health burden especially with the associated thromboembolic complications. Several surgical approaches have been developed. The most effective one is Cox-Maze III procedure using cut-and-sew technique. Recently, surgical ablation has been transformed into an easier and faster procedure using radiofrequency, microwave, and cryothermal energy. Patients and methods This is a prospective cohort study conducted after the approval of the Human Ethics Committee of Faculty of Medicine, Menoufia University. A total of 100 patients with permanent AF and concomitant mitral valve disease have been recruited. The patients were allocated into two equal groups. Group A included mitral valve surgery and left atrial maze procedure, whereas group B included mitral valve surgery without left atrial maze. Results Group A had significant longer bypass and clamp times than group B (P Conclusion Left atrial maze with mitral valve surgery results in a better outcome in terms of myocardial function and dimensions. In addition, sinus rhythm restoration has the potential benefit of reducing the incidence of thromboembolic complications.

Objective The objective of this study was to evaluate tricuspid valve (TV) ring annuloplasty for moderate functional tricuspid regurgitation (FTR) in patients undergoing mitral valve (MV) surgery. Background TV ring annuloplasty during MV surgery for severe FTR is recommended but for moderate FTR is controversial. Patients and methods Eighty patients with moderate FTR who were listed for MV surgery were classified into group A, the TV annuloplasty group which included 34 patients who underwent MV surgery and TV annuloplasty and group B, the TV nonrepair group, 46 patients who underwent MV surgery alone. Results At 1-month follow-up, in group A: no, mild, and severe FTR were detected in 70.6, 26.5, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 26.1, 58.7, 13, and 2.9% of patients, respectively (P = 0.001). Pulmonary artery pressure (PAP) in groups A and B was 27.2 ± 5.1 and 31.7 ± 6.8 mmHg, respectively (P = 0.001). At 6-month follow-up, in group A no, mild, and severe FTR were detected in 64.7, 32.4, and 2.9% of patients, respectively, whereas in group B, no, mild, moderate, and severe FTR were detected in 32.6, 50, 15.2, and 2.2% of patients, respectively (P = 0.01). PAP in groups A and B was 27.6 ± 5.1 and 32.2 ± 7.1 mmHg, respectively (P = 0.003). Conclusion Intervention for moderate FTR is recommended during MV surgery to avoid persistence or progression of the TR especially in patients with high PAP.

Purpose To compare higher spatial resolution 3D late gadolinium enhancement (LGE) cardiovascular magnetic resonance (Cardiac MR) with 2D LGE in patients with prior myocardial infarction. Materials and Methods Fourteen patients were studied using high spatial resolution 3D LGE (1.3 × 1.3 × 5.0 mm3) and conventional 2D LGE (2 × 2 × 8 mm3) scans. The signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) were measured. Total infarct volume, peri-infarct volume measured in a limited slab, and papillary muscle scar volume were compared using Bland–Altman analysis. Image quality was graded. Results 3D LGE had higher scar SNR (P < 0.001), higher myocardial SNR (P = 0.001), higher papillary scar-blood CNR (P = 0.01), and greater sharpness (P = 0.01). The scar volumes agreed (14.5 ± 8.2 for 2D, vs. 13.2 ± 8.8 for 3D), with bias ± 2 standard deviations (SDs) of 0.5 ± 6.8 mL, P = 0.59 R = 0.91. The peri-infarct volumes correlated but less strongly than scar (P = 0.40, R = 0.77). For patients with more heterogeneous scar, larger peri-infarct volumes were measured by 3D (1.9 ± 1.1 mL for 2D vs. 2.4 ± 1.6 mL for 3D, P = 0.15, in the matched region). Papillary scar, present in 6/14 (42%) patients, was more confidently identified on 3D LGE. Conclusion Higher spatial resolution 3D LGE provides sharper images and higher SNR, but less myocardial nulling. Scar volumes agree well, with peri-infarct volumes correlating less well. 3D LGE may be superior in visualization of papillary muscle scar. J. Magn. Reson. Imaging 2009;30:794–800. © 2009 Wiley-Liss, Inc.

In this study experimental infection of mature rabbit bucks was carried out by the isolated bacteria from field cases. The gross and histopathological changes in testes in addition to semen characteristics were evaluated. Total twenty one rabbit bucks used in this experimental study were divided into 3 groups (6 in each), the groups, first, second t volume of semen /ml was decreased significantly (p‹ 0.01), concentration x 106/ml of spermatozoa and percentage of motile sperm were decreased significantly (p‹ 0.001). Percentage of dead spermatozoa, major defects %, minor defects % and acrosomal defects (semen) were increased significantly (p‹0.001). Also the acrosomal defect from epididymis was increased significantly (p‹0.01). The third group was severly affected than first and second groups. The infected rabbit bucks with Pseudomonas aeruginosa and Pasteurella multocida either single or both resulted in moderate to severe gross scrotal inflammation, which lead to damage of the testicular parenchyma with different degrees of severity. Histopathological examination revealed less intense lesions in bucks infected with Pseudomonas aeruginosa compared with those infected with Pasteurella multocida or both organisms, in which the semeniferous tubules showed excessive necrosis and progressive to complete depletion of spermatogoneal cells.

Objectives The aim of the study was to study the different types of valve-sparing aortic root reconstruction techniques to assess the short-term results with respect to improvement of patient's functional status, left ventricular dimensions and functions, and durability of competent aortic valve and to detect predictors of failure of aortic repair. Background The focus on valve-sparing operations and the concomitant re-evaluation of the functional anatomy of the aortic root have demonstrated that aortic root deformation often coexists with architecturally and morphologically normal valve leaflets. Thus, sparing and realigning the leaflets and reconstructing the aortic root have the potential for avoiding prosthetic valve disease. Materials and methods This was a prospective analytical study conducted on 50 consecutive patients with aortic root aneurysm and dissection associated with significant aortic regurgitation. These patients were operated upon using aortic valve reimplantation technique and studied for aortic valve competence. Results Follow-up echocardiography was performed within 30 days postoperative, after 6 months, 1 year, and then yearly. Moderate aortic incompetence was found in four patients (P = 0.001) at 1 year, with 100% freedom from reintervention for valve-related problems. Conclusion Valve-sparing aortic root reimplantation (Tirone-David technique) is effective in correcting aortic insufficiency due to aortic root diseases, with good results with respect to durability of aortic repair.

Objectives The aim of this study was to investigate the overall outcome of adult patients undergoing redo-mitral valve replacement as emergency cases against elective cases. Background Patients with mechanical prosthetic heart valves are at risk of reoperation. The reported risk of mortality may be as low as 5.4-11% for elective reoperation, but as high as 38-61.5% for emergency procedures. Patients and methods Forty patients who had undergone previous mitral valve replacement were admitted for redo-mitral valve replacement during the period between May 2011 and May 2013 at the National Heart Institute. They were divided into two groups: group A: 20 patients were admitted from the ER as emergency cases; group B: 20 patients were admitted from outpatient clinics as elective cases. A mechanical valve was inserted with horizontal mattress pledgeted nonabsorbable sutures. Sutures were placed from left atrium to left ventricle. Tricuspid valve incompetence, if present, was corrected by tricuspid valve repair (De-Vega suture). Results The hospital mortality was 20%. There was no effect regarding age, sex, cardiac rhythm, number of previous operations, type of the previous prosthesis, and interval from last implantation. Taking into consideration that mortality was higher in the emergency group, the New York Heart Association (NYHA) functional class, left ventricular end systolic diameter, left ventricular end diastolic diameter, redo-cardiac surgery sternotomy, and adhesiolysis carry a significant risk of catastrophic bleeding, especially with the rush accompanying hemodynamic instability. Infective cardiac tamponade, permanent pacemaker, residual infective endocarditis, the need for dialysis, and cerebrovascular accidents were not statistically significant. Conclusion When significant valve dysfunction is first noted, reoperation should be undertaken to minimize the operative risk to avoid mortality and postoperative morbidities.

Objectives The aim of this study was to evaluate surgical results in patients with moderate tricuspid regurge undergoing mitral valve surgery either with or without concomitant tricuspid repair 6 months after surgery. Background Moderate tricuspid regurge has a variable natural history, as it may regress after mitral valve surgery without tricuspid repair, or may progress; hence, the decision to repair moderate tricuspid regurge in concomitant tricuspid repair with mitral valve surgery remains controversial. Patients and methods This study was conducted from January 2010 to June 2013. A total of 50 patients underwent mitral valve replacement for the first time with concomitant moderate tricuspid valve regurge. They were divided into two groups: group A (26 patients) who underwent mitral valve replacement alone, and group B (24 patients) who underwent mitral valve replacement and tricuspid valve repair using De Vega annuloplasty technique. Results The result showed that the tricuspid regurgitation improved postoperatively, irrespective of whether the repair was performed or not. However, statistical differences between group A and group B were significant. Conclusion Concomitant tricuspid valve repair with mitral valve surgery offered better early postoperative tricuspid valve function in patients with moderate tricuspid regurge, who underwent mitral valve surgery for chronic mitral valve disease.

Objectives The aim of the study was to achieve arterial myocardial revascularization using the 'Y-graft or T-graft' techniques and to measure intraoperative graft flow by transit-time flowmetry. Background Composite grafting techniques for coronary artery bypass grafts have been widely used. However, it remains unclear whether this technique provides similar blood flow to the left coronary artery. In this study, we evaluated composite grafting techniques by intraoperative measurement graft flow by transit-time flowmetry. Materials and methods Fifty patients who underwent coronary artery bypass grafting during a time period of 24 months were enrolled in this prospective study. All patients received sequential grafting using both internal thoracic arteries and left radial artery joined as a composite Y or T graft. Intraoperative left internal mammary artery (LIMA) flow was measured by transit-time flowmetry. Results This study provided evidence that the LIMA limb of a composite Y or T graft had intraoperative increase in mean flow, and there was statistical significance ( P Conclusion LIMA has the potential to provide sufficient blood flow to revascularize left coronary system.

Objectives The goal of this study was to determine whether the surgical management of moderate chronic ischemic mitral regurgitation (IMR) is to revascularize only or to revascularize and perform mitral valve repair as well. Background Ischaemic mitral regurgitation is a frequent complication of left ventricular global or regional pathological remodeling due to chronic coronary artery disease. Although there are numerous possible treatment modalities, the management of patients with moderate chronic IMR remains uncertain. Patients and methods Forty patients referred for coronary artery bypass grafting with moderate IMR and an ejection fraction more than 30% were randomized to receive coronary revascularization plus mitral valve repair (20 patients) or revascularization only (20 patients). Survivors were clinically and echocardiographically assessed early postoperatively and at 3 months' follow-up. Results There was no significant difference between the two groups as regards preoperative and demographic data. The operative time, ventilation time, and ICU stay were significantly higher in the repair group. Use of cardiac supports, complications, in-hospital mortality, and ward stay were not statistically significantly different. Postoperative and follow-up echocardiographic data showed no statistically significant difference in left atrial dimension, left ventricular dimension, and function between the two groups. Although the grade of mitral regurgitation showed improvement in both groups, there was significantly higher improvement in the repair group compared with the revascularization-only group. Conclusion Adding mitral repair to coronary revascularization in patients with moderate IMR may improve mitral regurgitation severity without additional risk. Improvement in functional capacity and left ventricular reverse remodeling was observed in both procedures.