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Article
Early Outcome of Bifurcational Coronary

Author: Ahmed Y. Bedair احمد بدير
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2011 Volume: 7 Issue: 1 Pages: 67-70
Publisher: Baghdad University جامعة بغداد

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Abstract

Background : The hepatopulmonary syndrome (HPS) is defined as the triad of liver disease, arterial deoxygenation, and pulmonary vascular dilatation. The reported prevalence of HPS in cirrhotic patients varies between 5% -17.5%.Objective : To estimate the prevalence of hepatopulmonary syndrome among patients with chronic liver disease and portal hypertension and to study the correlation between HPS and the severity of liver disease.Patients and methods : Thirty patients were studied for the presence of HPS using transthoracic contrast echocardiography for detection of pulmonary vasodilatation. Arterial oxygen saturation (SaO2) was determined in erect and supine position using a pulse oximeter , (SaO2 ≤ 92 % in supine position and/or a decrease of ≥ 4% after change from supine to upright position) to detect hypoxia and ortheodeoxia.Result : Eleven of thirty patients (36.6%) with chronic liver disease and portal hypertension were found to have contrast echocardiographic evidence of intrapulmonary right-to-left shunting. Arterial oxygen desaturation was present in 3 patients (27.3%) of those with intra-pulmonary right-to-left shunting ,they were considered as clinically significant HPS ,the remaining 8 patients were considered as subclinical HPS. Dyspnoea was more often present in patients with clinically significant HPS (100%) compared with subclinical HPS (25%), and patients without HPS (9%). HPS correlated significantly with severity of liver disease according to the Child-Pugh score.Conclusion: hepatopulmonary syndrome is not uncommon , the prevalence of clinically significant hepatopulmonary syndrome (in this study) was 10% of patients with chronic liver disease and it correlated with disease severity according to the Child-Pugh score.


Article
Effectiveness of Nursing Interventions on Patient's Knowledge Undergoing Percutaneous Coronary Intervention
فاعليه التداخل التمريضي على معارف المرضى الخاضعين للتداخل التاجي عن طريق الجلد

Authors: Hakema S. H. --- HaiderJ.H.
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2015 Volume: 5 Issue: 1 Pages: 33-41
Publisher: University of Kufa جامعة الكوفة

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Abstract

Objectives: to evaluated the effectiveness of nursing intervention on patient's knowledge regarding percutaneous coronary interventions procedure. Methodology: An quasi- experimental study (pre-post test) took place between 10th October 2013 to 30 Julia 2014 was carried out in the medical ward (Al-razi) at Ibn Al-Bitar specialized center for cardiac surgery. Total (100) patients in the study sample, the sample was randomly divided into two groups of (50) patients each. The study group was providing nursing interventions to them by the researcher. The group that was didn't provide nursing interventions to them by the researcher was considered the control group. Three instruments were used to conduct this study. They were a demographics form, clinical characteristics and knowledge assessment tool. Knowledge assessment tool consisted of (22) question. It consists of three parts: understanding coronary heart disease (CAD), coronary risk factors, percutaneous coronary interventions procedure. Reliability of the questionnaires was determine by calculating Cronbachs' Coefficient alpha =0.83. Descriptive data analysis was done through (frequency, percentage mean, standard deviation and relative sufficiency), inferential data analysis was done by (Fisher Exact Probability Test, Chi-Square test and Wilcoxon signed rank test).Results: The results of the present study shows that there are highly significant differences between the study group and control group regarding main domains of patients' knowledge (understanding coronary heart disease (CAD), coronary risk factors, percutaneous coronary interventions procedure) and overall main domains at post test at P = 0.00 value.Conclusion: the health educational program is effective to improve the patient's knowledge concerning PCI in the study group.Recommendations:Nurses should be playing a greater role to provide the nursing interventions to the patients undergoing PCI procedure.

الهدف: لتقويم فاعلية التداخل التمريضية على معارف المرضى فيما يتعلق بإجراء التدخل التاجي عن طريق الجلد.منهجيه البحث: دراسة شبه تجريبية (اختبار قبلي وبعدي) أجريت للفترة مابين 10 تشرين الثاني 2013 إلى 30 حزيران 2014في الردهة الباطنية (الرازي) في مركز ابن البيطار التخصصي لجراحة القلب.تألفت عينة الدراسة من (100) مريض،قسمت عشوائيا إلى مجموعتين (50) مريض الكل منهما. تم تقديم التداخل التمريضي لمجموعة الدراسة من قبل الباحث. واعتبرت المجموعة التي لم تقدم لها التدخلات التمريضية لهم من قبل الباحث المجموعة الضابطة.وتكونت أداه الدراسة من ثلاثة محاور, المحور الأول الخصائص الديموغرافية، والمحور الثاني الخصائص السريرية, وتكون الحور الثالث من مجموعه فقرات لقياس معارف المرضى وهي 22 فقره ,وتتألف من ثلاثة أجزاء: تتعلق بأمراض القلب التاجية , عوامل الخطورة التاجية وإجراء التدخل التاجي عن طريق الجلد. وتم قياس ثبات الاستبانه من خلال حساب معامل الفا =83.0.استخدم الإحصاء الوصفي (التكرارات، متوسط, النسبة المئوية، الانحراف المعياري والاكتفاء النسبي) والإحصاء الاستدلائي (اختبار فيشر الدقيق الاحتمالية،اختبار مربع كاي واختبار ويلكوكسون للرتب).النتائج : أشارت نتائج الدراسة الحالية بوجود فروقات ذات دلاله معنوية عاليه بين مجموعة الدراسة والمجموع الضابطة فيما يتعلق بالفقرات الرئيسية للمعارف المرضى المتعلقة بفهم مرض الشريان التاجي وعوامل الخطورة التاجية و إجراء التدخل التاجي عن طريق الجلد) والفقرات الرئيسية مجتمعه عند الاختبار البعدي بمستوى معنوية0.00 = الاستنتاجات: توصلت الدراسة بأن برنامجا لتثقيف الصحي ف عال في تحسين معارف المريض فيما يتعلق بأجراء التداخل التاجي عن طريق الجلد لمجموعه الدراسة. التوصيات : يجب على الممرض أن يلعب دورا اكبر في تقديم العناية التمريضية للمرضى الخاضعين للتدخل التاجي عن طريق الجلد .


Article
Success rate of Percutaneous Coronary Intervention of Chronic Total Occlusion

Author: Ghazi F. Haji
Journal: Al-Kindy College Medical Journal مجلة كلية الطب الكندي ISSN: 18109543 Year: 2012 Volume: 8 Issue: 1 Pages: 75-82
Publisher: Baghdad University جامعة بغداد

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Abstract

Back ground: Chronic total occlusion (CTO) of coronary arteries remains one of the most challenging lesion subsets in interventional cardiology even with the development of medical devices and operator expertise. Successful revascularization results in improved in angina status ,increased exercise capacity and reduces the need for lat CABG surgery .Objectives: This study sought to determine the overall procedural success rate of percutaneous coronary intervention (PCI) for CTOs and to examine the relation between variables such as; patients’ characteristics, risk factors, lesion characteristics and procedural success rate.Methods: In this study ,clinical and coronary angiography data of (80) patients with CTO who underwent PCI between May 2009 and May 2010 in Ibn Al-Baitar Hospital for cardiac surgery and Al-Nassryia cardiac center were prospectively analyzed . The clinical data were collected using the patients files and angiographic data by review of their films.Results: There were (80) Patients with CTO ,They included 62 men (77.5%) and 18 women (22.5%) ,Age range 36-76 year with mean age 55±8.75 and male to female ratio was 3:1 .The procedural success rate of PCI was 66 patients (82.5%). All 23patients(100%) with lesion length less than 15 mm had successful PCI compared to 43 out of 57 patients in whom the lesion was more than 15mm (75.4%) p value < 0.01. The procedure was successful in 54 patients out of 60 with tapered stump(90%) compared to 12 out of 20 patients with abrupt stump(60%) p value <0.005.In CTO lesion with angulations less than 45 degree ,the procedure was successful in 27 patients out of 28 (96.4%)compared to 39 out of 52 patients in whom the angulations was more than 45 degree 52(75%) p value<0.01. The most common cause of procedural un success was inability of guide wire crossing through the totally occluded segments which represented 11(78.5%), Inability to cross the lesion with a balloon in 2 patients(14.2%) and inability to dilate balloon in one patient (7.1%) P<0.001.Conclusion: Percutaneous coronary intervention of chronic total occlusion is an effective therapeutic procedure with high success rate 82.5%. The length of chronic total occlusion ,degree of angulations and stump morphology are strong predictors of success procedure.Keywords: Chronic total occlusion (CTO) – percutaneous coronary intervention (PCI) – coronary arteries


Article
Silent Thyroid Function Abnormalities in Patients Undergoing Coronary Angiography

Author: Ameen Mossa Mohammad, Joma Aziz Joma1, Bayar Ahmed Qasim, Ahmed Hassan Yousif1
Journal: Medical Journal of Babylon مجلة بابل الطبية ISSN: 1812156X 23126760 Year: 2019 Volume: 16 Issue: 3 Pages: 220-223
Publisher: Babylon University جامعة بابل

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Abstract

Background: Iodine is an essential element in the formation of thyroid hormones, the body may encounter situations in which high iodine loadoccur in the body like doing the contrast studies using the iodine‑containing contrast media. In most people, this iodine load is well‑tolerable;however, in some others, this may result in derangements in the thyroid function, from which hyperthyroidism is the most common.Objective: The objective of the study is to determine the subclinical changes in the thyroid functions in a cohort of patients with coronaryartery disease (CAD) undergoing coronary angiography (CAG) and/or percutaneous coronary intervention (PCI). Materials and Methods: Inthis pilot study, a total of 101 patients with CAD undergoing CAG and/or PCI were recruited during the year 2018. All cases had normalthyroid function tests including (thyroid‑stimulating hormone [TSH], free T4, and free T3) preprocedural. Six weeks after CAG/PCI serumTSH, free T4 and T3 were assessed again. Results: No significant differences were observed in levels of TSH, free T4, and free T3 betweenpreprocedures (CAG/PCI) and after 6 weeks with P values (0.645, 0.135, and 0.807), respectively. In addition, no difference was found betweenthe subgroup of CAG versus PCI. Conclusion: In euthyroid patients undergoing CAG/PCI minimal changes could occur in thyroid function.However, these changes are of limited significance in the short term.


Article
Patients’ Health Related Quality Of Life After Percutaneous Coronary Intervention In Baghdad City.
نوعية الحياة المتعلقة بالصحة للمرضى بعد التداخل القسطاري التاجي في مدينة بغداد

Authors: Ayad Majid Mousa --- Huda Baqer Hassan
Journal: kufa Journal for Nursing sciences مجلة الكوفة لعلوم التمريض ISSN: 22234055 Year: 2014 Volume: 4 Issue: 1 Pages: 11-17
Publisher: University of Kufa جامعة الكوفة

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Abstract

Objectives: The study aims to assess the patients’ health related quality of life and find out the association between the gender, age, marital status, educational level, employment, body mass index, severity of disease vessels, and number of implanted stents with health related quality of life.Methodology: descriptive study design is starting from October 2nd. 2012 to the 30th July 2013 was carried out at Iraqi center for heart diseases, Ibn Al-Nafees for cardiac surgery hospital and Ibn- Al-Betar specialist center for cardiac surgery in Baghdad City. purposive (non probability) sample consist of 100 patients collected through interview method by using questionnaires composed from two parts, first part composed from demographic and medical history data and second part includes short form 12 item health survey scale to measure health related quality of life .Reliability of the questionnaires was determine by calculating Cronbach s' Coefficient alpha = .882.Descriptive data analysis was done through frequency, percentage mean, standard deviation and relative sufficiency and inferential data analysis was done by contingency coefficient.Results: The results of the present study revealed that the patients have low level in quality of life for the general health and vitality domains , moderate level in quality of life for physical function, bodily pain and mental health domains, and high level in quality of life for role physical, role emotional and social health domains after percutaneous coronary intervention, and the findings revealed there were significant association between age and physical function and role physical; marital status and general health, bodily pain and vitality; level of education and general health at P≤0.05 value.Recommendations: According to present findings the researcher recommends to prepare educational program related to quality of life domains for patients after PCI .

الهدف: تهدف الدراسة الى تقييم نوعية الحياة المتعلقة بالصحة للمرضى بعد التداخل القسطاري التاجي في مراكز ومستشفيات مدينة بغداد القلبية وايجاد العلاقة بين الجنس والعمر والحالة الزوجية و التحصيل التعليمي و المهنة، و مقياس كتلة الجسم، عدد الشرايين المسدودة،وعدد الشبكات المزروعة مع نوعية الحياة بعد التداخل القسطاري التاجي للمرضى في مدينة بغداد.المنهجية: دراسة وصفية أجريت في مراكز والمستشفيات القلبية في مدينة بغداد للمدة من الثاني من تشرين الاول 2012 ولغاية الثلاثين من تموز 2013 و تم اختيار عينة غرضية غير احتمالية ل 100 مريض بعد التداخل القسطاري التاجي من المرضى الذين يراجعون العيادة الاستشارية في المراكز والمستشفيات القلبية في مدينة بغداد وجمعت المعلومات من خلال ملئ الاستبانة المتكونة من جزأين حيث تضمن الجزء الاول على المعلومات الديموغرافية والتاريخ الطبي للمريض وتكون والجزء الثاني من اثنا عشر فقرة والمتضمنة (الصحة الجسمية، الوظائف الجسمية،الدور الجسمي،الدور العاطفي،الوظائف الاجتماعية،الالم الجسمي،الحيوية،الصحة العقلية) وتم تحديد ثبات الاستبانة من خلال قياس التطابق الداخلي بين الفقرات بعد تطبيق مقياس كرون باخ الفا والمساوي = .882 وحددت مصداقيتها من خلال عرضها على 10 خبراء من ذوي الاختصاص ولتحليل البيانات تم استعمال الاحصاء الوصفي الذي تضمن التكرارات والنسب المئوية والوسط الحسابي والانحراف المعياري والاحصاء الاستدلالي الذي شمل اختبار معامل التوافق. النتائج: أشارت نتائج الدراسة الحالية بانخفاض نوعية حياة المرضى بعد اجراء التداخل القصطاري لمحوري الصحة العامة وحيوية المريض وتحسن في نوعية حياة المرضى لمحوري الدور الجسمي والدور العاطفي والصحة الاجتماعية ونوعية حياة متوسطة لمحوري الوظائف الجسمية والالم الجسمي والصحة العقلية واظهرت الدراسة الى وجود علاقة معنوية بين عمر المريض والوظائف والدور الجسمي وعلاقة معنوية بين الحالة الاجتماعية والصحة العامة ومحور الألم وحيوية المريض وعلاقة معنوية بين المستوى التعليمي والصحة العامة بمستوى معنوية اقل او يساوي 0.05 التوصيات: بناءا" على نتائج الدراسة الحالية يوصي الباحثان باجراء برنامج تثقيفي للمرضى بعد اجراء التداخل القصطاري يشمل كل محاور الحياة لتكيف المريض مع حالته الصحية الجديدة


Article
Complication Following percutaneous coronary intervention via the femoral artery Experience in lraqi center for the Heart Disease and lbn Al-Bitar Hospital for cardiac surgery.
المضاعفات الوعائية للشريان الفخدي من جراء القسطرة التشخيصية و العلاجية في المركز العراقي لامراض القلب و مستشفى ابن البيطار لجراحة القلب

Authors: Amal N. AL- Marayati --- Hilal Bahjet Al Saffar --- Salah M. Majeed
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2016 Volume: 58 Issue: 4 Pages: 325-329
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Vascular complications have been recognized as an important factor in morbidity after diagnostic and percutaneous coronary interventions.Objectives: This study sought to evaluate vascular complications after diagnostic coronary angiography and percutaneous coronary intervention (PCI) from the common femoral artery.Patients and methods: This prospective cohort study was carried out over a year period, from February 2008 till January 2009, at the Iraqi Center for the Heart Disease and Ibn Al-Bitar Hospital for Cardiac Surgery. A total number of 2400 patients underwent 3600 procedures, diagnostic coronary angiography (2196) and PCI(1404) via their common femoral arteries were included in this study.Result: A total 407(11.3%) patients developed different vascular complications (retroperitoneal hematoma, loss of distal pulse, arterial perforation each of them 0.03%, bruises 8.9%, pseudoaneurysm 0.69%, AV fistula 0.03%, hematoma ≥10cm 0.3% and <10cm 1.2%). We identified multiple factors associated with increased frequency of vascular complications like age, gender and past medical history. We have more frequent minor complications and more attendance to treat our complications surgically.Conclusions: This study has shown that the vascular complications continue to occur post PCI and diagnostic coronary angiography.

الخلفية: تهدف هذه الدراسة الى تقييم المضاعفات الوعائية التي تحدث بعد القسطرة التشخيصية و التداخل القسطاري من خلال الشريان الفخدي , لانه لوحظ ان المضاعفات الوعائية عامل مهم في المراضه بعد القسطرة التشخيصية و التداخل القسطاريطريقة البحث: تم اجراء هذه الدراسة في مركزين تخصصين لامراض القلب هما المركز العراقي لامراض القلب و مستشفى ابن البيطار لجراحة القلب امتدت الدراسة للفترة من شباط 2008 الى كانون الثاني 2009.النتائج: ضمت الدراسة عينة من 2400 مريض اجروا 3600 تداخل قسطاري منها 1404 تداخل علاجي و 2196 تداخل تشخيصي و لوحظ حصول مضاعفات لدى 407 مريض أي نسبة 11.3% . والمضاعفات التي تمت ملاحظتها قسمت الى مجموعتين (حسب تقسيم الكلية القلبية الامريكية) هي مضاعفات كبرى مثل ودمة خلف البريتون 0.03%, فقدان نبض الشريان الدواسة 0.03% , اختراق الشريان 0.03% , و مضاعفات صغرى مثل ودمة ≤10 سم 0.03%, ودمة > 10 سم 1.2%, تمدد الاوعية الدموي المزيف 0.69 %, ناسور شرياني وريدي 0.03%, ووجدنا عدة عوامل تودي الى زيادة المضاعفات الوعائية .ايضا وجدنا ان المضاعفات الكبرى لدينا اقل قليلا من الدراسات السابقة لكن الصغرى اكثر و حاجتنا للجراحة لعلاج هذه المضاعفات اكثر.الاستنتاج: المضاعفات الوعائية بعد اجراءالقسطرة التشخيصية و العلاجية ما زالت تحدث بالرغم من التطور الحاصل في هذا االمجال. مفاتيح الكلمات : المضاعفات الوعائية, الشريان الفخدي, التداخل القسطاري العلاجي


Article
Angiographic Predictors of Success of Revascularization by Percutaneous Coronary Intervention (PCI) Using the Japanese Chronic Total Occlusion Score

Author: Hilal Bahjet Al Saffar *,Zaid Abedel-Elah Mustafa Al- Najjar**, Zahraa H.Ismaeel AL-Ridhwany***
Journal: Iraqi Academic Scientific Journal المجلة العراقية للاختصاصات الطبية ISSN: 16088360 Year: 2016 Volume: 15 Issue: 4 Pages: 474-480
Publisher: The Iraqi Borad for Medical Specialization المجلس العراقي للاختصاصات الطبية

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Abstract

ABSTRACT:BACKGROUND:Chronic total occlusions (CTOs) are considered as the most complex lesions to treat via percutaneous coronary intervention (PCI), due to the indications, costs and technical difficulties related to these procedures. As a consequence, only about 10% of all coronary artery diseased patients (CAD), clinically eligible for revascularization, are currently being treated via percutaneous coronary intervention (PCI). The majority is treated either medically or by coronary artery bypass graft (CABG) surgery. OBJECTIVE: This study sought to estimate the value of application of J- CTO score as a model to stratify the complexity and predict success rates at Iraqi Center for Heart Disease. METHODS: One hundred patients with chronic total occlusion were enrolled in this study form October 2014 - May 2015 who were attending Iraqi Center for Heart Disease. Data were collected on demographic, clinical and angiographic characteristics and reviewed by experienced Chronic total occlusions(CTO) operators. Descriptive analyses were performed using Statistical Package of Social Sciences (SPSS) to assess the relationship between procedural success and any variable of the demographic, angiographic and/or clinical characteristics. The level of significance was set at 95% or higher.RESULTS: Sixty-one patients out of 100 patients (61%) had a successful PCI. Univariate analyses showed significant differences of Electrocardiography and number of diseased arteries with J-CTO score between the group with successful PCI compared with those with failed PCI. Angiographically, using Japanese chronic occlusion score we found that a “blunt stump” (42 vs. 75%, p=0.001), “calcifications” (37 vs.70%, p=0.003), “tortuosity” (21 vs. 67%, p=0.001), “CTO length” (44 vs. 84%, p=0.000) and a “re-attempt” (33 vs. 65%, p=0.036) all had a significant negative impact on procedural outcome. CONCLUSION: The J-CTO score is valuable tool for predicting successful revascularization of chronic total occlusion by Percutaneous coronary intervention (PCI).


Article
Complete and Incomplete Revascularization of patients with Non-ST-Elevation Acute Coronary Syndrome using Angioplasty and Stenting.

Author: Hassan U. Al-Najjar
Journal: Journal of the Faculty of Medicine مجلة كلية الطب ISSN: 00419419 Year: 2008 Volume: 50 Issue: 4 Pages: 424-427
Publisher: Baghdad University جامعة بغداد

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Abstract

Background: Angioplasty and stenting; Percutaneous coronary intervention (PCI) has become important tool of Reascularizing patients with stable angina and Acute ST-Elevation Myocardial Infarction, while their role in Non ST-elevation Acute coronary syndrome is expanding. The aim was to study the outcome of complete and incomplete Revascularization, by PCI, of pts with NSTE-ACS, and the effect of the traditional risk factors and their relation to the number of stents.
Patients and Methods:- After stabilization 115 out of 142 consecutive hospital admissions with Non St-Elevation Acute Coronary Syndrome were revascularized Percutanously.
Results:-Apart from two pts, who had advanced disease, PCI had succeeded in reascularizing the remaining 113 pts, (98%); 93 of them had Complete revascularization (81%) with elimination of all stenotic lesions, while 20 pts had Incomplete Revascularization The later consisted of fifteen Patients who had dilatation of the culprit lesion/s only (group a) and 5 pts who had dilatation of all lesions except uncrossable lesion/s despite painstaking attempts (group b). cardiac events:-Five of the 93 pts with complete revascularization (5.4%) had Major Cardiac Events compared to 4 of the 15 pts in group a; Culprit-lesion-only Revascularization (27%), suggesting that leaving behind angioplastable lesion/s might not be feasible, yet the sample is small. Risk Factors:- The likelihood of achieving Complete Revascularization was inversely linked the no. of risk factors. It had dropped from 100%, to 85%, 79%, and 67% in pts with nil, 1, 2, and 3-5 Risk Factors respectively. Conversely the no. of stents deployed was directly linked to the number of Risk Factors reflecting a more severe underlying disease.
Conclusion: Early PCI in had achieved complete revascularization of 81% of pts with NSTE-ACS. Complete Revascularization was associated with much lower Major Cardiac events than Revascularization of the Culprit lesion only. Frequency of Complete revascularization had proportionately increased with the no. risk factors reaching 100% in without risk factors (100%). The no. stents had proportionately increased with the no. of Risk factors suggesting more severe underlying disease.

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