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Helal AM, Mashali MH, Elmahrouk AF, Galal MO, Jamjoom AA, Kouatli AA. Right ventricle to pulmonary artery conduit: a comparison of long-term graft-related events between bovine jugular vein conduit, aortic homograft, and porcine-valved conduits. Cardiovasc Diagn Ther 2024; 14:109-117. [PMID: 38434570 PMCID: PMC10904299 DOI: 10.21037/cdt-23-364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 12/04/2023] [Indexed: 03/05/2024]
Abstract
Background The optimal conduit for right ventricle to pulmonary artery (RV-PA) reconstruction does not exist. Reinterventions are common due to conduit stenosis and endocarditis. Tailoring conduit choice according to patients' characteristics could improve the outcomes. The study aimed to compare graft-related events (infective endocarditis, transcatheter pulmonary valve replacement (PVR), transcatheter conduit dilatation, surgical conduit replacement, and transcatheter pulmonary branch intervention for RV-PA reconstruction using bovine jugular vein, aortic homograft, and porcine-valved conduits. Methods In a retrospective cohort study, 155 patients with 193 procedures that were done in King Faisal Specialist Hospital and Research Center-Jeddah (KFSHRC JED) for implanting RV-PA conduits from 1999 to 2021 were included. The patients were grouped according to the type of conduit into 3 groups; Group 1 (n=153) received bovine jugular vein (BJVs) grafts, Group 2 (n=29) received aortic homografts, Group 3 (n=11) received porcine-valved conduits. Factors associated with graft-related events were evaluated using stepwise Cox regression analysis. Results Patients with BJVs were significantly younger than those with porcine-valved conduits 3 (P=0.009). The weight of BJVs patients was significantly lower than homografts (P=0.002) and porcine-valved conduits patients 3 (P<0.001). The conduit size was as expected significantly lower in BJVs patients than patients who received porcine-valved conduits (P<0.001) and patients who received aortic homografts (P<0.001). There was no difference between Group 2 and 3 (P=0.084). Operative mortality occurred in 13 patients: 12 (7.84%) with BJV conduit and 1 (9.09%) with porcine valved conduit (P=0.351). Male gender [odds ratio (OR): 10.04; 95% confidence interval (CI): 1.28-78.86; P=0.028] and smaller conduit size (OR: 0.78; 95% CI: 0.61-0.99; P=0.048) were associated with increased operative mortality. Freedom from graft-related events at 5 and 10 years was 67% and 52% in BJVs patients, 74% and 36% in patients who received aortic homografts, and 53% in patients who received porcine-valved conduits. Factors associated with increased graft-related events were male gender (HR: 1.58; 95% CI: 1.004-2.50, P=0.048) and younger age (HR: 0.995; 95% CI: 0.991-0.999, P=0.041). Conclusions RV-PA reconstruction was associated with low mortality, unrelated to the conduit type. Reinterventions for graft-related events were common. The durability and graft-related events might be comparable among BJV grafts, aortic homografts, and porcine-valved conduits. Factors associated with increased graft-related events in this study were male gender and younger age.
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Affiliation(s)
- Abdelmonem M. Helal
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Mohamed H. Mashali
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Ahmed F. Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Mohammed O. Galal
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A. Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Amjad A. Kouatli
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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Abdelmohsen GA, Gabel HA, Alamri RM, Baamer A, Al-Radi OO, Binyamin A, Jamjoom AA, Elmahrouk AF, Bahaidarah SA, Alkhushi NA, Abdelsalam MH, Ibrahim H, Elakaby AR, Khawaji A, Alghobaishi A, Maghrabi KA, Zaher ZF, Al-Ata JA, Azhar AS, Dohain AM. Bidirectional glenn surgery without palliative pulmonary artery banding in univentricular heart with unrestricted pulmonary flow. Retrospective multicenter experience. J Cardiothorac Surg 2024; 19:67. [PMID: 38321557 PMCID: PMC10845678 DOI: 10.1186/s13019-024-02572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 01/30/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Although pulmonary artery banding (PAB) has been generally acknowledged as an initial palliative treatment for patients having single ventricle (SV) physiology and unrestrictive pulmonary blood flow (UPBF), it may result in unfavorable outcomes. Performing bidirectional Glenn (BDG) surgery without initial PAB in some selected cases may avoid the complications associated with PAB and reduce the number of operative procedures for these patients. This research aimed to assess the outcome of BDG surgery performed directly without doing initial PAB in patients with SV-UPBF. METHODS This Multicenter retrospective cohort includes all patients with SV-UPBF who had BDG surgery. Patients were separated into two groups. Patients in Group 1 included patients who survived till they received BDG (20 Patients) after initial PAB (28 patients), whereas patients in Group 2 got direct BDG surgery without first performing PAB (16 patients). Cardiac catheterization was done for all patients before BDG surgery. Patients with indexed pulmonary vascular resistance (PVRi) ≥ 5 WU.m2 at baseline or > 3 WU.m2 after vasoreactivity testing were excluded. RESULTS Compared with patients who had direct BDG surgery, PAB patients had a higher cumulative mortality rate (32% vs. 0%, P = 0.016), with eight deaths after PAB and one mortality after BDG. There were no statistically significant differences between the patient groups who underwent BDG surgery regarding pulmonary vascular resistance, pulmonary artery pressure, postoperative usage of sildenafil or nitric oxide, intensive care unit stay, or hospital stay after BDG surgery. However, the cumulative durations in the intensive care unit (ICU) and hospital were more prolonged in patients with BDG after PAB (P = 0.003, P = 0.001respectively). CONCLUSION Direct BDG surgery without the first PAB is related to improved survival and shorter hospital stays in some selected SV-UPBF patients.
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Affiliation(s)
- Gaser A Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia.
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt.
| | - Hala A Gabel
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Rawan M Alamri
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed Baamer
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Osman O Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Aliaa Binyamin
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, P.O. Box 40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Saud A Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Naif A Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Mohamed H Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Cardiology Department, Benha University, Benha, Egypt
| | - Hossam Ibrahim
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
| | - Ahmed R Elakaby
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Pediatric department, Al-Azhar University, Cairo, Egypt
| | - Adeep Khawaji
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdullah Alghobaishi
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Khadijah A Maghrabi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Zaher F Zaher
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Jameel A Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmad S Azhar
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
| | - Ahmed M Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, P.O.BOX: 80215, Jeddah, 21589, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Kasr Al Ainy School of Medicine, Cairo University, 99 El-Manial St., Cairo, 11451, Egypt
- Department of Pediatrics, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Elmahrouk AF, Shihata MS, Al-Radi OO, Arafat AA, Altowaity M, Alshaikh BA, Galal MN, Bogis AA, Al Omar HY, Assiri WJ, Jamjoom AA. Custodiol versus blood cardioplegia in pediatric cardiac surgery: a randomized controlled trial. Eur J Med Res 2023; 28:404. [PMID: 37798628 PMCID: PMC10552411 DOI: 10.1186/s40001-023-01372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 09/17/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Blood-based cardioplegia is the standard myocardial protection strategy in pediatric cardiac surgery. Custadiol (histidine-tryptophan-ketoglutarate), an alternative, may have some advantages but is potentially less effective at myocardial protection. This study aimed to test whether custadiol is not inferior to blood-based cardioplegia in pediatric cardiac surgery. METHODS The study was designed as a randomized controlled trial with a blinded outcome assessment. All pediatric patients undergoing cardiac surgery with cardiopulmonary bypass and cardioplegia, including neonates, were eligible. Emergency surgery was excluded. The primary outcome was a composite of death within 30 days, an ICU stay longer than 5 days, or arrhythmia requiring intervention. Secondary endpoints included total hospital stay, inotropic score, cardiac troponin levels, ventricular function, and extended survival postdischarge. The sample size was determined a priori for a noninferiority design with an expected primary outcome of 40% and a clinical significance difference of 20%. RESULTS Between January 2018 and January 2021, 226 patients, divided into the Custodiol cardioplegia (CC) group (n = 107) and the blood cardioplegia (BC) group (n = 119), completed the study protocol. There was no difference in the composite endpoint between the CC and BC groups, 65 (60.75%) vs. 71 (59.66%), respectively (P = 0.87). The total length of stay in the hospital was 14 (Q2-Q3: 10-19) days in the CC group vs. 13 (10-21) days in the BC group (P = 0.85). The inotropic score was not significantly different between the CC and BC groups, 5 (2.6-7.45) vs. 5 (2.6-7.5), respectively (P = 0.82). The cardiac troponin level and ventricular function did not differ significantly between the two groups (P = 0.34 and P = 0.85, respectively). The median duration of follow-up was 32.75 (Q2-Q3: 18.73-41.53) months, and there was no difference in survival between the two groups (log-rank P = 0.55). CONCLUSIONS Custodial cardioplegia is not inferior to blood cardioplegia for myocardial protection in pediatric patients. Trial registration The trial was registered in Clinicaltrials.gov, and the ClinicalTrials.gov Identifier number is NCT03082716 Date: 17/03/2017.
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Affiliation(s)
- Ahmed F Elmahrouk
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Mohammad S Shihata
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
- Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Musleh Altowaity
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Bayan A Alshaikh
- Cardiac Surgery Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Mohamed N Galal
- Pediatric Cardiac Surgery Department, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
| | - Haneen Y Al Omar
- Research Centre, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Wesal J Assiri
- Department of Nursing, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Centre,, MBC J-16, P.O. Box: 40047, 21499, Jeddah, Saudi Arabia
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Al-Ata JA, Abdelmohsen GA, Bahaidarah SA, Alkhushi NA, Abdelsalam MH, Bekheet SB, Al-Radi OO, Jamjoom AA, Elmahrouk AF, Alata AJ, Yousef AA, Dohain AM. Percutaneous coronary stent implantation in children and young infants following surgical repair of congenital heart disease. Cardiovasc Diagn Ther 2023; 13:638-649. [PMID: 37675094 PMCID: PMC10478021 DOI: 10.21037/cdt-23-54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/12/2023] [Indexed: 09/08/2023]
Abstract
Background Coronary artery stent implantation (CSI) in the pediatric population is rare. Only a few reports were published on managing postoperative coronary artery obstruction using coronary stents following surgical repair of congenital heart diseases (CHD). This study aimed to analyze the feasibility, indications, procedural technique, risk factors, and short-term outcomes of CSI after pediatric cardiac surgery. Methods In this retrospective cohort study, we reviewed all pediatric patients who underwent surgical repair of CHD requiring postoperative CSI in two cardiac centers (King Abdulaziz University Hospital and King Faisal Specialist Hospital and Research Center) between 2012 and 2022. Survival to hospital discharge was the study's primary outcome. The secondary outcomes included procedural success, duration of mechanical ventilation, intensive care unit (ICU) stay, hospital stay, need for coronary reintervention, and late mortality. A descriptive analysis was performed for the collected data from the patients' medical records. Results Eleven patients who underwent postoperative CSI were identified. The most common anatomic diagnosis was congenital aortic valve stenosis. All patients underwent cardiac catheterization on extracorporeal membrane oxygenation support except one patient, who presented with chest pain after cardiac surgery. Procedural success was achieved in all patients with excellent revascularization documented by post-procedural angiograms. Both patients who had late coronary events after cardiac surgery survived hospital discharge. There was no in-hospital mortality among the two patients who required stenting of only the right coronary artery. The four patients who required more than 120 minutes to complete the procedure had early mortality. After CSI, the median duration of mechanical ventilation and ICU stay was 12 and 17 days, respectively. Six patients (54.5%) survived hospital discharge post-CSI; they did not require re-intervention during the follow-up period (38-1,695 days). Conclusions CSI in pediatric patients can be performed with excellent procedural success for treating coronary artery stenosis after cardiac surgery. It could be considered a potential treatment strategy for this population.
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Affiliation(s)
- Jameel A. Al-Ata
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Gaser A. Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Saud A. Bahaidarah
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Naif A. Alkhushi
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohamed H. Abdelsalam
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Samia B. Bekheet
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Osman O. Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A. Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F. Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdulaziz J. Alata
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Aly A. Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed M. Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
- Pediatric Critical Care Unit, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
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Helal AM, Baho HA, Elmahrouk AF, Mashali MH. PR and QRS interval changes after transcatheter pulmonary valve replacement in children. Egypt Heart J 2023; 75:66. [PMID: 37486586 PMCID: PMC10366049 DOI: 10.1186/s43044-023-00394-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 07/20/2023] [Indexed: 07/25/2023] Open
Abstract
BACKGROUND Changes in PR intervals after transcatheter pulmonary valve replacement (TCPVR) have not been thoroughly evaluated in children. This study evaluated the changes in PR and QRS intervals six months after TCPVR in children with congenital heart disease. RESULTS This study included 41 patients who underwent TCPVR from 2010 to 2022. ECG of patients was reviewed before and six months after TCPVR, and the PR and QRS intervals were reported. Right ventricular systolic pressure (RVSP) was retrieved indirectly from echocardiography and compared pre- and 6-months after TPVR. The median age was 13 years (25th-75th percentiles: 11-16), and 61% were males. The preoperative diagnosis was tetralogy of Fallot (n = 29, 71%), transposition of great vessels (n = 4, 10%), common arterial trunk (n = 3, 7%), pulmonary valve stenosis (n = 3, 7%) and pulmonary atresia (n = 2, 5%). The Melody valve was used in 30 patients, and Edwards Sapien was used in 11 patients. RVSP was significantly reduced six months after the procedure (pre-RVSP 40 (30-55) mmHg vs. post-RVSP 25 (20-35) mmHg; P < 0.001). The PR interval was 142 (132-174) msec before TPVR and 146 (132-168) msec post-TCPVR (P = 0.442). Post-TPVR PR was positively related to the pre-PR (β: 0.79 (0.66-0.93), P < 0.001) and inversely related to the right ventricular outflow tract size (- 1.48 (- 2.76 to - 0.21), P = 0.023). The pre-TPVR QRS was 130 (102-146) msec, and the post-TPVR QRS was 136 (106-144) msec (P = 0.668). CONCLUSIONS In children undergoing TCPVR, the PR and QRS intervals did not change significantly during a 6-month follow-up.
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Affiliation(s)
- Abdelmonem M Helal
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Haysam A Baho
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, 21499, Jeddah, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Mohamed H Mashali
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
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Aluthman U, Ashour MA, Bafageeh SW, Chandrakumaran A, Alrehaili TS, Abdulrahman OA, Elmahrouk AF, Alaamri S, AlGhamdi SA, Jamjoom AA. Minimally-invasive approach via percutaneous femoral cannulation for the resection of intra-cardiac masses: a single center experience in the Middle-East. J Cardiothorac Surg 2023; 18:203. [PMID: 37400815 DOI: 10.1186/s13019-023-02295-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 05/25/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND Intra-cardiac masses are rare and challenging lesions with an overall incidence ranging of 0.02-0.2%. Minimally invasive approaches have been recently introduced for surgical resection of these lesions. Here, we evaluated our early experience using minimally invasive techniques in addressing intra-cardiac lesions. METHODOLOGY This is a retrospective descriptive study conducted between April 2018 to December 2020. All patients were diagnosed with cardiac tumors and treated via a right mini-thoracotomy with cardiopulmonary bypass through femoral cannulation at King Faisal Specialist Hospital and Research Centre, Jeddah. RESULTS Myxoma was the most common pathology representing 46% of cases followed by thrombus (27%), leiomyoma (9%), lipoma (9%) and angiosarcoma (9%). All tumors were resected with negative margins. One patient was converted to open sternotomy. Tumor locations were in the right atrium, left atrium, and left ventricle in 5, 3, and 3 patients, respectively. The median ICU stay was 1.33 days. The median length of hospitalization was 5.7 days. There was no 30-days hospital mortality recorded in this cohort. CONCLUSION Our early experience shows that minimally invasive resection can be performed safely and effectively for intra-cardiac masses. The minimally invasive approach using a mini-thoracotomy with percutaneous femoral cannulation can be an effective alternative in resecting intra-cardiac masses that achieves clear margin resection, quick post-operative recovery, and low rates of recurrence for benign lesions.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia.
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud Bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | | | | | | | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
| | - Shalan Alaamri
- College of Medicine, University of Jeddah, Jeddah, Saudi Arabia
| | | | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Centre, Ar Rawdah, 2865, Jeddah, 23431, Saudi Arabia
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Yousef AA, Elmahrouk AF, Hamouda TE, Helal AM, Dohain AM, Alama A, Shihata MS, Al-Radi OO, Jamjoom AA, Mashali MH. Factors affecting the outcomes after bidirectional Glenn shunt: two decades of experience from a tertiary referral center. Egypt Heart J 2023; 75:53. [PMID: 37378691 DOI: 10.1186/s43044-023-00381-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/25/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Despite the improved management of patients with a single ventricle, the long-term outcomes are not optimal. We reported the outcomes of the bidirectional Glenn procedure (BDG) and factors affecting the length of hospital stay, operative mortality, and Nakata index before Fontan completion. RESULTS This retrospective study included 259 patients who underwent BDG shunt from 2002 to 2020. The primary study outcomes were operative mortality, duration of hospital stay, and Nakata index before Fontan. Mortality occurred in 10 patients after BDG shunt (3.86%). By univariable logistic regression analysis, postoperative mortality after BDG shunt was associated with high preoperative mean pulmonary artery pressure (OR: 1.06 (95% CI 1.01-1.23); P = 0.02). The median duration of hospital stay after BDG shunt was 12 (9-19) days. Multivariable analysis indicated that Norwood palliation before BDG shunt was significantly associated with prolonged hospital stay (β: 0.53 (95% CI 0.12-0.95), P = 0.01). Fontan completion was performed in 144 patients (50.03%), and the pre-Fontan Nataka index was 173 (130.92-225.34) mm2/m2. Norwood palliation (β: - 0.61 (95% CI 62.63-20.18), P = 0.003) and preoperative saturation (β: - 2.38 (95% CI - 4.49-0.26), P = 0.03) were inversely associated with pre-Fontan Nakata index in patients who had Fontan completion. CONCLUSIONS BDG had a low mortality rate. Pulmonary artery pressure, Norwood palliation, cardiopulmonary bypass time, and pre-BDG shunt saturation were key factors associated with post-BDG outcomes in our series.
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Affiliation(s)
- Aly A Yousef
- Division of Pediatric Critical Care, Department of Pediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
- Department of Pediatrics, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia.
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt.
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Abdelmonem M Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulhadi Alama
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohammad S Shihata
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
- Cardiac Surgery Section, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box:40047, Jeddah, 21499, Saudi Arabia
| | - Mohamed H Mashali
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
- Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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8
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Mashali MH, Yousef AA, Elmahrouk AF, Ba-Atiyah W, Rasol MA, Arafa MA, Shihata MS, Jamjoom AA, Hamouda TE. Reintervention after repair of tetralogy of Fallot: a one-decade single-center experience. Cardiothorac Surg 2023. [DOI: 10.1186/s43057-023-00096-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Abstract
Background
Reinterventions after tetralogy of Fallot repair (TOF) remains a common clinical problem. The objective of this study was to evaluate types of reintervention after TOF repair and identify the risk factors for reinterventions.
Methods
This retrospective study was conducted from 2010 to 2022 and included 171 patients with complete TOF repair. Patients were grouped according to the occurrence of reintervention into two groups: patients who did not have reintervention (n = 138) and those who required reintervention (n = 33).
Results
Median follow-up was 36 (13–67) months. The first reintervention was required in 33 patients. Freedom from the first reintervention at 1, 3, 5, and 7 years was 91%, 85%, 81%, and 76%, respectively. Surgical reintervention was required in 12 patients and transcatheter intervention in 21 patients. Second reinterventions were required in 11 patients; 4 had surgery, and 7 had a transcatheter intervention. Third reinterventions were performed on two patients; one had surgery, and one had a transcatheter intervention. The most common interventions were performed at the level of pulmonary arteries (n = 17), followed by the pulmonary valve and the right ventricular outflow tract (n = 15). The risk of reintervention was associated with the low weight (HR: 0.65 (95% CI: 0.48–0.88); P = 0.005) and small LPA diameter (HR: 0.36 (95% CI: 0.21–0.60); P < 0.001) at the time of the primary intervention and the nonuse of the transannular patch (HR: 0.27 (95% CI: 0.08–0.85); P = 0.026).
Conclusions
The risk of reintervention is high after tetralogy of Fallot repair. In our experience, the smaller the left pulmonary artery and weight at the repair time increased the risk of reintervention. Using a transannular patch in our series was associated with a lower risk of reintervention.
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9
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Aluthman U, Bafageeh SW, Ashour MA, Barnawi HI, Bogis AA, Alamri R, Elmahrouk AF, AlGhamdi SA, Ismaeil N, Shihata M, Jamjoom AA. A robotic-assisted hybrid coronary revascularization program: Establishment and early experience in the Middle East. J Card Surg 2022; 37:4783-4789. [PMID: 36349707 DOI: 10.1111/jocs.17123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/10/2022] [Accepted: 10/24/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Hybrid coronary revascularization (HCR) is a technique that merges coronary artery bypass grafting surgery and percutaneous coronary intervention (PCI) approaches for the treatment of multivessel coronary artery disease. The surgical component of the procedure is minimally invasive and can be done using robotic technology that avoids the need for sternotomy. Our objective is to study all patients who underwent robotic-assisted HCR (RHCR) to evaluate the feasibility and safety of the procedure during the establishment phase. METHODS This study is a retrospective chart review conducted at King Faisal Specialist Hospital and Research Centre in Jeddah (KFSRC-J). The study focuses on patients who underwent RHCR between July 2018 to December 2020. The study was approved by the institutional review board #2020-103. RESULTS Robotic-assisted HCR was performed on 78 patients (mean age, 56 years (range, 43-72 years); 89.75% males) during the study phase. Left internal mammary artery grafting was used in all patients. There was no hospital mortality, and the mean hospital and intensive care unit (ICU) stay were 5.8 and 1.4 days, respectively. We found that 93.6% of the patients had no blood transfusion. There were no major adverse cardiac events (MACE) and perioperative MI recorded. There was a 3.8% rate of postoperative complications. The percentage of surgeries converted to conventional and re-exploration for bleeding were 1.2% and 2.6%, respectively. The average operation time was 164 min. CONCLUSION This study emphasizes on the safety and effectiveness of RHCR in treating patients with multivessel coronary artery disease. Moreover, robotic-assisted hybrid coronary revascularization offers an alternative, functionally complete revascularization option to a selected group of patients with minimal surgical trauma, short hospital and ICU length of stay, quick recovery, and little to no blood transfusion requirement.
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Affiliation(s)
- Uthman Aluthman
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Salman W Bafageeh
- College of Medicine, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia
| | - Mohammed A Ashour
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hani I Barnawi
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Abdulbadee A Bogis
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan Alamri
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed F Elmahrouk
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Nabeel Ismaeil
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Shihata
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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10
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Helal AM, Elmahrouk AF, Bekheet S, Barnawi HI, Jamjoom AA, Galal MO, Abou Zahr R. Patent ductus arteriosus stenting versus modified Blalock-Taussig shunt for palliation of duct-dependent pulmonary blood flow lesions. J Card Surg 2022; 37:2571-2580. [PMID: 35726659 DOI: 10.1111/jocs.16692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 04/23/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patent ductus arteriosus (PDA) stenting is an alternative to modified Blalock-Taussig shunt (MBTS) as first-stage palliation of duct-dependent lesions. The superiority of one approach over the other is still controversial. Our objective was to compare PDA stent versusMBTS for palliation in regard to safety, efficacy, and efficiency. METHODS From 2010 to 2021, 134 patients had first-stage palliation with either PDA stent (n = 83) or MBTS (n = 51). Twenty-seven patients failed the primary treatment and were converted to the other group. The study endpoints were hospital outcomes, interstage reintervention, and concomitant procedures at the second-stage palliation. RESULTS Patients with PDA stent were significantly younger. The prevalence of antegrade pulmonary blood flow (PBF) was higher in patients who had MBTS and graft thrombosis was higher in the PDA stent. Hospital stay was significantly longer in patients who had MBTS. Predictors of prolonged mechanical ventilation were low-weight, MBTS, and conversion. Intensive care unit stay significantly increased with conversion, low-weight, and antegrade PBF. The interstage intervention was required more frequently in PDA-stent group. Predictors of reintervention were conversion and pulmonary atresia with the intact interventricular septum. Pulmonary artery plasty was required more frequently during the second-stage palliation in PDA-stent group. CONCLUSION PDA stent is an alternative to MBTS for first-stage palliation. It is associated with shorter hospital stays and avoidance of surgery at the expense of a high rate of stent thrombosis and interstage reintervention. Conversion increased the risk of the procedure. More studies are needed to determine factors that affect PDA-stent outcomes and patient selection criteria.
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Affiliation(s)
- Abdelmonem M Helal
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed F Elmahrouk
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine Tanta University, Tanta, Egypt
| | - Samia Bekheet
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Paediatric Cardiology Division, Department of Paediatrics, Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Hani I Barnawi
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiac Surgery Section, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammed O Galal
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Riad Abou Zahr
- Paediatric Cardiology Division, Department of Paediatrics, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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11
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Elmahrouk AF, Ismail MF, Arafat AA, Dohain AM, Edrees AM, Jamjoom AA, Al-Radi OO. Combined Norwood and cavopulmonary shunt as the first palliation in late presenters with hypoplastic left heart syndrome and single-ventricle lesions. J Thorac Cardiovasc Surg 2022; 163:1592-1600. [PMID: 35027212 DOI: 10.1016/j.jtcvs.2021.10.061] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 09/23/2021] [Accepted: 10/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A primary cavopulmonary shunt as a component of the initial Norwood palliation could be an option in patients with hypoplastic left heart syndrome and single-ventricle lesions. We present our initial experience with this approach in carefully selected patients with unrestricted pulmonary blood flow and low pulmonary vascular resistance. METHODS The study included 16 patients; the mean age was 137.9 ± 84.2 days. All patients underwent a Norwood palliation consisting of atrial septectomy, Damus-Kaye-Stansel connection, and arch augmentation in addition to the cavopulmonary shunt as the initial palliation. RESULTS The mean preoperative pulmonary to systemic blood flow (Qp/Qs) ratio on room air (n = 9) and with 100% oxygen (n = 8) was 5.3 ± 3.2 and 8.6 ± 4.3, respectively. The mean pulmonary vascular resistance on room air (n = 10) and 100% oxygen (n = 9) was 4.8 ± 3.1 and 1.7 ± 0.97 WU/m2, respectively. Delayed chest closure was needed in 12 patients, and 6 patients required postoperative inhaled nitric oxide. One patient underwent takedown of the cavopulmonary shunt and construction of the right ventricle to pulmonary artery conduit after 1 month. The mean intensive care unit stay was 18.9 ± 15.4 days. There were 2 in-hospital deaths (48 hours and 8 days after surgery) and 2 postdischarge deaths (6 months and 2 years after hospital discharge). Seven patients have undergone the Fontan completion successfully, and 5 patients await further surgery. CONCLUSIONS First-stage Norwood palliation with cavopulmonary shunt for patients with hypoplastic left heart syndrome or single-ventricle lesions is feasible in late presenters with low pulmonary vascular resistance.
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Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Mohamed F Ismail
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Cardiothoracic Surgery Department, Mansoura University, Mansoura, Egypt
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ahmed M Dohain
- Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt; Department of Pediatrics, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Azzahra M Edrees
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia; Division of Cardiac Surgery, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.
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12
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Hamad AMM, Elmistekawy EM, Elmahrouk AF. Necrotizing Chest Wall Fasciitis Complicating Closed Tube Thoracostomy: Can It Be Avoided? J Chest Surg 2021; 54:436-438. [PMID: 34376626 PMCID: PMC8548204 DOI: 10.5090/jcs.21.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/09/2021] [Accepted: 03/10/2021] [Indexed: 12/02/2022] Open
Affiliation(s)
- Abdel-Mohsen M Hamad
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt.,Department of Thoracic Surgery, King Fahd Specialist Hospital, Buraydah, Saudi Arabia
| | - Elsayed M Elmistekawy
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt.,Cardiac Surgery Division, Department of Surgery, University of Ottawa Heart Institute, Ottawa, Canada
| | - Ahmed F Elmahrouk
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt.,Department of Cardiovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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13
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Hamad AMM, Elmahrouk AF, Elmistekawy EM. Respiratory Distress and Chest Pain in an Airplane Passenger With Radiolucent Left Hemithorax. Chest 2021; 159:e319-e323. [PMID: 33965156 DOI: 10.1016/j.chest.2020.12.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/08/2020] [Accepted: 12/01/2020] [Indexed: 11/25/2022] Open
Abstract
CASE PRESENTATION A 43-year-old man experienced sudden onset of chest pain and shortness of breath onboard a domestic flight. After consultation with the airline's operations center, a decision was made to land the plane in its destination airport. After landing, an ambulance was ready, and the patient was transferred to the ED in our facility. Patient evaluation was immediately started, and oxygen supply and venous access were secured.
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Affiliation(s)
- Abdel-Mohsen M Hamad
- King Fahad Specialist Hospital, Buraydah, Saudi Arabia; Faculty of Medicine, Tanta University, Tanta, Egypt.
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14
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Helal A, Elmahrouk AF, Jamjoom AA, Al-Ata JA. Gastrointestinal presentation of COVID-19 in a pediatric heart transplant recipient. Cardiothorac Surg 2020; 28:24. [PMID: 38624531 PMCID: PMC7652410 DOI: 10.1186/s43057-020-00034-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-associated coronavirus disease 2019 (COVID-19) most commonly causes a mild respiratory illness; however, there are wide ranges of presenting symptoms and disease severity. It has a mortality rate around 7%. Case presentation We present a case of a 9-year-old female patient with hypoplastic left heart syndrome status post heart transplantation at age of 7 days. She presented to our emergency room complaining of intermittent fever, chills, fatigue, poor appetite, and diarrhea.A throat swab nucleic acid test was positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Intravenous fluids therapy was used for correction of hydration status. To the best of our knowledge this is the first reported case of non-pulmonary presentation of coronavirus disease-2019 (COVID-19) in a pediatric heart transplant recipient, which was successfully managed conservatively. Conclusions Gastrointestinal manifestations can be the only presenting symptom in pediatric heart transplant recipients with COVID-19. Conservative treatment could be used successfully. Immunomodulatory medications that are used in heart transplant recipients may have protective value in SARS-CoV-2 infection.
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Affiliation(s)
- Abdelmonem Helal
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
- Department of Pediatrics and Pediatric Cardiology, Cairo University, Cairo, Egypt
| | - Ahmed F. Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box: 40047, Jeddah, 21499 Saudi Arabia
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ahmed A. Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, MBC J-16, P.O. Box: 40047, Jeddah, 21499 Saudi Arabia
| | - Jameel A. Al-Ata
- Pediatric Cardiology Section, Department of Pediatrics, King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
- Section of Pediatric Cardiology, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia
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15
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Dohain AM, Ismail MF, Elmahrouk AF, Hamouda TE, Arafat AA, Helal A, Edrees A, Alamri RM, Al-Mojaddidi AMA, Abdelmotaleb ME, Elassal AA, Al-Radi OO, Jamjoom AA. The outcomes of bidirectional Glenn before and after 4 months of age: A comparative study. J Card Surg 2020; 35:3326-3333. [PMID: 33032371 DOI: 10.1111/jocs.15055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/07/2020] [Accepted: 09/10/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We aim to present our experience with the bidirectional Glenn (BDG) in patients less than 4 months of age and to compare their outcomes with the patients who underwent BDG after the age of 4 months. METHODS A retrospective review of data was performed for patients who underwent the BDG procedure from 2002 to 2018 at our institutions. We reviewed the patients' demographics, echocardiographic findings, cardiac catheterization data, operative details, postoperative data, and outcome variables. RESULTS The study was conducted on 213 patients. At the time of the BDG operation, 32 patients were younger than 4 months (younger group) and 181 patients were older than 4 months (older group). The preoperative mean pulmonary artery pressure was significantly higher in the younger group (p = .035) but there were no significant differences between both groups in Qp/Qs, ventricular end-diastolic pressure, indexed pulmonary vascular resistance, and preoperative oxygen saturation. However, the initial postoperative oxygen saturation of the younger group was lower than the older group (p = .007). The duration of mechanical ventilation, duration of pleural drainage, ICU stay, and hospital stay after BDG were significantly longer in the younger group compared to the older group. The early mortality was higher in the younger group, but this difference did not reach statistical significance (p = .283). CONCLUSION Performing BDG procedure in infants less than 4 months of age is safe, with favorable outcomes. Early BDG is associated with a less-smooth postoperative course without a significant increase in early or late mortality.
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Affiliation(s)
- Ahmed M Dohain
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt
| | - Mohamed F Ismail
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Mansoura University, Mansoura, Egypt
| | - Ahmed F Elmahrouk
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Tamer E Hamouda
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Benha University, Benha, Egypt
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Abdelmonem Helal
- Department of Pediatrics, Pediatric Cardiology Division, Cairo University, Cairo, Egypt.,Pediatric Cardiology Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Azzahra Edrees
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Rawan M Alamri
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M A Al-Mojaddidi
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohamed E Abdelmotaleb
- Department of Pediatrics, Pediatric Cardiology Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Elassal
- Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Osman O Al-Radi
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Division, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Cardiovascular Department, Division of Cardiac Surgery, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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16
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Elmahrouk AF, Ismail MF, Arafat AA, Dohain AM, Helal AM, Hamouda TE, Galal M, Edrees AM, Al-Radi OO, Jamjoom AA. Outcomes of biventricular repair for shone's complex. J Card Surg 2020; 36:12-20. [PMID: 33032391 DOI: 10.1111/jocs.15090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Shone's complex is a rare lesion affecting the mitral valve (MV) and left ventricular outflow tract (LVOT). The objective of this study is to report the outcomes after Shone's complex repair, the growth of mitral and aortic valve and LVOT, and long-term survival. METHODS This retrospective study included all patients diagnosed with Shone's complex, who underwent biventricular repair. Data including patients' characteristics, type of the MV lesion and the associated lesions were collected. Patients were followed up regularly with echocardiography, and the changes in mitral and aortic valve z-score and LVOT z-score were recorded. RESULTS Thirty-seven patients were included in the study, the median age was 3.4 months, and 11 patients (30.6%) had pulmonary hypertension. The main procedure performed during the first surgical intervention was coarctation repair in 26 patients (70%). Twelve patients had MV repair, and five had MV replacement. Operative mortality occurred in 1 patient (2.7%), median follow up was 52 (25-75th percentile: 22-84) months. Survival at 1, 5, and 10 years was 94.4%, 90%, and 76.9%, respectively. Reoperation was required in 13 patients, mainly for LVOT repair (n = 8). Reoperation was significantly associated with associated aortic valve lesion (p = .044). The growth of the MV z-score was 0.35 per year; p < .001, aortic valve z-score 0.086 per year; p = 0.422, and the LVOT z-score was 0.53 per year; p = .01. CONCLUSION Biventricular repair of Shone's complex has good outcomes. Reoperation is frequently encountered, especially with low aortic valve z-score. The MV and LVOT have significant growth following Shone's complex repair.
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Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Mohamed F Ismail
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Mansoura University, Mansoura, Egypt
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed M Dohain
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdelmonem M Helal
- Department of Pediatric Cardiology, Cairo University, Giza, Egypt.,Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Tamer E Hamouda
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Benha University, Benha, Egypt
| | - Mohamed Galal
- Department of Cardiac Surgery, Cardiac Center, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Azzahra M Edrees
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Surgery, Cardiac Surgery Section, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Department of Cardiovascular, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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17
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Hamad AMM, Elmahrouk AF, Abdulatty OA. Alveolar air leakage in COVID-19 patients: Pneumomediastinum and/or pneumopericardium. Heart Lung 2020; 49:881-882. [PMID: 32980170 PMCID: PMC7500942 DOI: 10.1016/j.hrtlng.2020.09.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 08/28/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Affiliation(s)
- Abdel-Mohsen M Hamad
- Department of Thoracic Surgery, King Fahd Specialist Hospital, Buraydah, Saudi Arabia.
| | - Ahmed F Elmahrouk
- Department of Cardiovascular Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Osama A Abdulatty
- Department of cardiology, King Fahd Specialist Hospital, Buraydah, Saudi Arabia
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18
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Daoulah A, Al-Faifi SM, Alhamid S, Youssef AA, Alshehri M, Al-Murayeh M, Farghali T, Maghrabi M, Balghith M, ElSayed O, Alasmari A, Arafat AA, Elmahrouk AF, Eldesoky A, Refaat WA, Alshahrani SS, Ghazi AM, Al-Azizi KM, Dahdouh Z, Lotfi A. Spontaneous Coronary Artery Dissection in the Gulf: G-SCAD Registry. Angiology 2020; 72:32-43. [PMID: 32787614 DOI: 10.1177/0003319720946974] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Data on spontaneous coronary artery dissection (SCAD) is based on European and North American registries. We assessed the prevalence, epidemiology, and outcomes of patients presenting with SCAD in Arab Gulf countries. Patients (n = 83) were diagnosed with SCAD based on angiographic and intravascular imaging whenever available. Thirty centers in 4 Arab Gulf countries (Kingdom of Saudi Arabia, United Arab Emirates, Kuwait, and Bahrain) were involved from January 2011 to December 2017. In-hospital (myocardial infarction [MI], percutaneous coronary intervention, ventricular tachycardia/fibrillation, cardiogenic shock, death, implantable cardioverter-defibrillator placement, dissection extension) and follow-up (MI, de novo SCAD, death, spontaneous superior mesenteric artery dissection) cardiac events were recorded. Median age was 44 (37-55) years, 42 (51%) were females and 28.5% were pregnancy-associated (21.4% were multiparous). Of the patients, 47% presented with non-ST-elevation acute coronary syndrome, 49% with acute ST-elevation myocardial infarction, 12% had left main involvement, 43% left anterior descending, 21.7% right coronary, 9.6% left circumflex, and 9.6% multivessel; 52% of the SCAD were type 1, 42% type 2, 3.6% type 3, and 2.4% multitype; 40% managed medically, 53% underwent percutaneous coronary intervention, 7% underwent coronary artery bypass grafting. Females were more likely than males to experience overall (in-hospital and follow-up) adverse cardiovascular events (P = .029).
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Affiliation(s)
- Amin Daoulah
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Salem M Al-Faifi
- Department of Internal Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Sameer Alhamid
- Department of Emergency Medicine, 37849King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Ali A Youssef
- Department of Cardiology, 289167Saud Al Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia.,Department of Cardiology, 68831Suez Canal University, Ismailia, Egypt
| | - Mohammed Alshehri
- Department of Cardiology, 48077Prince Khaled Bin Sultan Cardiac Center, Khamis Mushait, Kingdom of Saudi Arabia
| | - Mushabab Al-Murayeh
- Department of Cardiology, 48103Aseer Central Hospital, Abha, Kingdom of Saudi Arabia
| | - Tarek Farghali
- Department of Cardiology, 68796Assiut University, Assiut, Egypt
| | - Mohamed Maghrabi
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia.,Department of Cardiology, Al Hada Military Hospital, Taif, Kingdom of Saudi Arabia
| | - Mohammed Balghith
- Department of Cardiology, 48149King Saud Bin Abdulaziz University for Health Science, Riyadh, Kingdom of Saudi Arabia
| | - Osama ElSayed
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Abdulaziz Alasmari
- Department of Internal Medicine, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Faculty of Medicine, 68781Tanta University, Egypt
| | - Ahmed F Elmahrouk
- Cardiothoracic Surgery Section, Department of Cardiology, 195017King Faisal Specialist Hospital & Research Center, Jeddah, Kingdom of Saudi Arabia
| | - Akram Eldesoky
- Department of Cardiology, 48077Prince Sultan Cardiac Center, Al Qassim, Kingdom of Saudi Arabia
| | - Wael A Refaat
- Department of Cardiology, 204603Prince Sultan Cardiac Center, Al Hassa, Kingdom of Saudi Arabia
| | - Saif S Alshahrani
- Department of Emergency Medicine, 195017King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman M Ghazi
- Department of Cardiology, 289167Saud Al Babtain Cardiac Center, Dammam, Kingdom of Saudi Arabia
| | - Karim M Al-Azizi
- Department of Cardiology, 384526Baylor Scott & White The Heart Hospital, Plano, TX, USA
| | - Ziad Dahdouh
- Department of Cardiovascular Medicine, 195017King Faisal Specialist Hospital & Research Center, Riyadh, Kingdom of Saudi Arabia
| | - Amir Lotfi
- Department of Cardiovascular Medicine, 21645Baystate Medical Center, Tufts University School of Medicine, Springfield, MA, USA
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19
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Elmahrouk AF, Elghaysha E, Arafat AA, Edrees A, Aluthman U, Jamjoom AA. Bolus potassium in frustrated ventricular fibrillation storm: Evidence are growing! J Card Surg 2020; 35:2117. [PMID: 32652774 DOI: 10.1111/jocs.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Ahmed F Elmahrouk
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Ehab Elghaysha
- Cardiac Surgery Intensive Care Unit (CSICU) Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Intensive Care Unit, Basildon and Thurrock University Hospital, Essex, UK
| | - Amr A Arafat
- Cardiothoracic Surgery Department, Tanta University, Tanta, Egypt
| | - Azzahra Edrees
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Uthman Aluthman
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ahmed A Jamjoom
- Division of Cardiac Surgery, Cardiovascular Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
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20
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Alamri RM, Dohain AM, Arafat AA, Elmahrouk AF, Ghunaim AH, Elassal AA, Jamjoom AA, Al-Radi OO. Surgical repair for persistent truncus arteriosus in neonates and older children. J Cardiothorac Surg 2020; 15:83. [PMID: 32393289 PMCID: PMC7216609 DOI: 10.1186/s13019-020-01114-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 04/27/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives Persistent truncus arteriosus represents less than 3% of all congenital heart defects. We aim to analyze mid-term outcomes after primary Truncus arteriosus repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair. Methods This retrospective cohort study included 36 children, underwent repair of Truncus arteriosus in the period from January 2011 to December 2018 in two institutions. We recorded the clinical and echocardiographic data for the patients preoperatively, early postoperative, 6 months postoperative, then every year until their last documented follow-up appointment. Results Thirty-six patients had truncus arteriosus repair during the study period. Thirty-one patients had open sternum post-repair, and two patients required extracorporeal membrane oxygenation. Bleeding occurred in 15 patients (41.67%), and operative mortality occurred in 5 patients (14.7%). Patients with truncus arteriosus type 2 (p = 0.008) and 3 (p = 0.001) and who were ventilated preoperatively (p < 0.001) had a longer hospital stay. Surgical re-intervention was required in 8 patients (22.86%), and 11 patients (30.56%) had catheter-based reintervention. Freedom from reintervention was 86% at 1 year, 75% at 2 years and 65% at 3 years. Survival at 1 year was 81% and at 3 years was 76%. High postoperative inotropic score predicted mortality (p = 0.013). Conclusion Repair of the truncus arteriosus can be performed safely with low morbidity and mortality, both in neonates, infants, and older children. Re-intervention is common, preferably through a transcatheter approach.
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Affiliation(s)
- Rawan M Alamri
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed M Dohain
- Pediatric Cardiology Division, Department of Pediatrics, King Abdulaziz University, Jeddah, Saudi Arabia.,Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Giza, Egypt
| | - Amr A Arafat
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt
| | - Ahmed F Elmahrouk
- Department of Cardiothoracic Surgery, Tanta University, Tanta, Egypt. .,Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.
| | - Abdullah H Ghunaim
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmed A Elassal
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Zagazig University, Zagazig, Egypt
| | - Ahmed A Jamjoom
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Osman O Al-Radi
- Cardiac Surgery Division, Department of Surgery, King Abdulaziz University, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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21
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Ismail MF, Elmahrouk AF, Arafat AA, Hamouda TE, Edrees A, Bogis A, Arfi AM, Dohain AM, Alkhattabi A, Alharbi AW, Shihata MS, Al‐Radi OO, Al‐Ata JA, Jamjoom AA. Bovine jugular vein valved xenograft for extracardiac total cavo‐pulmonary connection: The risk of thrombosis and the potential liver protection effect. J Card Surg 2020; 35:845-853. [DOI: 10.1111/jocs.14484] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Mohamed F. Ismail
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineMansoura UniversityMansoura Egypt
| | - Ahmed F. Elmahrouk
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineTanta UniversityTanta Egypt
| | - Amr A. Arafat
- Department of Cardiothoracic Surgery, Faculty of MedicineTanta UniversityTanta Egypt
| | - Tamer E. Hamouda
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Department of Cardiothoracic Surgery, Faculty of MedicineBenha UniversityBenha Egypt
| | - Azzahra Edrees
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Abdulbadee Bogis
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Amin M. Arfi
- Section of Pediatric Cardiology, Department of PediatricsKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ahmed M. Dohain
- Division of Pediatric Cardiology, Department of PediatricsFaculty of Medicine Cairo UniversityCairo Egypt
- Section of Pediatric Cardiology, Department of PediatricsKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Abdullah Alkhattabi
- Section of Gastroenterology, Department of Internal MedicineKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ahmed W. Alharbi
- Section of Gastroenterology, Department of Internal MedicineKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Mohammad S. Shihata
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Osman O. Al‐Radi
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Section of Cardiothoracic Surgery, Department of SurgeryKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Jameel A. Al‐Ata
- Section of Pediatric Cardiology, Department of PediatricsKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Section of Pediatric Cardiology, Department of PediatricsKing Abdulaziz UniversityJeddah Saudi Arabia
| | - Ahmed A. Jamjoom
- Department of Cardiothoracic SurgeryKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
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22
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Elmahrouk AF, Elghaysha E, Arafat AA, Edrees A, Aluthman U, Jamjoom AA. Bolus potassium in frustrated ventricular fibrillation storm. J Card Surg 2019; 35:480-481. [DOI: 10.1111/jocs.14380] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ahmed F. Elmahrouk
- Division of Cardiac Surgery, Cardiovascular DepartmentKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ehab Elghaysha
- Cardiac Surgery Intensive Care Unit (CSICU) Cardiovascular DepartmentKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
- Intensive Care UnitBasildon and Thurrock University HospitalEssex United Kingdom
| | - Amr A. Arafat
- Cardiothoracic Surgery DepartmentTanta UniversityTanta Egypt
| | - Azzahra Edrees
- Division of Cardiac Surgery, Cardiovascular DepartmentKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Uthman Aluthman
- Division of Cardiac Surgery, Cardiovascular DepartmentKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
| | - Ahmed A. Jamjoom
- Division of Cardiac Surgery, Cardiovascular DepartmentKing Faisal Specialist Hospital and Research CenterJeddah Saudi Arabia
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23
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Elmahrouk AF, Helal A, Ismail MF, Hamouda T, Mashali M, Jamjoom AA, Al-Ata JA. Isolated right superior vena cava draining into the left atrium in a child with vein of Galen aneurysmal malformation-case report. J Cardiothorac Surg 2018; 13:66. [PMID: 29895303 PMCID: PMC5998586 DOI: 10.1186/s13019-018-0758-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 06/01/2018] [Indexed: 11/10/2022] Open
Abstract
Background Isolated right Superior Vena Cava drainage into the left atrium in the absence of other cardiac anomalies is an extremely rare condition. The vein of Galen aneurysmal malformation is a congenital vascular malformation. It comprises 1% of all pediatric congenital anomalies. The association vein of Galen aneurysmal malformation, with congenital heart disease has been described. Case presentation We describe a 16-months old toddler presenting at 7-months of age with respiratory distress and cyanosis. CT brain showed Vein of Galen aneurysmal malformations. Echocardiography showed partial anomalous systemic venous drainage in the form of right superior vena cava drained into left atrium. Four sessions of Endovascular embolization were performed. Surgical repair of partial anomalous systemic venous drainage was done successfully. Conclusions The superior vena cava in our case overrides the atrial septum promoting direct drainage of venous return into the LA, thus causing dilated left ventricle instead of dilatation of right ventricle which is the usual presentation of VAGMs.
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Affiliation(s)
- Ahmed F Elmahrouk
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia. .,Cardiothoracic Surgery Department, Faculty of Medicine, Tanta University, Tanta, Egypt.
| | - Abdelmonem Helal
- Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Pediatric Cardiology, Qasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Mohamed F Ismail
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Mansoura University, Manasoura, Egypt
| | - Tamer Hamouda
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Cardiothoracic Surgery Department, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohammed Mashali
- Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department of Pediatric Cardiology, Qasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed A Jamjoom
- Cardiothoracic Surgery Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Jameel A Al-Ata
- Department of Pediatric Cardiology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.,Department Of Pediatrics, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
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24
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Elmahrouk AF, Hamouda T, Ismail MF, Jamjoom A. Transposition of Great Arteries with Left Main Coronary Artery Atresia-Case Report. Thorac Cardiovasc Surg Rep 2018; 7:e16-e17. [PMID: 29577005 PMCID: PMC5864522 DOI: 10.1055/s-0038-1637737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 02/05/2018] [Indexed: 11/02/2022] Open
Abstract
Background The coronary artery anatomy in patients with transposition of the great artery (TGA) is a contributing factor for outcome in arterial switch procedure. Case Presentation A full-term, 7-day-old baby boy diagnosed as dextro-TGA (dTGA) with intact ventricular septum. Intraoperatively, the left coronary sinus had a blind indentation from which a firm cord-like left main coronary artery originates. Procedure completed as usual for a routine arterial switch operation. Conclusion About 5% of patients with D-TGA have a single coronary artery. Assessment of blood flow to all branches intraoperatively is mandatory to choose between either transfer of single ostium or bypass grafting to the other coronary system.
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Affiliation(s)
- Ahmed F Elmahrouk
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Tamer Hamouda
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
| | - Mohamed F Ismail
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Ahmed Jamjoom
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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25
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Elmahrouk AF, Ismail MF, Bugis A, Badawy N, Aboelghar HM, Hamouda T, Jamjoom A. Staged Surgical Palliation for HLHS in a Girl with Severe Factor X Deficiency. Thorac Cardiovasc Surg Rep 2018; 7:e12-e15. [PMID: 29577004 PMCID: PMC5864519 DOI: 10.1055/s-0038-1637743] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 01/25/2018] [Indexed: 11/01/2022] Open
Abstract
Background Factor X deficiency (also known as Stuart-Prower factor deficiency) is an autosomal recessive extremely rare hereditary hematologic disorder, affecting around 1:1,000,000 of the general population. Case Presentation This case report describes a patient with hypoplastic left heart syndrome and severe factor X deficiency, who underwent staged surgical palliation. From stage 1 Norwood palliation, through superior cavopulmonary anastomosis and ending with total cavopulmonary connection with satisfactory hemostasis and no significant perioperative bleeding complication. Conclusion The need to maintain hemostasis while aiming to prevent intracardiac thrombosis requires multidisciplinary team approach including hematologist, cardiac surgeon, pediatric cardiac intensivist, and anesthesiologist along with meticulous hemostasis during surgery and careful monitoring of coagulation profile in the postoperative period.
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Affiliation(s)
- Ahmed F Elmahrouk
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Tanta University Faculty of Medicine, Tanta, Egypt
| | - Mohamed F Ismail
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Mansoura University Faculty of Medicine, Mansoura, Egypt
| | - Abdulbadee Bugis
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Nashwa Badawy
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
| | - Hesham Mohamed Aboelghar
- Department of Pediatrics, Menoufia University Faculty of Medicine, Shebin El-Kom, Saudi Arabia.,Department of Hematology and Oncology BMT, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Tamer Hamouda
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia.,Department of Cardiothoracic Surgery, Faculty of Medicine, Benha University, Benha, Egypt
| | - Ahmed Jamjoom
- Department of Cardiothoracic Surgery, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
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26
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Elmahrouk AF, Hamouda TE, Kasab I, Ismail MF, Jamjoom AA. Short term outcome of conventional versus off-pump coronary artery bypass grafting for high-risk patients. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jescts.2017.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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