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Article
Early Clinical Outcome of Urgent Coronary Artery Bypass Grafting at the Iraqi Center for Heart Diseases

Authors: Khaldoon Majid Ali --- Mohamed S. Ahmed --- Emad Al Mashat
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2015 Volume: 14 Issue: 2 Pages: 244-249
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND :Coronary artery bypass grafting (CABG) can be divided according to it's timing into:elective, urgent, emergency and salvage.The purpose of urgent CABG is to reperfuse the coronary artery blood flow rapidly, improves areas of myocardial ischemia, repair ventricular dysfunction and prevent the spread of the infarction area. Urgent CABG has a higher morbidity and mortality than elective CABG.OBJECTIVE:The purpose of this study was to identify preoperative and peroperative risk factors associated with this morbidity and mortality, evaluate clinical outcomes and recommend the possible solutions.MATERIALS AND METHODS:This is a retrospective study that reviewed the hospital records of 50 patients who underwent urgent CABG at the Iraqi Center for Heart Diseases for three years (2008-2010). The main daignostic tools were coronary angiography and echocardiography. All underwent conventinal CABG on cardio-pulmonary bypass with cardioplegic arrest. Variables that may be related to operative risk were analaysed.RESULTS :Forty-three patients underwent isolated CABG, while six patients underwent postinfarction ventricular septal defect repair and one patient underwent mitral valve replacement in addition to CABG, Postoperative mortality was 20%.CONCLUSION:The most common cause of mortality was Low Cardiac Output Syndrome followed by Acute Renal Failure.Preoperative risk factors for perioperative mortality were age more than 65 years, preoperative cardiogenic shock and low ejection fraction below 40.KEYWORDS: urgent CABG, postinfarction VSD, low cardiac output syndrome.


Article
The Evaluation of Calcium Score Validity in the Diagnosis of Patients with Coronary Artery Disease by Using CT Angiography
تقييم مدى فعالية قياس درجة الكالسيوم في تشخيص مرضى الشريان التاجي بأستخدام جهاز التصوير المقطعي الوعائي

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Abstract

Background: Coronary artery disease is one of important diseases as in many cases ends up with death. Among many types of coronary artery disease is the lipoprotein plaque deposition on the artery wall. Many reports appeared in the literature concerning the causes, investigation, and treatment of the coronary artery disease. As computed tomography scanners were developed, a new non-invasive procedure was introduced using the calcium present in the plaque as an indicator for the amount of plaque in the coronary artery. Objective: To investigate the validity of the calcium score in the diagnosis of coronary artery disease, and also to find the relation between calcium score with calcification and plaque.Patients and methods: Sixty one patients 40 were men and 21 were women evaluated for calcium score. They had symptoms of chest pain and were subjected to electro cardio gram examination to determine their eligibility for computed tomography angiography to investigate the coronary calcification as a marker of atherosclerosis. The history of diseases including hypertension and diabetes were recorded and check renal function test. Anthropometric measurements and the level of fasting lipid profile for patients and normal subjects were tasted. Patients were advised to come fasting prior to the examination. They have been given Beta blocker to reduce the heart rate in the range of 55-65 beats/min. Contrast medium was injected IV by means of injector immediately before scanning.Results: Results revel that not all patients suffering from chest pain with electro cardio gram changes show high calcium score; on the other hand patients with high calcium score they have an increased plaque in their coronary artery. At low calcium score calcium score (0-100), cholesterol, triglyceride and high density lipoprotein are generally inversely proportional with calcium score with the exception of LDL remains virtually unchanged throughout the whole range of calcium score (0 > 300) as appear in the figures . While at high calcium score concentration (>300) lipoproteins are directly proportional with calcium score in contrast with high density lipoprotein which is inversely proportional with calcium Score.

خلفية الدراسة: ان مرض الشريان التاجي هو واحد من اهم الامراض التي تؤدي الى الوفاة. وهو واحد من انواع متعددة من امراض الشريان التاجي الناتج عن ترسب اللويحات الدهنية على جدران الشريان. وهناك العديد من البحوث التي اشارت الى اسبابها, وتحقيقاتها, وطرق علاجها ومع تطور التصوير الطبقي المقطعي الذب فتح صفحه جديدة بتطور طرق الشخيص الخارجي والمستخدم في تشخيص وجود درجة الكالسيوم في الويحات الدهنية كمؤشر على كمية اللويحات المترسبة في الشريان التاجي, اذ يمكن تحديد الموقع و كمية الانسداد باستخدام هذا الجهاز.الهدف من الدراسة: التحقق من صحة استخدام درجة الكالسيوم كعلامة في تشخيص امراض الشريان التاجي اضافة الى ايجاد العلاقة بين هذه درجة الكالسيوم , التكلس ,الويحات المتكون على الجدران للشريان.المرضى وطرائق العمل: تم فحص 61 مريض ممن ظهرت عليهم أعراض آلام في الصدر بينهم 40 رجل و21 امرأة بعد الفحص بواسطة ECG لحساب القيمه الصحيحة باستخدام جهازCT لتحقق من وجود التكلسات كدليل على تصاب الشرايين. التأريخ المرضي من ناحية ضغط الدم و السكري تم تسجيلها بالاضافة الى القياسات الانثروبومترية , مستوى الدهون في الحاله الطبيعية وغير الطبيعية ( الزيادة). كافة العينات تم جمعها من المرضى وهم ممتنعين عن الطعام (صائم). وتم اعطائهم دواء يقلل من دقات القلب ليصل الى مدى بين 55-65 دقة لكل دقيقة. تستخدم مادة ملونة اثناء الفحص تحقن وريديا بواسطة جهاز حقن خاص.النتائج: اظهرت نتائج الدراسة الحالية ان جميع الذين يعانون من الم في منطقة الصدر لم يتم فحصهم بواسطة ECG فأن ليس لديه درجة كالسيوم في الشرايين؛ من ناحية اخرى الذين يعانون من درجة كالسيوم عالية تزداد بزيادة اللويحات في شراينهم.اما في حالة درجة الكالسيوم القليلة بين (0-100) الكلسيتيرول, الدهون الثلاثية, فقد اضهرت تناسب عكسيا وكثافة الدهون المرتفعة الكثافة.

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