Dr. Mohammad Fazle Maruf: From A Heart Surgeon's Diary : Cardiac Surgery

Showing posts with label Cardiac Surgery. Show all posts

Monday, September 10, 2018

আর্থিক ভাবে অস্বচ্ছল হৃদরোগীর সংখ্যা আমরা জানিনা,কোন পরিসংখ্যান ও নেই আমাদের দেশে। কিন্তু প্রতিদিনের অভিজ্ঞতা বলে এরা অনেক! ব্যায়বহুল চিকিৎসায় এদের অসহায়ত্বে নিজেরাই অসহায় হয়ে পড়ি। এ অসহায়ত্বেই নিই CVARF (CardioVascular Aid & Research Fund) তৈরির উদ্যোগ। বন্ধু, আত্মীয়-স্বজন ও শুভাকাঙ্খীদের সহযোগিতা অতুলনীয়! স্বতঃস্ফূর্ত অনুপ্রেরণা ও অনুদানে প্রস্তুত CVARF এইসব অসহায় ,দরিদ্র এবং হৃদরোগের সার্জারী সম্বন্ধে অজ্ঞ রোগীদের চিকিৎসায় এগিয়ে আসলো। কয়েকজন রোগী সার্জারীর মাধ্যমে সম্পূর্ণ আরোগ্য লাভ করলো।
CVARF এর সহায়তায় গত ৩,৪ ও ৫ ই সেপ্টেম্বর পরপর ৩ দিন ৩ টি দরিদ্র শিশুর জন্মগত হৃদরোগের অপারেশন করা হয়। সফল অস্ত্রোপচারে তারা এখন সুস্থ্য।
এ বছরের ফেব্রুয়ারী (২০১৮ইং) থেকে এখন পর্যন্ত CVARF এ তিনটি বাচ্চাসহ মোট আটজনের কার্ডিয়াক সার্জারী সম্পন্ন করে। যাঁদের সাহায্য, সহযোগিতা,অনুদান ও পরামর্শে এই প্রয়াস, তাঁদের প্রতি রইলো কৃতজ্ঞতা ও সালাম। মহান আল্লাহতাআলা আপনাদের সাহায্যকর্ম কবুল করুন। আমিন। # CVARF8

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Friday, April 21, 2017

OFF-PUMP CORONARY ARTERY BYPASS
GRAFT (OPCABG) SURGERY IN PATIENTS
WITH LEFT MAIN CORONARY ARTERY
STENOSIS: ANALYSIS OF EXPERIENCE
IN 145 PATIENTS

Mohammad Fazle Maruf1, Suman Nazmul Hosain2, Md
Kamrul Hassan1, Zahangir Haider Khan3, Asif Ahsan
Chowdhury4, Tahmina Akter4, Rezaul Karim4, NA Kamrul
Ahsan5

Bangladesh Medical Journal, Vol. 37, No. 2 July 2008

Abstract:
The presence of significant left main arterial stenosis has been
considered a relative contraindication to OPCAB surgery. The
development of newer techniques and an increasing
understanding of the hemodynamic changes make the
surgeons confident to perform OPCAB in patients with
significant left main artery stenosis. Between January 2004 to
March 2008, 145 patients with left main artery stenosis
underwent OPCAB surgery at NICVD. Gradual adoption and
integration of maturing heart surgery in fast years led to a
trend towards overall improvement in CABG outcomes. Offpump
coronary artery surgery appears to be a safe and effective
technique in patients with significant Left Main coronary artery
disease. The postoperative morbidity and length of ICU and
hospital stay are shorter. OPCAB could be an effective
alternative to the conventional method CABG with same or
better early results and is cheap and cost effective. The longterm
results are to be evaluated.

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Tuesday, February 24, 2015

Aortic Root Replacement with Composite valve graft conduit for aortic root aneurysm in a Patient with Marfan Syndrome.

Mohammad Fazle Maruf

For reprint information contact: Mohammad Fazle Maruf, Department of Cardiothoracic Surgery, Chittagong medical College.

Abstract

A 34 yrs old man of marfan syndrome, visited us with the complaints of palpitation, easy fatigability and chest discomfort for last 1year. He was pointed out to have the aortic root enlargement with severe aortic regurgitation & mild mitral regurgitation by echocardiography and CT angiogram. We excised the aneurysm, implanted a composite graft with prosthetic valve conduit (Bentall's operation), directly attached the coronary arteries to the aortic graft, and made the distal anastomosis to the divided aorta. Postoperative course was uneventful. To our knowledge, this is the first successful case of Bentall’s operation in NICVD.

Introduction

Marfan Syndrome is an autosomal dominant hereditary connective tissue disorder with the clinical manifestations involving the ocular, skeletal and cardiovascular systems. The cardiovascular manifestations include aortic root dilatation,aortic valvular insufficiency, Mitral valve prolapse, Mitral regurgitation,aortic dissection and aortic rupture.Rupture of an ascending aortic aneurysm is the most common cause of death in patients with Marfan syndrome. We report our results of the surgical management of the Aortic Aneurysm with severe Aortic regurgitation & mild Mitral regurgitation.

Case Study

A man of 37 yrs come to us from Munshigonj with symptoms of palpitation,dyspnea and chest pain for 1 year. In addition to his positive family history of Marfan syndrome,he had the clinical findings of long slender body stature, arachnodactyly and high arch palate.

A systolic murmur was heard at the fourth left intercostal space and an early diastolic murmur was detected at the left sternal border.His BP was 120/20 mm of Hg.Chest radiography showed Cardiomegaly and a dilated ascending aorta.Transesophageal echocardiography showed severe aortic regurgitation and mild Mitral regurgitation. CT Angiogram revealed that the aortic root was measured 84mm x74mm x70mm sparing aortic arch. Coronary arteries are normal.

During surgery Cardio Pulmonary bypass was established through aortic and two stage single venous cannulation. The ascending aorta was separated from the main pulmonary artery. Moderate hypothermia achieved & aortic cross clamp applied. Ascending aorta opened longitudinally and selective antegrade cardioplegia was given to arrest the heart. Aortic valve was excised and aorta resected . Bental procedure (Composite graft replacement of the ascending aorta with aortic valve replacement and re-implantation of the coronary arteries in to the graft) was performed with 25 mm ATS composite bileaflet metalic Aortic valve conduit. Coronary orifice holes were made in the tube with a wire electrocautery. The Coronary ostia were anastomosed to the graft using 6-0 polypropylene running sutures. The aortic arch was found to be intact and it was anastomosed into the distal end of the graft. In addition, composite graft was wrapped with native aortic wall. Cross clamp time was 108 mins. Re-exploration was done on same day for post operative bleeding (2900ml in 5 hours). Generalized oozing was found and haemostasis was secured. Rest of the post operative period was uneventful & he was discharged with good recovery. He is still under my followup.